SPIROMETRY IN COVID-19 PNEUMONIA PATIENTS ON CONTINUOUS REMOTE PATIENT MONITORING

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The long-term implications of COVID-19 pneumonia remain under investigation. Many of those that suffered from the illness continue to experience symptoms weeks to months following their initial recovery. We assessed patients with COVID-19 pneumonia who were discharged from the hospital to an outpatient-based continuous remote patient monitoring (CRPM) program. METHODS: Forty hospitalized patients diagnosed with COVID-19 pneumonia between the ages of 28 and 78 were referred to a designated CRPM team for evaluation and enrollment in a remote monitoring pilot program prior to discharge between the dates of December 2020 and April 2021. Enrolled patients were issued an FDA-approved biophysiologic monitoring device, digital tablet for video teleconferencing, and an in-home Wi-Fi/Mobile Data hub following nursing-led training prior to departing the medical facility. The provided equipment was capable of continuous, near-real time monitoring of SpO2, heart rate, respiration rate, surface/axillary temperature, and mobility data;intermittent data was also collected via a linked automatic blood pressure cuff and portable spirometer. Patients were monitored 24 hours, 7 days per week during their enrollment by dedicated tele-health nursing staff and received serial automated prompts to perform blood pressure assessments and spirometry using the included equipment. Initial and final pulse oximetry and spirometric data was reviewed, consisting of forced vital capacity (FVC), forced expiratory volume at one second (FEV1), FEV1/FVC ratio. Patients were disenrolled from the program in the following circumstances: the patient was readmitted to the hospital, the patient chose to disenroll themselves, or the supervising physician determined the patient to be stable for ≥ 72 hours. RESULTS: Forty patients enrolled in the pilot program. Twenty-seven of these patients completed initial and final spirometry and pulse oximetry prior to program discharge. Total days of enrollment were on average 31 ± 25 days. Initial pulse oximetric data returned with a mean of 95 ± 1.6%. Of note, 13 of the 27 patients required supplemental oxygen following hospital discharge. Initial spirometric data for these individuals returned with mean values for FVC (L) of 1.77 ± 0.82, FEV1(L) of 1.22 ± 0.47, and FEV1/FVC of 75 ± 20%. Prior to program disenrollment, mean pulse oximetry was measured at 97 ± 1.9% with only 2 of the 27 patients continuing to require oxygen. Final spirometric data returned with mean values for FVC (L) of 2.61 ± 1.16, FEV1(L) of 1.89 ± 0.72, and FEV1/FVC of 78 ± 19%. CONCLUSIONS: This study evaluated early and late home-tested spirometry and pulse oximetry in patients with COVID-19 pneumonia discharged from the hospital to a CRPM pilot program. Nearly half of the patients (48%) required supplemental oxygen at the time of discharge with only 7.4% requiring oxygen once discharged from the pilot program. Spirometric data indicated an increase of 47.5% in FVC, an increase of 55% for FEV1, an increase of 4.1% in FEV1/FVC between initial and final testing. Correlation with in-lab spirometry testing and percent predicted values will aid in determining the accuracy of the deficits identified on home testing. CLINICAL IMPLICATIONS: This study provides insight into the rate of lung function recovery in hospitalized COVID-19 pneumonia patients, and introduces a novel method to closely monitor recovering patients on an outpatient-basis. DISCLOSURES: No relevant relationships by Sean Hipp, source=Web Response No relevant relationships by Theresa Kinshella, source=Web Response No relevant relationships by Kevin Loudermilk, source=Web Response Speaker/Speaker's Bureau relationship with Janssen Please note: $1001 - $5000 Added 12/02/2020 by Michael Morris, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 Added 12/02/2020 by Michael Morris, source=Web Response, value=Honoraria No relevant relationships by Caitlin Smith, ource=Web Response No relevant relationships by Robert Walter, source=Web Response No relevant relationships by Daniel Yourk, source=Web Response