Oxygen saturation of 92 or 93 in COVID-19 patients should not be considered critical; instead, this level is only a buffer that enables the patient to reach hospital on time, according to All India Institute of Medical Sciences (AIIMS) director Randeep Guleria. In a statement released by the Health Ministry on Thursday, he advised that judicious use of oxygen was the need of the hour.
“Misuse of oxygen cylinders is a serious matter of concern these days. A few people stock oxygen cylinders at home, fearing that they may need it later. This is not advisable. If your oxygen saturation level is 94% or above, it still means there is sufficient oxygen in the body. There is no need to panic. Misusing the same by a person with normal levels of oxygen can deprive someone whose saturation level is well below 90 or 80,” he stated.
The Ministry statement said, “Oxygen is crucial for the treatment of patients with severe COVID-19, since the disease affects lung functioning. Shortness of breath or difficulty of breathing is one of the most common symptoms in patients with severe COVID-19. It also hampers the supply of oxygen to various parts of the body. They hence need oxygen therapy, to be supplied through medical oxygen’’.
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According to a World Health Organisation training manual on pulse oximetry, if the oxygen saturation is 94% or lower, the patient needs to be treated quickly. A saturation of less than 90% is a clinical emergency.
The latest clinical guidance for management of adult COVID-19 patients, issued by the Health Ministry, states the an oxygen concentration less than or equal to 93% on room air requires hospital admission, while that below 90% is classified as a severe disease, requiring admission in the ICU.
“However, given the prevalent situation in the wake of the 2nd wave, we must do whatever we best can, in order to try and replenish our oxygen levels, in the event of delay or inability in getting hospital admission as per the clinical management protocol and people are now using oxygen concentrators while at home,’’ note experts.
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Oxygen concentrators can be used only in moderate cases of COVID-19, when the patient experiences drop in oxygen levels and where the oxygen requirement is a maximum of 5 litres a minute, say the experts while cautioning that using a concentrator without medical guidance can be very harmful.
Usage of concentrators
Speaking on the appropriate usage of concentrators, Professor and Head of Department Anaesthesia, B. J. Medical College, Pune, Sanyogita Naik said: “Oxygen concentrators are also very useful for patients experiencing post-COVID-19 complications which necessitate oxygen therapy.’’
Participating in a recent webinar organised by the Ministry, Chaitanya H. Balakrishnan, Covid co-ordinator, St. John’s Medical College Hospital, Bangalore, said patients with moderate pneumonia induced by COVID-19 - with oxygen saturation less than 94 - could benefit from supplemental oxygen given through the concentrator, but only till they got hospital admission. However, patients using it themselves without suitable medical advice could be harmful.
Till patients got a hospital bed, concentrators could be beneficial but should not be used without guidance from chest physician/internal medicine specialist. “It is also vital to assess the patients’ pre-existing lung conditions,’’ he added.
The Ministry said that it was essential to ensure proper fire safety measures and train all staff in safe handling of oxygen, as the increased storage and handling of oxygen cylinders during COVID-19 heightened the risk of hospital fires.
“There are also additional requirements and rules for medical oxygen, including requiring a person to have a prescription to order medical oxygen. It is important for citizens to ensure judicious use of the vital product, especially during a public health emergency. Misuse or overstocking of these will only lead to panic and black marketing,’’ the Ministry pointed out.