Delhi doctors employ oxygen treatment to keep Covid patients off ventilators

Oxygen saturation refers to the extent to which haemoglobin is saturated with oxygen.

Giving oxygen, after making patients afflicted with severe coronavirus disease (Covid-19) lie flat on their stomach, helps in improving the oxygen saturation in the blood and boost recovery without ventilation, critical care experts treating patients in the intensive care units have observed.

Medical professionals interact with visitors, outside the Covid-19 ward, during lockdown, in LNJP hospital, New Delhi, India, on Sunday, May 10, 2020.(Vipin Kumar/HT PHOTO)

Oxygen saturation refers to the extent to which haemoglobin is saturated with oxygen.

The patients are oxygenated while lying on their stomach for around two hours, then they are given oxygen while being made to lie on both their sides for one hour each and finally on their back for another hour, before repeating the cycle.

“This method — known as Awake Proning — is used on patients whose oxygen saturation level is low. When the patient is in a prone position, the fluid in their lungs shift, helping them breathe better. We have seen dramatic results – with oxygen saturation in patients increasing from 87% to 95% after a session (normal oxygen saturation is 95% to 100%). With such results, we prevent people from going on a ventilator,” said Dr Amit Kohli, intensive care specialist from Lok Nayak hospital, which is handling the highest number and most serious Covid-19 cases in the city.

Providing high flow oxygen through the nose or breathing masks has also helped in keeping people off ventilators.

“If you see the ratio of people on ventilators, it is not that much. This is because most Covid-19 patients in respiratory distress seem to be responding well to various other techniques of oxygenation,” said Dr Kohli.

Of the 4,781 people who currently have the viral infection in Delhi, 91 are in intensive care unit with only 27 — less than 5% — are on ventilators. Across the country, around 1.8% of all Covid-19 patients are on ventilators.

Most Covid-19 patients land up in the intensive care units with acute respiratory distress, with fast breathing rates of 25 times or more. A healthy adult breathes in about 12 to 20 times in a minute.

“Around 3 to 5% of our patients also show gastric symptoms. Reports from other countries also suggest viral myocarditis or inflammation of the heart wall. We do not have conclusive evidence from India, but it can be happening here as there have been cases of young, generally healthy, people suddenly dying. Then, there are other unusual symptoms that have started showing up like the Covid Toe,” said Dr Abhijeet Kumar working in the Covid-19 ICU at Safdarjung hospital.

Covid Toe is a bluish discolouration of the toes.

“So far, we have seen Covid Toe in only one patient in the second week of illness. We still do not know the reason for the symptom, it could be lesions caused by thrombosis or blood clot. There have been reports from around the world about blood clotting faster in Covid-19 and we have started giving anti-coagulants (medicine to prevent blood clots) to many of our patients,” said Dr Anjan Trikha, professor of anesthesiology at All India Institute of Medical Sciences.

The doctors use a Modified Early Warning Score scale to determine who might get these severe symptoms. Patients are graded according to their age, oxygen saturation, heart and respiratory rate, comorbidities — such as chronic kidney disease, cancer. The most common comorbidity in these patients is chronic kidney disease, the doctors say.

The doctors also look at chest X-Ray or CT scan to see whether the patient might get severe symptoms. “In fact, the radiological findings can show up much earlier in pre-symptomatic and asymptomatic patients. A patient might be very comfortable, but their X-Rays show damage to the lungs,” said Dr Kohli.

Early intervention is needed as the symptoms can progress rapidly. “Death from Covid-19 may occur in five to seven days of a patients first developing symptoms,” said Dr Kohli.