• January 25, 2022

Dr Barney Isaac, CMC, Vellore, Well being Information, ET HealthWorld

Aug 23, 2021

Shahid Akhter, editor, ETHealthworld, spoke to Dr. Barney Isaac, Professor of pulmonary drugs on the Christian Medical School, Vellore, to know extra about CMC’s success with non-invasive air flow in combatting Covid-19.

Covid-19: Impression on the respiratory system
Covid-19 has had a huge effect on the respiratory system. The respiratory system is the most common system that’s concerned throughout acute covid and is the trigger for morbidity and mortality in covid. There’s additionally a long-term sequelae amongst those that survive covid within the respiratory system and that’s the story that’s persevering with on. Coming to the acute influence of the respiratory system on account of covid, it takes a toll by involving the alveoli due to which there’s oxygenation that’s affected, so the preliminary remedy could be to provoke oxygen, however when sufferers’ lungs grow to be extra concerned, there may be requirement of not simply oxygen, however extra help to the respiration and one of many modalities of remedy is non-invasive air flow or NIV.

Covid-19 administration: Position of NIV

The position of NIV or non-invasive air flow in Covid care, as I alluded to the respiratory system, is the most common system which is concerned in sufferers with Covid leading to Covid pneumonia and acute respiratory misery syndrome. Initiation of non-invasive air flow by the use of both a CPAP, which is steady optimistic airway stress or a BI-PAP, which is bilevel optimistic airway stress was not the form of technique in ARDS in pre-Covid occasions, however nevertheless in Covid due to the elevated compliance of the lung which is sort of completely different from the standard ARDS the place there may be stiff lung, the position of NIV was tried out and it was present in early experiences within the European international locations which acquired hit earlier by Covid that it did have some profit and therefore we additionally began initiating non-invasive air flow in our hospital and what we realized that early initiation of non-invasive air flow has vital optimistic impacts by delaying the necessity for progressive respiratory failure, the necessity for invasive mechanical air flow and the necessity for crucial care and likewise ultimately lowering the mortality or loss of life in sufferers with Covid ARDS. NIV: Initiatives taken at CMC
I want to emphasize the initiatives that we took in CMC for managing Covid sufferers with NIV. I’d classify it into what we did within the first wave and what we did within the second wave. Like everybody else Covid took us for shock in sudden improve in numbers, who required non-invasive air flow and within the first wave we arrange respiratory intermediate care unit, the place one in every of our respiratory wards have been made right into a 14-beded standard NIV ward. What I imply by that is that these weren’t invasive ventilators or NIV mode of ventilator was used, however we used standard CPAP and BIPAP machines with oxygen entrained into them and we delivered NIV remedy to sufferers who have been worsening in what we name the level-2 wards then. And these sufferers have been initiated early on with NIV and managed and we had a hit of about 78% within the sufferers who have been stepped up for NIV care to the respiratory intermediate care unit.

We concurrently began coaching physicians of different specialties into being aware of administration of NIV in Covid. This was taken care of by the medical schooling division of our establishment and there have been a number of gamers who put down NIV modules which the medical doctors went by after which there was a sensible session the place we cleared their doubts and had some palms on coaching. This was supplemented by the same module and coaching for the respiratory and demanding care therapist to step up their care within the sufferers who have been requiring NIV in Covid. So, whereas this was happening, truly, the primary wave died down and whereas we have been getting again to work, the second wave hit us in numerically elevated numbers and we have been hit about seven-eight occasions greater than what we have been hit within the first wave.

Conventionally it was thought that in non-critical care arrange, non-air situation arrange one wouldn’t give NIV in Covid, nevertheless it occurred that within the second wave the numbers have been so excessive that we needed to convert seven of our stage 2 non-air conditioned NIV stage 2 wards into NIV wards for covid and we needed to additionally procure large variety of machines as a result of the variety of sufferers who required NIV was far larger than the sufferers, than the machines we needed to help these sufferers. So, shortly the administration scaled up the procurement of NIV and we have been capable of give on the peak of the pandemic 160 sufferers have been on NIV within the stage 2 wards which have been outdoors of the crucial care NIV beds.

There was an enormous improve and this required coaching of not solely a respiratory and demanding care therapist, we needed to rope in allied well being skilled from different departments like anesthesia, cardiology and so forth, who needed to be educated to have the ability to handle the NIV settings and altering of those sufferers. Though it regarded like a conflict zone, the place there was hectic work that went on. We’re pleased to say that we have now managed about 14,000 sufferers over the span of the 2 waves and quite a few sufferers we have now not counted in all probability in numbers of 800 and 900 who acquired NIV within the stage 2 wards which has now scaled all the way down to solely about 20 sufferers, who require NIV as of date.

Covid-19: Learnings and preparation for the third wave
After we put together for such pandemics and the third wave is a chance, we should be ready in varied methods; one, we must always have paramedical workers who’re educated in managing NIV, we must always have ample NIV machines which might provide what’s required for these sufferers. Three, we must always have ample area that’s required. We’ve got the lucky chance of a brand new campus in Kannigapuram, which acquired opened up as a Covid ward which helped in stepping up the beds and 4, we have to prepare medical doctors who want to have the ability to handle sufferers with NIV and this could occur once we are between waves, when we’re not caught in a pandemic, in order that we’re ready to face a pandemic simply when it strikes in order that most profit might be given for optimum variety of sufferers.

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