Critical care study led by Indians lists 27 treatment strategies for coronavirus

BENGALURU: An international group of experts has formulated a set of 27 strategies to address grey areas in the management of Covid-related Acute Respiratory Failure (C-ARF).

The formulations come from a Delphi survey, which aims to solve complex problems by obtaining opinions from a panel of experts, involving respiratory health experts across the world.

The study, ‘Expert consensus statements for the management of C-ARF using a Delphi method’, was led by 39 Indians and published in the international journal Critical Care. 

“C-ARF is a condition in which patients’ lungs are severely affected and inflammated. It is a dreaded complication, often leading to death,” said Dr Pradeep Rangappa, consultant for intensive care at Columbia Asia Hospital and one of the authors of the study. 

“Lack of high-quality evidence on respiratory management of C-ARF has resulted in wide variation in clinical practice,” he said.

This prompted them to undertake the study which agrees on standard practices to be followed in India and across the world, with a consensus among experts and scientific validation.

Dr Rangappa said that some of the recommended management techniques include systemiccorticosteroids, with dexamethasone being the preferred choice. Awake self-proning -- asking patients to lie on their stomachs -- to be done to improve oxygenation in patients with C-ARF who require it.

“For example, lung protective ventilation should be used for C-ARF patients. Ventilation requires complex settings and this procedure involves settings that will protect the lungs and improve recovery,” he said.

Another strategy is tracheostomy -- which is creating an opening in the neck to insert a tube into the windpipe.

“Intubation through the mouth can be done only for 10 days. If patients require ventilation even after that, tracheostomy should be done,” he explained. 

Dr Rangappa, part of the tele-ICU group in Karnataka, said that many of these strategies have already been adopted by the state.