Dr Mangala Borkar
Oxygen is the absolute requirement for a Covid-19 patient in whom the level has dropped. Normally, the level is more than 95. Mostly 97 or more. If it drops below 94-it is a red flag. Especially after walking for 3 to 6 minutes.
Oxygen may be administered at the rate of 1-5 liters per minute by nasal prongs (tubes in both nostrils) or a simple mask.
Then there are special masks with a balloon-like reservoir bag attached, for higher oxygen requirements.
You: If the patient comes with very low levels like 70 or 60?
Me: He would need a ventilator with a special tight-fitting mask to push oxygen into his wind pipe and lungs_ non-invasive ventilation ( NIV) or a special device called high flow nasal oxygen. In worst cases, a tube needs to be passed into the patient’s windpipe and attached to the ventilator. That’s why we insist that patients should go to a hospital at the earliest.
You: How does one keep a track of oxygen consumption?
Me: The gauge on the device like liquid oxygen tank or jumbo cylinders tells you how much oxygen remains.
You: Any chance of unscrupulous practices?
Me: Yes - One can’t say whether the cylinders you get are full or half. The truck that brings liquid oxygen is ideally weighed before delivery and after emptying. It may supply a number of tanks at different hospitals. Currently, one needs to fill tanks daily or even twice a day as against, say once a fortnight, in pre-Covid days. In these busy days, it’s difficult to know whether you got what you were supposed to.
Dr Ajit Bhagwat, Senior Cardiologist
The following can be done to conserve oxygen:
1. Not giving oxygen to those with saturation over 93%-94% unless there are other complications.
2. Using a mask rather than a cannula is better because patients cannot easily remove it and it is unlikely to fall off inadvertently in a drowsy patient.
3. When patients are eating, they remove the mask for about half an hour - the oxygen outlet should be closed and restarted only when the patient puts it back.
4. High flow nasal oxygen (HFNO) is lifesaving in serious cases and may be used judiciously.
Dr Amol Joshi, Neonatologist, In-charge, oxygen committee, GMCH, Aurangabad
1. Use Oxygen Concentrators that collect oxygen from the air, in cases who need less than 10 liters oxygen per minute, to reduce the pressure on the routine oxygen supply.
2 Prefer BiPAP (NIV) to HFNO in severe cases.
3. Step up oxygen supply in a graded manner as needed, starting from a lower level.
4. Check pipelines regularly for leakages.
Dr Dhananjay Khatavkar—Physician-Intensivist
1.Use high quality pipes and accessories.
2. An optimal target of oxygenation is SPO2 of 93. Higher O2 saturation has not shown survival benefits.
3. The use of oxygen should be curtailed in Non-Covid hospitals
4. Oxygen should not be misused to falsely show the relatives that the patient is serious.
5. All health care workers - from doctors to attendants- should be trained to save oxygen.
Dr Shrikant Sahastrabuddhe—Intensivist
1.Use the minimum quantity and concentration of oxygen, strictly in cases who need it.
2. For NIV, keep the target of oxygen saturation at 92-93 %. For invasive ventilation, a target of 85% may suffice.
3. With the commonly used nasal prongs, one of the two tubes may be in a nostril and the other hanging out. Continuous vigilance is needed to prevent this. Explain to the patient whenever possible, about the importance of using these devices properly.