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Tuesday, June 15, 2021

Karnataka advises hospitals: Use NIVs to cut back on oxygen demand

One of the major suggestions is to use ventilators to provide oxygen to ICU patients in a more efficient manner, instead of high flow nasal oxygen (HFNO) systems which were the norm in the first wave of the pandemic last year.

Written by Johnson T A | Bengaluru |
Updated: May 18, 2021 6:52:06 am
COVID-19 patients undergo treatment at a Covid Care Centre, as coronavirus cases surge in Bengaluru. (PTI)

With Karnataka among the states having seen deaths due to oxygen shortage, the BJP government has advised several steps to hospitals to cut back the steep demand. One of the major suggestions is to use ventilators to provide oxygen to ICU patients in a more efficient manner, instead of high flow nasal oxygen (HFNO) systems which were the norm in the first wave of the pandemic last year. This was conveyed by Health Minister Dr K Sudhakar at a recent meeting with district health officers, directors of medical colleges and super speciality hospitals.

“Patients with moderate symptoms need about 20-60 litres of oxygen per minute. So we have to find ways to reduce dependence on oxygen and are trying to utilise non invasive ventilators (NIV) as an alternative. This will reduce oxygen demand by 80%. All patients on HFNO will be shifted to ventilator beds,” the minister said.

The state has also directed hospitals not to increase oxygenated beds without notifying authorities. The move is a shift from the first wave of the Covid-19 where ventilators were advised only as the last resort. Ventilators were also in short supply during the first wave, but their numbers have since been boosted.

“In the first wave HFNO usage was advised because oxygen consumption and supply were not an issue. Now oxygen demand is so high that inefficient use through HFNO must be restricted, hence the decision that non-invasive ventilation is better,’” said Dr C Nagaraja, director of the Rajiv Gandhi Institute of Chest Diseases, a state-run Covid hospital.

“There has been a three-fold increase in infections and severity in the second wave,” Nagaraja added. “A non-invasive ventilator will use only 50% of the oxygen used up through HFNO.”

In the first wave, ICU doctors avoided putting patients on ventilators unless absolutely necessary on account of a high percentage of deaths among those intubated and put on ventilators for breathing support. “There was a thinking that once you intubate, they do not come off the ventilator. The guidelines were also to delay intubation. The advice was to use oxygen, HFNO or BiPAP (Bilevel Positive Air Pressure). Now non-invasive ventilation (which does not require intubation) is being used early,” said Dr Vijay Kumar, the ICU head at Vikram Hospital.

“We never realised in the first wave that HFNO systems suck so much oxygen. They consume 60 to 80 litres per minute. Our 6,000-litre oxygen tank which needed refilling every 10 days is getting depleted in a day,” said the head of a 150-bed government hospital.

Hospitals have been reporting a nearly 10-fold increase in oxygen consumption in the second wave. “I am living hand to mouth when it comes to oxygen. In non-Covid times I needed 1,400 litres per day. My consumption on May 13 was 10,000 litres,” said Dr Sanjiv Lewin, the head of medical services at St John’s Medical College Hospital, which has over 1,000 Covid beds.

In a May 9 order calling for “rational use of oxygen”, Chief Secretary P Ravikumar said, “Oxygen supply has not increased but hospitals are increasing their consumption by increasing oxygenated beds. This is the core reason for hospitals running out of oxygen. This is unsustainable.”

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