The Maharashtra and Central governments have issued a number of circulars and orders dictating the volume of oxygen that should be used by the doctors for patients on oxygen beds, ICU bed patients and ventilators. It has caused much confusion among the medical community.
Physicians and ICU specialists believe that rather than capping the volume to be used for patients, it would be better to let the treating doctors decide the amount of oxygen to be used. The State and Central governments should instead more on making medical oxygen available easily in the hospitals.
The Maharashtra Health Directorate in a notice on September 27 created a ready reckoner for oxygen usage, which should be referred to at the facilities treating Covid patients. On September 25, the Union Ministry of Health and Family Welfare in a notification had even gone to the extent of prescribing an oxygen usage monitoring committee in the hospitals.
Irrational restrictions
Avinash Bhondwe, President of the Maharashtra unit of the Indian Medical Association (IMA), said that the Association had complained to the Maharashtra government about contradictory and irrational rationing guidelines concerning medical oxygen use. Now, with the help of the NITI Ayog, the State government has issued one more notification about the usage of oxygen on Covid patients. It shows usage up to 10 litres/minute for oxygen beds and 40 litres/minute for ICU ventilator beds. Such volumes seem a little more reasonable than earlier guidelines.
The doctors should not have such obligatory restrictions while saving the lives of dying patients. The government should believe that the doctors work ethically and to the best interest of the patient’s actual condition. It should not doubt the doctors and restrict them from the usage of oxygen or for any that matter any other mode of the treatment, Bhondwe said.
Critical cases
Subhal Dixit, Immediate Past President of Indian Society of Critical Care Medicine, said that each body type requires a different amount of oxygen. While treating serious Covid patients, factors such as the status of the lungs, its injuries due to the viral infection and vital gases dissolved in the blood are critical. In some critical patients, high-flow nasal oxygen machines which deliver oxygen at the rate of 30-40 litres per minute are required. In one day, about 15 jumbo cylinders are used for such patients, which may increase the cost burden but can also save lives, he said.
A former medical director of a large public hospital in Mumbai said that the State government has “not applied its mind” while making medical gas available at the right time to the hospitals. To cover up its inefficiencies in procuring and supplying the oxygen, this bogey of excess use by doctors and notifications has been raised. Ideally, they should engage with IITs and come up with an urgent solution for making medical oxygen on a large scale.
Maharashtra Health Secretary Pradeep Vyas was not available for comments.