Respiratory Tele Monitoring COVID 19 (TMR COVID-19)

Study Overview
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Brief Summary
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The determinants of the evolution to a severe form for COVID-19 pneumonia remain unclear. COVID-19 pneumonia is characterized by a hypoxemia with a possible rapid worsening and related resuscitation requirement. The monitoring of patients in hospital wards (excluding intensive care unit) is therefore both necessary and complicated given the contagious risks for health workers. The COVID 19 Respiratory Tele Monitoring (RTM COVID 19) research project is based on a comparison between usual nurse respiratory monitoring (4 to 6 time per day) of respiratory parameters (capillary oxygen saturation, respiratory rate, hearth rate) and a continuous monitoring of these respiratory parameters with continuous monitoring by a portable, wireless and stand-alone device. The main objective of this work is a more sensitive and earlier detection of respiratory degradation events in patients with COVID-19 pneumonia (capillary desaturation, increased respiratory rate) requiring the introduction of oxygen therapy, its increase or a resuscitation requirement with possible intensive care admission. A prospective, randomized, multicentre, comparative exposure study will be conducted with planned inclusion of 80 patients. This investigation will focus on patients with COVID-19 pneumonia hospitalized in dedicated medical wards of two University Hospitals in France. A randomization will be stratified by Hospital and adapted so that each Hospital provides the same number of subjects in each arms: Control Respiratory Monitoring Group (40 patients) Experimental Respiratory Monitoring Group (40 patients) The main criterion is respiratory degradation event, during a 4 days period after ward admission, which motivates a change in the therapeutic strategy defined by the presence of at least one of these elements: Capillary saturation < 94% (regardless of oxygen intake) for at least 2 minutes. And/or an increase in respiratory rate > 20/minute for at least 2 minutes. The modification of the therapeutic strategy is defined by: Introduction of oxygen therapy for included patients without oxygen therapy or supplementation of oxygen therapy > 2 litres/minutes for included patients with oxygen therapy And/or introduction of a high oxygen concentration mask And/or Request an On-Site Opinion from a member of the resuscitation team. And/or Transfer to intensive care or resuscitation unit And/or Need for immediate resuscitation for life-threatening distress.

Official Title
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Interest of Respiratory Tele Monitoring in COVID-19 Pneumonia

Conditions
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Covid19

Intervention / Treatment
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* Device: Radius PPG Tetherless Pulse Oximetry (Masimo)
* Device: usual monitoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient with COVID 19 pneumonia assessed by PCR and CT scann. Patient admited in a dedicated medical ward Patient with oxygen supply less or equal to 4 liters per minute. Written informed consent Exclusion Criteria: Patient with limitation of care. Patient with immediate risk to ICU transfer within the first 12 hours Patient with neurological or psychiatric symptoms that interfere with respiratory parameters interpretation. Patient with acute or chronic respiratory disease such as COPD, cancer. Pregnancy, age < 18 of vulnerable profile. Patient refusal to participate or previously included in a clinical research trial.

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control Respiratory Monitoring Group<br> | Device: usual monitoring<br>* usual nurse respiratory monitoring<br>|
| Experimental: Experimental Respiratory Monitoring Group<br> | Device: Radius PPG Tetherless Pulse Oximetry (Masimo)<br>* continuous monitoring by a portable, wireless and stand-alone device<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| respiratory degradation event 1 | Capillary saturation < 94% (regardless of oxygen intake) for at least 2 minutes | during the 4 days period | 
| respiratory degradation event 2 | an increase in respiratory rate > 20/minute for at least 2 minutes | during the 4 days period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| New Early Warning Score (NEWS) evaluation | post hoc comparison of the respiratory monitoring using the experimental device with the NEWS on the repiratory event occurence | during the 4 days period | 
| Assessment of caregiver feelings | post hoc analysis of the team in regard to the monitoring strategy used based on a self-assessment questionnaire | during the 4 days period | 
| Intensive Care Unit tansfer | post hoc analysis of the frequency of ICU transfer | during the 4 days period |