Awake
Proning and High-flow nasal cannula (HFNC)
are the Game Changers in Covid Treatment
that Help Cure Patients
Apollo Speciality Hospitals, Vanagaram
was one of the first hospitals in Chennai to step up and treat COVID
patients in the private sector. An exclusive fever clinic at the hospital has
treated over more than thousand patients. Apollo Speciality Hospitals
Vangaram has saved many lives with HFNC
and Awake Proning eliminating the
need for ventilation.
Many
COVID patients are profoundly Hypoxemic with low oxygen saturation- a condition
called “Silent / Happy Hypoxia”. They will be completely normal and comfortable
with no breathing difficulty, however, their oxygen level will be deteriorating
at a faster pace. This can be picked up only by pulse oximeter. These patients
really do well with oxygen supplementation alone.
With progression of the disease some of these patients with
“Silent Hypoxia” become more hypoxic in spite of oxygen supplementation. This
is where we have seen the results of “Awake Proning”. In any patient requiring
more than 4 litres oxygen an awake proning protocol is employed. This simple
non-invasive technique can eliminate the need for ventilation in some Covid-19
patients. “Awake Proning” is basically having patients turn over onto their
stomach or onto their side while lying down. This method has been remarkably
effective in boosting the “Blood Oxygen Saturation” levels in the covid
patients who have silent Hypoxia.
Based on observation at Apollo Hospitals Vanagaram, the
results are so encouraging in people with both silent Hypoxia and severe Hypoxia
said Dr. Ebenezer, Senior Consultant and ICU Incharge “When the patients lie on
the back, the fluid in the lung in Acute Respiratory Distress Syndrome
accumulates in the bottom of the lung, the heart and other abdominal contents
further compress the lung region leading to non-uniform ventilation. When
proning is done the patient’s body is parallel to the ground, this flipping
over will give more room to the lungs without any compression. Awake Proning
eliminates the need for intubation and ventilatory support in some patients”
He also added, “Some patients with a severe disease become
progressively hypoxic at the same time breathless requiring some form of
support and assistance for which we use a High Flow Nasal Cannula or a
non-invasive ventilator. In these patients also we employ awake proning to help
us tide over the crisis and offset the hypoxemia.”
Below are details of few patients on who both Awake Proning
and HFNC were used:
·
65yr old gentleman with
coronary artery disease and H/O spine
surgery had severe covid pneumonia. His CT severity index on admission
was 26 and he became progressively hypoxic. We tried NIV but he was not
tolerating, on employing HFNC with
awake proning he beautifully settled down, A team of ICU technicians and nurses diligently worked on the
protocol. Finally after two weeks of stay in ICU he was weaned off HFNC and walked home safely.
·
40 yr old diabetic patient was admitted with
severe hypoxemia, admission CT scoring
was 33, was treated effectively with HFNC/NIV and awake proning we were
able to avoid intubation. Once we explained in detail the protocol and sought
the cooperation of the patient we were surprised by his willingness to strictly
adhere to the protocol. Constant motivation and encouragement from his family was a force multiplier.
·
72yr old DM with underlying COPD admitted with
very bad lungs, severely hypoxic was initially managed with NIV and routine
supportive treatment. Subsequently he became breathless and was intubated and
placed on ventilatory support.after a prolonged stay on the ventilator he was
successfully weaned and extubated, discharged after forty days in hospital proving that age is after all a number.
·
65yr old with no comorbids shifted from
another hospital with severe respiratory distress COVID positive was
subsequently intubated and ventilated. Patient required prolonged periods of
paralysis and sedation. He was on LMWH. On stopping sedation paucity of
movement noticed on left side. Shifted for CT brain, Right MCA territory infarct noted. Neurologist opinion obtained
and treated appropriately. He started spiking fevers became hypotensive
requiring vasopressors ,blood cultures grew MDR Acinetobacter, treated with
colistin, survived septic shock. Slowly
patient was weaned and extubated.
Neuro-rehabilitation was provided and patient is ready for discharge.
·
39 yr old patient with
admitted with C/O fever,cough and breathing difficulty with a CT severity of
33,got intubated for worsening hypoxia and was successfully weaned and
extubated.He was treated with steroids, LMWH and Tocilizumab. He was a young
individual who responded very well to invasive
ventilatory support based on tried and tested ARDS ventilatory protocol.
Happy hypoxemia is a true
phenomenon, HFNC and awake proning is a game changer and where
there is a need there should be no hesitation no dilemma in instituting invasive
ventilator support. Across the globe sick COVID pneumonia patients did not
die because they were ventilated rather they died on the ventilator due to the
disease per se and in many instances many lives were lost because of absolute
lack of ventilators. As the war against COVID intensifies Apollo
Speciality Hospitals Vanagaram will continue to be a beacon of hope for
the sick and suffering in and around Chennai.
