ROLE OF ELECTRICALLY DRIVEN CPAP MACHINE WITH OXYGEN ENRICHMENT FOR OXYGEN CONSERVATION IN COVID ICU

ABSTRACT

INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 that occurs in 20-41% of patients with severe disease. (7) SARS-CoV-2 patients present with a wide spectrum of clinical severity, ranging from asymptomatic to pneumonia to ARDS-like phenotypes. (8,9) During the early months of the COVID-19 pandemic unprecedented numbers of patients presented to hospitals with acute respiratory failure. With intensive care services at risk of being overwhelmed, strategies were soussght to reduce invasive mechanical ventilation (IMV). Whilst not previously a standard treatment for viral pneumonitis, early anecdotal accounts and preliminary data highlighted the use of continuous positive airway pressure (CPAP) in COVID-19. (7,10) Subsequently it gained traction as an intervention that could be delivered outside of the intensive therapy unit (ITU) and high-dependency unit (HDU) along with conservation of oxygen. Oxygen conservation posed a huge challenge in COVID ICU’s. HFNO being the major cause of oxygen consumption. Electrically driven CPAP machines • Use air to maintain Continuous positive airway pressure. • Decrease atelectasis. • Increase surface area of alveolus. • Improves V/Q matching. Thus, improving oxygenation and saving Oxygen with the use of electrically driven CPAP with oxygen supplement. CPAP has mostly been studied in relation to OSA and a lot is yet to be explored regarding its potential in COVID ICU’s. OBJECTIVES: I. To note the change in Spo2 II. To note if CPAP delivery system can reduce oxygen consumption as to HFNO III. To note if treatment is well tolerated IV. To note if use of CPAP can avoid/delay the use of HFNO/NIV METHOD: Patient’s vitals were noted before shifting to electrically driven CPAP machine and monitored throughout. Properly fitted vented Bi-pap mask was attached with the electrically driven CPAP machine and the oxygen was supplemented with the help of tubing connecting the Bi-pap mask vent to the flow-meter. The flow of oxygen was titrated according to patients requirements ranging from 8-12 liters/min.The pressure was set as per patients need and titrated as per the condition of the patient. During meal times the patients were shifted to HFNO. RESULT: Out of the total 30 patients in our study, 25 patients were successfully treated with the Electrically driven CPAP machine with O2 enrichment and did not require stepping up to further modalities of oxygen therapy. Around 1700 - 1900 L/hr of oxygen was being used by HFNO whereas only 600 - 720 L/hr of oxygen was used by use of CPAP which helped us to save about 29-80% of oxygen by the use of CPAP machine. CONCLUSION: From our limited study we can only conclude that the CPAP when used with Oxygen enrichment in COVID ICU’s can help in conservation of Oxygen by improving the respiratory mechanics of the COVID affected lung, which becomes an essential aim in a pandemic to serve maximum patients with limited resources.