Hosps lower O2 saturation from 97% to 92% for judicious use
With the crisis intensifying, hospitals have been told to lower saturation levels
With oxygen crisis intensifying at government hospitals here, doctors have been instructed to maintain saturation levels depending on the patient’s condition, sometimes with just 85 per cent, in stable cases to put the much-in-demand gas to judicious use.
While the target saturation levels for the stabilisation of a COVID patient used to be 97-98 per cent around two months ago, it is now being kept to 92 per cent, multiple sources confirmed.
“Oxygen conservation team members have instructed to remove ventilators of patients if their saturation level is 90 per cent and observe if there is a further dip for a few hours without ventilators. But due to the unpredictable nature of the infection, we are losing some patients during the observation while many of them deteriorate and are again put back on oxygen, “said a general physician on duty at COVID-19 ward at Stanley Medical College and Hospital.
Doctors claimed that daily monitoring and change in the oxygen levels of patients are carried out to ensure availability of oxygen for other patients, as there are close to 100 new admissions daily to the emergency unit at a government hospital. “Saturation levels between 90-94 per cent is considered ideal for even severe cases. But patients are coming with 20-30 per cent saturation and that is when maximum oxygen support is given. We are not able to help such cases,” said G Vishal*, a member of the oxygen conservation team at Rajiv Gandhi Government General Hospital. A daily audit of oxygen at the hospital is being carried out and in the case of stable patients, the level is maintained at 85 per cent to ensure the conservation of the oxygen for 2-3 hours daily. Dr Radhakrishnan, head of the department of Anaesthesia Department at Stanley Medical College and Hospital said that the conservation team had told that the saturation levels are being monitored with a target of about 92 per cent, as the body functions continue the same way in higher saturation levels. Dr K Kolandaisamy, public health expert and former Director of Public Health and Preventive Medicine said that proning and oxygen level monitoring is necessary. “As per needs, patients can be taken down from oxygen support to ensure availability for others. However, they cannot be discharged,” he added.
Amid rampant complaints of shortage in oxygen supply due to which private hospitals are reportedly sending COVID-19 patients to government facilities, the Madras High Court asked the State government to look into the allocation of oxygen to private and government hospitals, and also patients other than those with COVID.
As the first bench comprising Chief Justice Sanjib Banerjee and Justice Senthilkumar Ramamoorthy was hearing a suo motu plea on the State’s preparedness, the Chief Justice noted that some intervenors have pointed out that elderly patients suffering from COPD or other problems were not getting the regular supply of oxygen and that it was difficult to find supply for them.
“While the State takes care of COVID patients and the emergency it faces on that account, the needs and concerns of the others must also be kept in mind and addressed without compromising such cases in the wake of pandemic,” he said.
The non-COVID patients, too, should be able to receive oxygen in the usual course, the bench stressed, and added: “Local authorities should take appropriate measures to ensure continuous supply for such purpose.”
Pointing out that there appeared to be an element of rationing of oxygen, as the State has not received the allocated supply, the bench said, “One of the intervenors pointed out that oxygen was not being supplied to many private hospitals. The State may look into the allocation of oxygen to the private and government hospitals in the State. In any event, the allocated supply is 519 MT against the State’s projection of 800 MT of oxygen required daily.”
During the hearing, the intervenors made submissions about the acute shortage of oxygen supply to private hospitals resulting in them being forced to send such patients to government hospitals, adding up to their burden.