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Role of oxygen therapy – Burning Issues – Free PDF Download

  • The ongoing second surge in Covid-19 cases has seen a huge rise in the demand for supplemental oxygen. What makes the gas so vital in Covid-19 management?

  • A small proportion of Covid-19 patients need oxygen support, when shortness of breath progresses to a more acute condition. Most patients with Covid-19 have a respiratory tract infection, and in the most severe cases their symptoms can include shortness of breath. In a small proportion of such cases, this can progress to a more severe and systemic disease characterised by Acute Respiratory Distress Syndrome (ARDS).

  • Shortness of breath occurs because of the way Covid-19 affects the patient’s respiratory system. The lungs enable the body to absorb oxygen from the air and expel carbon dioxide. When a person inhales, the tiny air sacs in the lungs — alveoli — expand to capture this oxygen, which is then transferred to blood vessels and transported through the rest of the body.
  • Respiratory epithelial cells line the respiratory tract. Their primary function is to protect the airway tract from pathogens and infections, and also facilitate gas exchange. And the SARS-CoV-2 coronavirus can infect these epithelial cells.

  • To fight such infection, the body’s immune system releases cells that trigger inflammation. When this inflammatory immune response continues, it impedes the regular transfer of oxygen in the lungs. Simultaneously, fluids too build up. Both these factors combined make it difficult to breathe. Low levels of oxygen triggered by Covid-19 are inflammatory markers, which include elevated white blood cell counts and neutrophil counts.

How many symptomatic people now require oxygen?

  • In India, as of Tuesday, 1.75% of the patients were in ICU beds, 0.40% were on ventilator, and 4.03% were occupying oxygen beds. Since the total active cases have now risen to 20,31,977, the number of patients requiring oxygen beds is significant.
  • Severe cases are defined in three categories: severe pneumonia, acute respiratory distress syndrome, and sepsis. The clinical management protocol recommends oxygen therapy at 5 litres/min.
  • Does a patient always show Covid symptoms when their oxygen levels drop?
  • In silent hypoxia, patients have extremely low blood oxygen levels, yet do not show signs of breathlessness. “In patients with silent hypoxia, the amount of oxygen carried in our blood, otherwise known as blood oxygen level, is lower than expected compared to the other vital signs.
  • It recommends that instead of solely relying on a pulse oximeter, the patient should monitor for gastrointestinal symptoms, muscle soreness, fatigue, and changes in taste and smell as well as the more common initial symptoms such as fever, cough, and shortness of breath.

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