Medical Oxygen: A Lifesaving Drug During the COVID-19 Pandemic—Source and Distribution

Oxygen is an essential lifesaving medicine used for several indications at all levels of health care. The COVID-19 pandemic and its recent second wave have resulted in a surge in demand for necessary resources, including trained staf, hospital beds, and medical supplies like oxygen. Limited availability of these resources resulted in added risk of adverse outcomes. Also, the widespread unregulated use of oxygen by the general public in household settings poses safety concerns. This review focuses on sources of medical oxygen like cryogenic oxygen plants, pressure swing adsorption, oxygen concentrators, and oxygen cylinders. Their specifcations, storage, distribution within healthcare settings, regulation, and safety concerns have been considered. Resources needed for calculating oxygen demand, surge planning, identifying the suitable source, and distribution systems for diferent settings have been detailed. This review aims to help the hospital administrators, biomedical engineers, and clinicians plan and rationalize oxygen usage in low- and middle-income countries during the COVID-19 pandemic.

Advances in the Management of Pediatric Septic Shock: Old Questions, New Answers

Septic shock in children is associated with high mortality, especially in developing countries. Management includes early recognition,timely antibiotics, aggressive fluid resuscitation, and appropriate vasoactive therapy, to achieve the therapeutic end points. The evidenceat each step in management has evolved over the past decade with a paradigm shift in emphasis from a ‘protocolized care’ to an‘individualized physiology-based care’. This shift mirrors the general trend one observes in critical care with respect to various treatmentmodalities i.e. moving away from a liberal to a more conservative approach be it fluids, ventilation, transfusion, antibiotics or insulin. Theage-old questions of how much fluid to give, what inotropes to start, when to administer antibiotics, are steroids indicated and when toconsider extracorporeal therapies in refractory shock are finding new answers from the recent spate of evidence. It is therefore imperativefor all of us to be aware of the recent changes in management, to enable us to adopt an evidenced based approach while managingchildren with septic shock. In this review, we have tried to summarize the key changes in evidence that have occurred over the pastdecade at various steps in the management of pediatric septic shock