Bhubaneswar: With Oxygen shortage crippling treatment of Covid-19 patients in many states, the Odisha government on Tuesday issued standard operating procedure (SOP) for rational use of the life-saving gas in Covid facilities across the State.
“Oxygen is precious and we may face acute shortage if not managed properly, rationally and judiciously,” additional chief secretary of health department PK Mohapatra stated in a letter.
He further said timely use of oxygen can reduce the mortality as well as morbidity to a large extent.
“It is noticed that the number of Covid cases are increasing day by day and Government is keen in setting up of sufficient Covid facilities with General beds, HDU beds and ICU beds. Such patients require oxygen which is the mainstay of treatment,” Mohapatra wrote.
He asked all district collectors, municipal commissioners, dean and principals of medical colleges, CDM and PHOs to ensure that the SOP is followed scrupulously in all government and private Covid-19 hospitals.
“Expert teams shall visit periodically for strict observation of such protocols. Any deviation to the rational use shall be viewed seriously,” he cautioned.
SOP for rational use of Oxygen in Covid facilities
- The flow of oxygen should be adjusted to the lowest permissible level to target an oxygen saturation of 92% to 94% for the hospitalized COVID -19 patients
- Indiscriminate use of BIPAP/HFNC should be avoided, When required, BIPAP should be preferred over HFNC as the latter consumes large amount of oxygen. HFNC device should be used only in the ICU setting under supervision of a respiratory physician/physician. Patient should be put on HFNC only after approval of the senior most respiratory physician/physician,
- Prone positioning should be intermittently done in patients of COVID -19, along with adjunctive physiotherapy. This optimizes the respiratory status.
- Individualisation of oxygen therapy should be done taking into account the clinical signs like respiratory rate etc. and not just the saturation level, Once the desired saturation is achieved. now or oxygen should not be increased as it may not provide any additional benefit to the patient. Up-titration instead of down titration of oxygen flow levels should be the norm.
- Triaging of patients as per their oxygen status should be done at regular intervals.
- The critical part of the timely use of oxygen is to see that the oxygen in the container is up to appropriate level and timely changing of empty cylinders is done. This will prevent sinking of the patient due to want of oxygen at proper pressure and percentage.
- An audit of safety of oxygen use by the ICU/HDU/general bed should be done by the clinical team leader on a daily basis.