Non-invasive Oxygen Strategies to Manage Confirmed COVID-19 Patients in Indian Intensive Care Units: A Survey
Ashwin Subramaniam, Jumana Y Haji, Kollengode Ramanathan, Arvind Rajamani
Conservative oxygen therapy, COVID-19, High flow nasal cannula oxygen therapy, Hypoxemia, Indian intensive care unit, Low flow nasal oxygen, NIV: Noninvasive mechanical ventilation, SARS-COV-2
Citation Information :
Subramaniam A, Haji JY, Ramanathan K, Rajamani A. Non-invasive Oxygen Strategies to Manage Confirmed COVID-19 Patients in Indian Intensive Care Units: A Survey. Indian J Crit Care Med 2020; 24 (10):926-931.
Background: About 5% of hospitalized coronavirus disease 2019 (COVID-19) patients will need intensive care unit (ICU) admission for hypoxemic respiratory failure requiring oxygen support. The choice between early mechanical ventilation and noninvasive oxygen therapies, such as, high-flow nasal oxygen (HFNO) and/or noninvasive positive-pressure ventilation (NPPV) has to balance the contradictory priorities of protecting healthcare workers by minimizing aerosol-generation and optimizing resource management. This survey over two timeframes aimed to explore the controversial issue of location and noninvasive oxygen therapy in non-intubated ICU patients using a clinical vignette. Materials and methods: An online survey was designed, piloted, and distributed electronically to Indian intensivists/anesthetists, from Private Hospitals, Government Hospitals, and Medical College Hospitals (the latter two referred to as first-responder hospitals), who are directly responsible for admitting/managing patients in ICU. Results: Of the 204 responses (125/481 in phase 1 and 79/320 in phase 2), 183 responses were included. Respondents from first-responder hospitals were more willing to manage non-intubated hypoxemic patients in neutral pressure rooms, while respondents from private hospitals preferred negative-pressure rooms (p < 0.001). In both the phases, private hospital doctors were less comfortable to use any form of noninvasive oxygen therapies in neutral-pressure rooms compared to first-responder hospitals (low-flow oxygen therapy: 72 vs 50%, p < 0.01; HFNO: 47 vs 24%, p < 0.01 and NPPV: 38 vs 28%, p = 0.20). Interpretation: Variations existed in practices among first-responder and private intensivists/anesthetists. The resource optimal private hospital intensivists/anesthetists were less comfortable using noninvasive oxygen therapies in managing COVID-19 patients. This may reflect differential resource availability necessitating resolution at national, state, and local levels.
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