12:00 p.m., March 28, 2021
The idea arose during the first wave to relieve saturated hospitals: why not give oxygen at home to certain patients in a situation of respiratory distress? Since March 2020, at least 60,000 patients have been cared for at home, according to the Federation of Home Health Providers (Fedepsad). They would be around 5,000 today. “Initially, there was a hesitation because we did not do it for acute illnesses, remembers a hospital infectious disease specialist. But the length of stays had to be reduced …”
The same epidemic causes producing the same saturation effects, oxygen therapy is again considered as a possible remedy to deal with the third wave. While the Ministry of Health is evaluating the extent of these transfers to the home, Fedepsad estimates that “three times as many patients” could be equipped with “concentrators” (machines extracting oxygen from the air). “We have built up a large stock for fear of a new peak,” explains Didier Perrin, administrator of Fedepsad. “There is still room for maneuver, we can take care of a much larger number of patients,” says Élisabeth Hubert, president of the National Federation of Home Hospitalization Establishments (Fnehad).
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Indicated at the output of the sheave
After the spring 2020 tsunami, the practice was reviewed by the Haute Autorité de santé (HAS). In the eyes of the independent agency, it is very suitable for patients leaving the hospital. “There is no medical obstacle to prescribing oxygen at home for two weeks or a month to a patient who has passed the difficult course in the hospital”, says Charles-Hugo Marquette, pulmonologist at the CHU of Nice.
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Only 10% of the 250 people we took care of had to be transferred to hospital; 90% were therefore able to overcome the difficult course at home!
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The patient is then supervised by his attending physician and by a private nurse, or placed in hospitalization at home (HAD). “In a country as focused on hospitals as ours, a HAD can arouse reluctance, notes Elisabeth Hubert, former Minister of Health, while we offer the same quality and safety of care.” Doctor in charge of strategy for the Health Service Foundation, Nicolas Gandrille observed in the field in the Paris region that “the hospital outside the walls” was “an effective solution” for patients with Covid-19: “Very few had to return to the hospital.”
A beneficial role for relatives
On the other hand, home oxygen for patients with severe forms in order to avoid hospitalization is debated. “Some city professionals are too overwhelmed to be able to monitor patients very closely,” laments an informed source. In its recommendations, the HAS has also judged that this use should remain “exceptional” and reserved for patients without comorbidity. “People likely to be admitted to intensive care must be hospitalized because the damage is sometimes brutal”, explains Charles-Hugo Marquette. To mitigate this risk, a pilot project, initiated by the Argenteuil hospital (Val-d’Oise) and implemented by the HAD service of Doctor Gandrille, is organizing close monitoring of these patients, in particular with the visit of nurses twice a day: “Only 10% of the 250 people we took care of had to be transferred to the hospital; 90% were therefore able to overcome the difficult course at home!”
A third contingent of patients is concerned: those too old or frail to hope to derive any benefit from resuscitation. But it’s not just about palliative medicine. “Many are doing well, especially thanks to the presence of their loved ones,” says Professor Marquette. A sign that the vaccination is effective, requests for oxygen therapy from nursing homes are drastically decreasing.
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