Do we need new ventilator protocol to treat Coronavirus in India?

New Delhi, April 9, 2020-

With the coronavirus pandemic striking hard and spreading rapidly in India, a big question arises whether we need a new COVID-19 ventilator protocol to treat infected patients in the country?

According to Manoj Goel, Director, Pulmonology, Fortis Memorial Research Institute in New Delhi, the principle of ventilation in corona patients follows the same protocol as in any other case of serious pneumonia due to any other cause.

“However, the handling of the ventilator, the process of putting them on a ventilator and care of the patient on ventilator required extra measure which includes using various protective measures of preventing infection from the patient to the surrounding atmosphere which can lead to infection through the air to others,” Goel told.

The other point is that these patients generally require more prolonged and high levels of ventilator support as compared to other patients, the doctor said.

“Many times they are ventilated in a prone position which means patients are made to lie on their tummy rather than the back. It is more difficult to remove them from the ventilator which means the weaning from ventilators is also more prolonged, difficult and associated with higher chances of failure,” he added.

Satyanarayana Mysore, HOD, Interventional Pulmonology and Sleep Medicine, Manipal Hospitals in Bengaluru, told: “The original patients profile from Wuhan showed lung predominant involvement. This was presented in the form of pneumonia, ARDS (acute respiratory distress syndrome), interstitial fibrosis etc.

“In this condition, the virus or our defence mechanism of the body will overwhelm and the air sacs will get flooded. This is when a mechanical ventilator will be of help,” he said.

If patients present with ARDS, they will be put on mechanical ventilation, sedation, and supportive measures. They will be on what we call as ARDSNET protocol. In summary, ventilatory management will not change.

“As far as hypoxia that is not due to ARDS, a different strategy of high flow humidified oxygen, blood transfusion, chelation may need to be considered,” the doctor said, adding that the Indian experience in COVID-19 is fortunately mild to moderate disease and quite less percentage of the patient thus far needed ventilation.

According to Dr Rajan Sharma, President of the Indian Medical Association (IMA), due to the spread of COVID 19, there is an unprecedented demand for provision of mechanical ventilators.

“Mechanical ventilators have been in demand and shall be made use judiciously during such emergency situations. While our experience on COVID 19 is too initial, from the current protocol, there is a need to shift from hyperventilation and extensive ventilation and stress is on providing adequate oxygen,” Sharma said.

Savitha Kuttan, CEO of Omnicuris, an online medical education platform, said that according to government data, India is critically short on ICU beds and ventilators, which is worrying because the five per cent of COVID-19 patients require an ICU admission.

“We need to decide in what manner will scarce medical resources be distributed if the cases go up and our healthcare infrastructure is overrun. The chapter on triage under the National Disaster Management Act of 2005 states that the sickest will be tended to first,” Kuttan said.

“If the crisis deepens and hospitals are left to decide, it will be solely at their discretion, and the general public will have no means to understand the basis of the decisions,” she noted.

Meanwhile, the total tally of COVID-19 cases in India reached up to 5,734 on Thursday. Of these, 5,095 are active cases, 166 are dead, one has migrated, while 472 people have been discharged after recovery.

Maharashtra is the worst affected state so far with 1,135 active cases.  (Agency)


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