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Thursday, June 24, 2021

Amid staff crunch, hospitals in Karnataka struggle to utilise PM Cares ventilators

The demand for ICU ventilator beds across the state has been relentless through the second wave of the pandemic.

Written by Johnson T A | Bengaluru |
Updated: June 1, 2021 7:10:25 am
Out of 637 ICU ventilator beds available under the government quota in the city of Bengaluru, only 14 were empty on Monday evening.

At the ICU inside SNR District Hospital in Kolar district, 20 new ventilators — part of the 2,913 machines provided so far to Karnataka under the PM Cares scheme — have been unpacked but only four of them are installed. The reason: shortage of trained staff to put the ventilators to use.

The demand for ICU ventilator beds across the state has been relentless through the second wave of the pandemic, and the state government had issued directions to hospital authorities to utilise the devices amid reports about more than 40 per cent of such new ventilators lying unused in Karnataka in March. But hospitals have been struggling to put the devices to use due to lack of staff with specialised training.

Out of 637 ICU ventilator beds available under the government quota in the city of Bengaluru, only 14 were empty on Monday evening. The waiting period for an ICU ventilator bed at the peak of the crisis in early May was three days or more, according to staff working in Covid war rooms and hospitals in Bengaluru.

“There is a lot of pressure from the government to utilise all the ventilators despite the lack of staff to handle the ventilators such as intensivists. Just providing the equipment is not enough. There is no trained staff and infrastructure in hospitals to utilise ventilators,” said a doctor in-charge of a 150-bed Covid-19 facility in Bengaluru

“We have installed four of our 20 ventilators and are getting people trained quickly to use the remaining 16 in our hospital,” said Dr Ravi Kumar, the district health officer in Kolar.

Last month, the previous district health officer and resident medical officer at the Kolar district hospital were suspended for non-utilisation of the 20 ventilators, among other reasons, said an official.

The government is providing basic training to para medical staff at taluk and district level hospitals, which face a lack of specialists, to utilise the ventilators.

Two weeks ago, Prime Minister Narendra Modi had directed officials to conduct an audit on the status of utilisation of ventilators provided under the PM Cares scheme. The Centre had said in a statement that the PM had taken note of reports about the machines lying unused in some states.

Meanwhile, Karnataka Chief Minister B S Yediyurappa said on Saturday that all ventilators received under the PM Cares scheme had been put to use. “There were some modifications and repairs required and it has been done… No ventilators are lying idle now,” he said.

In a statement on Saturday, the state government said, “All the ventilators supplied to district hospitals, medical colleges and private medical colleges and hospitals are confirmed to be in use and there is a huge demand for additional ventilators in these institutions.”

The state government said 2,025 ventilators were received last year and all of them have been installed. It said that in the second phase, 888 ventilators have been supplied by the Centre, of which 712 have been installed while the remaining 176 will be distributed as per need.

According to a reply given in the Rajya Sabha on February 2 by the Union health ministry on improvements in the health sector in the aftermath of the first wave, the number of ventilators in the public sector in Karnataka increased from 311 on April 21, 2020 to 1,263 by January 28 this year.

Karnataka Health Minister Dr K Sudhakar on May 11 ordered the use of ventilators in a non-invasive way, in place of high flow oxygen systems to conserve oxygen – since ventilators use around 20 to 30 litres of oxygen per minute compared to HFNO systems which use upto 60 litres per minute.

High-end ICU ventilators are needed for severely ill Covid-19 patients whose lungs have collapsed.

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. “The thinking was 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.

“The outcomes among patients who go onto ventilators (invasive) is poor even in the second wave,” said a doctor at the Victoria Hospital.

“It may be noted Karnataka has taken ICU care to the taluk hospitals by oxygenating 50 beds and creating ICU ventilator beds in each taluk after the first wave. Karnataka is among the rare states where ICU care has been taken to taluk level,” the state government said in its statement on ventilator usage on Saturday.

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