NASHIK: Amid the rising demand for oxygen, the Indian Medical Association, Nashik has released guidelines for all the doctors in Nashik on rational use of Oxygen. “The IMA release will quench anxiety of patients and their relatives also,” stated District Collector Suraj Mandhare. The IMA guidelines addressing the doctors state, “Use only oxygen concentrators for home care, leave cylinders for hospitals and health care facilities.
Form an oxygen audit committee in the hospital, who will be responsible for all oxygen usage in the hospital. To save oxygen, it adds, “Fix all leaking oxygen outlets, valves, and pressure gauge, also make sure oxygen flow meters are off when the patient does not need oxygen. Also, cancel all routine surgeries and routine admissions to the hospital at present; this will save a significant amount of oxygen.”
The guidelines to doctors also underline certain technical aspects on the rational use of oxygen in the pandemic. It further adds: Change the target oxygen saturation to 93% -95%. There is good evidence to suggest that a restrictive oxygenation strategy improves mortality in critical patients. Use awake-prone ventilation to improve oxygen saturation. Use CARP protocol which has shown to improve oxygenation.
Taper oxygen quickly to the minimum required to keep saturation level to 93%-95%. Stop use of High Flow Nasal Oxygen machines (HFNO) until further notice. The HFNO machines use a very large quantity of Oxygen; sometimes up to 80 liters per minute. Those patients who may need HFNO – should be managed on Non-Invasive Ventilation (NIV) with minimum FiO2 required to keep saturation between 93% – 95%.
Use CARP Protocol along with NIV to have effective use of oxygen. On invasive ventilator aim for saturation of 88%–92% only or a PaO2 of 55mm Hg – 65mmHg, and prone patients on invasive ventilation to improve oxygenation, it concludes.
