- NIV can be used as a first-line treatment nowadays to combat coronavirus before ICU
- NIV should be used for patients with mild symptoms of respiratory illness and COVID-19
- Multiple ventilation is not recommended in the current status of COVID-19 in India
Lucknow, April 18 th , 2020: Surya foundation in association with Midland Hospital organized a live panel of discussion with experts on the current status of use of NIV in COVID-19. Addressing to the current status of COVID-19 in India, the webinar catered the Discussion on the use of Noninvasive ventilation in COVID-19 crisis, which is an effective therapy with less risk of infection and improved survival in patients with respiratory failure.
The medical experts in the area of pulmonary and respiratory illness from the corners of India including Dr. Sujeet Rajan, Respiratory physician, Bombay Hospital, Dr. B.P. Singh, Director and Senior Respiratory Consultant, Midland Hospital, Lucknow, Dr. Dhruv Chaudhary, Senior Professor and Head, Department of Pulmonary and Critical Care Medicine University of Health Sciences Rohtak, Haryana, Dr. Lancelot Pinto, Consultant Respirologist at P.D. Hinduja National Hospital and Medical Research Centre Mumbai, Maharashtra were present in this forum of discussion conducted through web.
This platform of discussion catered to the use of Noninvasive ventilation as per the guidelines of COVID-19, how to titrate and initiate to support the patient’s breathing and what are the precautions need to be taken during the procedure by the doctors and medical staff.
Midland Hospital Lucknow, Director and Senior Respiratory Consultant, Dr. B.P. Singh said, “There are a range of clinical solutions available for managing patients in respiratory failure but Non-invasive ventilation (NIV) therapy provides both oxygenation and ventilation support and can enable providers to tailor ventilation pressures and flows to match the patient’s breathing patterns.
Some COVID-19 guidelines have therefore suggested NIV as a bridging therapy only, before transfer to the ICU. While NIV won’t be an option for every patient with COVID-19 depending on the severity of their symptoms, it has the potential to help many patients in respiratory distress. In context of the COVID-19 status in India, Multiple ventilation is not recommended infact it is considered as a warning because patients come with different-different complaints and keeping the spread of the deadly COVID-19 in mind, the ventilation of 3 or more should be prohibited and thankfully right now we are in not in the need of practicing so, as the situation is still under control.”
P.D. Hinduja National Hospital and Medical Research Centre Mumbai, Consultant Respirologist, Dr. Lancelot Pinto said, “India must follow South Korea as they opened designated centers everywhere for people who are not ready to visit hospitals. The developed country even ramped up PPE which helped to have a control and now South Korea is out of lockdown and will be instructed for lockdown again if cases surge. As a developing country, India should make mid-ground approach by mandating masks and social distancing as strictly as possible.
“Delivery of NIV allows the patient to take deeper breaths with less effort. NIV at two levels of pressure delivers a positive inspiratory pressure swing in synchrony with the patient’s inspiratory effort. And the most important part is that we should not use NIV for so long which can develop lung complaints in patients, it is also advised not to use auto CPAP and NIV with much pressure rate because many patients have low saturated oxygen but look very normal.”, he added.
University of Health Sciences Rohtak, Haryana, Department of Pulmonary and Critical Care Medicine ,Senior Professor and Head, Dr. Dhruv Chaudhary said, “The use of NIV is associated with a marked reduction in the need for intubation, decrease in complication rate, reduced duration of hospital stay and a substantial reduction in hospital mortality. The current use of noninvasive ventilation is growing up, and is becoming a major therapeutic tool in the intensive care unit. NIV should be used as a first-line treatment nowadays to combat coronavirus.
There are different ways to support COVID-19 patients with NIV therapy and depending on the route of the best course of treatment, each comes with different considerations, if oxygen is being delivered via HFNC, CPAP or BiPAP they require different settings in mask and ventilation with varied pressure. There are some precautionary measures which are necessary for NIV therapy by healthworkers such as airway protection, droplet rotection, contact prevention, good ventilation is a very important point which has
been taught to us by COVID-19. Also do switch off your AC to prevent dispersal, hand hygiene and leakage tested masks with filters on both expiratory and respiratory ports or vents.”
Bombay Hospital, Respiratory physician, Dr. Sujeet Rajan said, “The d oubling phase of coronavirus in India is 6 days which is comparatively better than other countries. And concerning about non-invasive ventilation the experts’ panel points out that these approaches performed by systems with good interface fitting do not create widespread dispersion of exhaled air, and their use can be considered at low risk of airborne transmission. Practically, non-invasive techniques can be used in non-severe forms
of respiratory failure. However, if the scenario does not improve or even worsen within a short period of time the mechanical ventilation must be preferred.”
“Hydroxychloroquine is not working much in addition to the search of the anti-coronavirus vaccine. We are also waiting for the vaccine to come.” ,he added.