General internal medicine, Medical specialty

Dr Mangala BorkarThe vast majority - almost 85% of Covid patients who are asymptomatic or mild - maintain their oxygen levels on room air, but a serious patient needs hundreds of liters of pure oxygen.Imagine a very real and now a common scenario - there is no oxygen bed or a severe shortage of oxygen - and someone needs it badly! Would a device that gathers oxygen from the room air and delivers it to the needy be the answer? Yes and no! Let us ask the experts.Dr S H Talib, Senior Intensivist, Professor Emeritus, Internal Medicine, GMC, Aurangabad·Room air contains 21% oxygen and 79% nitrogen. If we increase the proportion of oxygen, it will raise the oxygen in the lungs.·Standard cylinders contain 1360-3400 lit of compressed oxygen. Small portable cylinders contain 240 litres of oxygen.·An oxygen concentrator is a medical device (that needs a doctor’s prescription as per the FDA) that takes, filters, humidifies room air and releases nitrogen back to air, thus concentrating oxygen to about 90%. A pressure valve helps to regulate oxygen supply, ranging from 1-8 litres per minute.·According to a 2015 WHO report, concentrators are designed for continuous operation and can produce oxygen 24 hours a day up to 5 years or more.·They are of two types, one is a stationary, sturdy concentrator and the other is portable. The portable may be 1) ‘pulse flow’ in which oxygen is gulped with each breath. 2) Continuous flow.·The concentrators should not be used for moderate to severe disorders or when assisted ventilation is needed. For a short period, it is better to use an oxygen cylinder.Always buy or rent a higher capacity oxygen concentrator than that is required. And beware, fraudsters are selling humidifiers and nebulizers as oxygen concentrators.Dr Anand Nikalje, Intensivist·It is useful for patients who still need 2-5 liters of oxygen at home,·Or in stable patients in the ward.·As a stand-by in emergency.·Few ventilators can even work on the low flow oxygen.·But it does not have a battery back-up.Dr Anant Kulkarni-Physician- Intensivist·Good for patients who need oxygen at home.·The hassle of getting oxygen cylinders changed or refilled is obviated.·But do not have a battery back-up. Do not work on inverters. Need an uninterrupted power supply or a generator.Dr Vishal Dhakre, Physician Intensivist·Useful at home.·Need to stop the device after 3-4 hours for 40-60 minutes as it gets heated. So, an oxygen cylinder may be needed as a back-up if continuous oxygen supply is needed.·The cost that was Rs 30,000 to Rs 50,000 earlier has almost doubled now. There should be a stand-by in case of power failure or machine breakdown.Dr Shailaja Rao, GeriatricianAn elderly relative was left with post-Covid lung complications since last August, that required him to take 3-4 liters of oxygen per minute, intermittently. His oxygen concentrator works fine for him, as there is no problem in disconnecting the machine every few hours to let it cool. CPAP can also be attached to it if needed.Dr Ramesh Baheti, Consultant.I can say from personal experience - it is portable, very easy to operate, can run on UPS and be used during travel in a car or an ambulance. After discharge, at home a severely ill Covid patient can get hypoxia due to even minimal exertion and become a victim of cardiac arrest. Hence, one should continue oxygen therapy till it is needed - and a concentrator is a good option.A senior doctor who does not wish to be named-“My mother, who is on chemotherapy for mouth cancer, was discharged after two weeks of moderate Covid infection. Since her oxygen levels were borderline, to be on the safe side, I rented a concentrator. But it broke down in a day. I decided to buy one-to find that the costs have suddenly escalated. I hope that strict measures will be taken to cap the prices and prevent black marketing and hoarding of this device.

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