Past few weeks have been a challenging time for all the health care workers, especially those who are front liners and directly involved in the management of Corona patient during this pandemic time. As this is a new experience for all of us, hence one can feel the fear and uncertainty in the management of these patients.
As intensive care physicians, what we are offering in our hospital at present is to review these patients on the Covid ward in a view to assess them for a need of ventilatory requirement. If they are in need of invasive ventilation then they are brought to a specific area in theatre for intubation and ventilation with all the necessary precautions and preparations. These patients are not currently offered any of the non invasive interventions which are normally offered to non-covid patients such as Nasal high flow oxygen, CPAP or BIPAP as these can be aerosol generating.
Hereby, I share my experience of assessing two Covid patients in our hospital with impending respiratory failure. There were twenty Covid patients altogether in the Covid ward at the time, hence two of them needed assessment for possible intubations. The first patient was 39 years old female with morbid obesity and Asthma who was progressively getting hypoxic and was already on 50% oxygen. The other patient was 59 years old lady with past history of hypothyroidism and cholecystectomy who was also hypoxic and was on 50% oxygen as well. After assessment, the decision was made to withhold intubation as long as it was possible and just to increase FIO2 to 60%. Chest X-ray of both the patients showed bilateral infiltrates. Both patients required intubation and invasive ventilation later on as they become more hypoxic during the course.
Personally I feel that the rate of intubation and ventilation are much higher in these patients as the alternatives such as non invasive technique are not ideal in these situation for obvious reasons. There are few hospitals which are offering CPAP hood, can be a useful tool to buy some time before invasive ventilation or avoid it completely.
Dr S Shakir Hasan
Manchester, UK