The peaking COVID19 in J&K has suddenly escalated the need for Intensive Care, with our healthcare system grappling to meet the requirement. Being an experienced critical specialist I want to talk about how we can meet this demand better and save more lives in J&K with the existing resources.
As COVID19 cases increase, patients can be treated with less invasive breathing support that would help relieve a shortage of ventilators. Non-invasive ventilation includes CPAP (Continuous Positive Airway Pressure)and BIPAP (Bi Level Positive Airway Pressure) machines.
These kinds of machines supply pressurized air into the airways, a process called positive pressure ventilation as the device helps open the lungs with this air pressure. Both these machines work via a tube into a face mask. And advantage of this kind of ventilation is that there is no need for sedation or muscle relaxation. While using these machines, patients must be conscious, able to initiate their own breaths and to maintain their own airway.
Months back in Italy, when hospitals were overwhelmed with COVID19 patients in respiratory failure. Doctors had to make difficult life or death decisions about who gets ventilators and who does not. The CPAP machine was only considered in Italy to address the lack of ventilators. When used early, it reduced deterioration to the point that invasive ventilators were not required. Many countries, when desperately trying to cope with the pandemic, have used CPAP; having a more significant and positive role than initially thought.
Many COVID19 patients develop ARDS (Adults Respiratory Distress syndrome) and require respiratory support for Type-1Respiratory failure or hypoxic Respiratory failure before they succumb.
The signs and symptoms of ARDS are Tachypnoea (Increase Respiratory Rate) , increased use of accessory muscles, tachycardia, pale and cold peripheries, sweating, confusion, agitation or reduced level of consciousness and cyanosis. As there are a limited number of ventilators available for the increased number of COVID patients and secondly weaning patients off ventilator support proves to be extremely challenging and not always successful.
Non-invasive ventilation is very useful in the early disease process. It prevents deterioration and reduces the need for invasive ventilation. With a very high number of patients requiring invasive ventilators, limited availability of ICU beds and overstretched resources, bridging or holding measures such non invasive ventilation machines need to be used to improve oxygenation prior to invasive Ventilators. It improves both oxygenation & work of breathing. Another major advantage of these machines (CPAP & BIPAP) these can be used in wards and don’t require an ICU setting.
These devices are extremely cost effective and do not require huge funds for procurement. Their current cost is almost 15-20 times cheaper than the non invasive machines. CPAP is a preferred form of non-invasive ventilation in the management of hypoxemic COVID19 patients. BIPAP is commonly used in COPD patients with COVID19. It prevents Alveolar collapse, increases lung volume and improves gaseous exchange. We have observed that patients who end up being intubated on ventilators have really poor outcomes. Many COVID19 patients can be saved with these non-invasive machines. In my opinion, based on experience and learning from other parts of the world, it is far better to use a non-invasive ventilator rather than an invasive ventilator.
Dr Showkat Shah is a renowned critical care specialist based in Srinagar. He can be emailed at shahshowkat07@gmail.com