NIHR Patient Safety Translational Research Centre, Department of Primary Care and Public Health, Imperial College London, London, UK.
NIHR Patient Safety Translational Research Centre, Department of Primary Care and Public Health, Imperial College London, London, UK.
Lancet Digit Health. 2022 Apr;4(4):e279-e289. doi: 10.1016/S2589-7500(21)00276-4.
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv, and bioRxiv) from database inception to April 15, 2021, and included feasibility studies, clinical trials, and observational studies, including preprints. We found 561 studies, of which 13 were included in our narrative synthesis. These 13 studies were all observational cohorts and involved a total of 2908 participants. A meta-analysis was not feasible owing to the heterogeneity of the outcomes reported in the included studies. Our systematic review substantiates the safety and potential of pulse oximetry for monitoring patients at home with COVID-19, identifying the risk of deterioration and the need for advanced care. The use of pulse oximetry can potentially save hospital resources for patients who might benefit the most from care escalation; however, we could not identify explicit evidence for the effect of RPM with pulse oximetry on health outcomes compared with other monitoring models such as virtual wards, regular monitoring consultations, and online or paper diaries to monitor changes in symptoms and vital signs. Based on our findings, we make 11 recommendations across the three Donabedian model domains and highlight three specific measurements for setting up an RPM system with pulse oximetry.
COVID-19 大流行导致卫生系统增加了使用远程监测和分诊患者工具的使用。在本系统评价中，我们旨在评估脉搏血氧仪在 COVID-19 患者家庭远程患者监测（RPM）中的有效性和安全性。我们从数据库建立到 2021 年 4 月 15 日搜索了五个数据库（MEDLINE、Embase、Global Health、medRxiv 和 bioRxiv），并纳入了可行性研究、临床试验和观察性研究，包括预印本。我们发现了 561 项研究，其中 13 项被纳入我们的叙述性综合分析。这 13 项研究均为观察性队列研究，共涉及 2908 名参与者。由于纳入研究报告的结局存在异质性，因此无法进行荟萃分析。我们的系统评价证实了脉搏血氧仪在家监测 COVID-19 患者的安全性和潜力，确定了病情恶化的风险和需要进行高级护理。脉搏血氧仪的使用可以为最有可能受益于护理升级的患者节省医院资源；然而，我们无法确定 RPM 联合脉搏血氧仪与其他监测模型（如虚拟病房、定期监测咨询以及在线或纸质日记监测症状和生命体征变化）相比对健康结局的影响的明确证据。基于我们的发现，我们在三个 Donabedian 模型领域提出了 11 项建议，并强调了三个具体的测量指标，以建立一个使用脉搏血氧仪的 RPM 系统。
