From arranging medication or oxygen bottles to transporting patients or the dead, if there is one thing that is brutal Covid-19 Wave taught the citizens of India that people are really on their own. After oxygen concentrators, the next life-saving medical device that comes to mind is owning a ventilator. And why not? Fans start at only Rs 70,000 while expensive models can cost around Rs 2 lakh.
While this amount sounds a little too much to many, there is at the same time a sizeable percentage of the population in India who can afford it. After all, it’s “cheaper” than paying a deposit for a brand new car. The desperation of being adequately prepared for the fight against Covid-19 has also fueled the idea of why not creating an “intensive care unit at home” if one can afford it. If there is a GP who is always available for video calls, an “intensive care unit at home” is not a bad idea given the oxygen and ventilation bed shortages recently observed across India.
Now there are two types of ventilators: Non-invasive ventilator ((NIV) and invasive mechanical ventilator (IMV). For home use, you can only opt for a non-invasive ventilator, as medical expertise is required to use a mechanical ventilator. Note that a non-invasive ventilator must be prescribed by a doctor. Here are all the details you need to know about non-invasive ventilators and whether or not you should buy one.
Non-invasive ventilator (NIV). The fundamental difference between an invasive mechanical ventilator (IMV) and a non-invasive ventilator
What is a non-invasive ventilator (NIV)?
The fundamental difference between an invasive ventilator (IMV) and a non-invasive ventilator (NIV) is that with invasive mechanical ventilation, an endotracheal tube is inserted into a patient’s neck and a highly visual ventilator takes over the mechanical function of the lungs. IMV is performed on a seriously ill person.
“In NIV, a customized face mask is placed over the patient’s nose and mouth, and the device helps the patient breathe by delivering a predetermined amount of compressed air to the lungs. NIV as a technology eliminates the need to insert tubes or pacify the patient, making it easier for both the patient and healthcare professional to use, ”he said Dr. Sibasish Dey, Head of Medicine, Asia and Latin America, ResMed. For those who didn’t know, ResMed is a medical device company.
Non-invasive ventilators require constant medical supervision and trained home nurses
Dr. Vikas Maurya, Director and HOD, Pulmonology, Fortis Hospital Shalimar BaghNew Delhi said, “NIVs are also used in hospitals and are an effective solution for treating patients. It is widely used by patients at home to treat respiratory diseases. However, when it comes to treating Covid-19 patients at home, that’s a different story. Any type of oxygen therapy requires constant medical supervision, which may not be possible at home. Expert supervision is required to know when to connect a person to a ventilator or when to regulate oxygen flow. In Covid-19 cases, the situation can worsen very quickly and ventilators alone cannot help a patient. You need constant medical supervision. When a GP suggests using an NIV, they should specifically inform the patient’s family of the risks involved in relying on only one NIV. ”
Dr. ResMed’s Dey also emphasized the fact that “the patient must be aware and willing to collaborate during the NIV procedure”. He also warns that an NIV cannot and should not be used by untrained caregivers.
“NIV requires frequent monitoring and titration, among many other practices. Mask sealing problems and leakage are common problems associated with the use of NIV. Therefore, trained nurses are recommended for every patient on NIV or bilevel ventilation. Patients who do not respond to NIV within a clinically defined period of time are planned for invasive mechanical ventilation, ”emphasized Dr. Dey.
He added that in chronic situations or in conditions where long-term NIV is required, cloud-connected NIVs can aid remote monitoring as these devices can monitor patient data and provide a trend that can be clinically assessed. In such situations, a nurse / lung technician must set up the device for the patient and monitor its effects for at least four days to a week.
Can Non-Invasive Home Ventilators Help Treat Covid-10 Patients?
Dr. Maurya emphasized that NIV is not a miracle cure. It is not the device itself that can help a patient, but the use of the device is more important. “While using an NIV at home on a critical patient, if the condition worsens, family members have less time to respond and take the patient to hospital,” he added.
Even so, Dr. Maurya that an NIV could be an ideal device for someone recovering from Covid-19. “If the patient is out of danger and requires an oxygen flow of less than 3 liters per minute (LPM), he is considered stable and can be transferred to a home setup. Then you can rely on an NIV. Even if the situation worsens, at least family members have some time to react. ”
“For Covid-19, the World Health Organization (WHO) guidelines recommend the use of NIV and CPAP (Continuous Positive Airway Pressure) early in the infection to prevent symptoms from worsening and as bridging therapy. For now, Ministry of Health and Family Welfare (MoHFW) Guidelines for Covid-19 recommend NIV for serious illnesses. NIV has lower oxygen consumption than high flow nasal cannulas (HFNC), which is an important consideration in today’s scenario, ”explained Dr. Dey.
What do non-invasive ventilators cost?
The cost of a basic NIV starts at Rs 70,000 to Rs 90,000 and can increase depending on the model and features required. It can be purchased directly from the manufacturer, licensed retailer, or from ecommerce websites such as Amazon. Ask your doctor for the contact details of the verified dealers for such devices.
What should you think about when purchasing non-invasive ventilators and how should you use them?
Dr. Dey explains that there are a few things to remember when purchasing, setting up, and using a prescription NIV machine. These are:
– Careful device selection based on available guidelines, clinical judgment, and known risk factors and predictors for NIV failure.
-Choose the correct mask. An oronasal mask is recommended and the size should be appropriate.
– For COVID-19 management with NIV, a non-ventilated mask with an exhalation port and an antiviral filter is recommended.
– Consult a pulmonologist who can advise the patient of the required model / type of NIV and the recommended settings.
-The purchase of an NIV / bilevel therapy device must always be made from a verified or licensed manufacturer in order to avoid counterfeit devices.
Other important things to consider when purchasing a non-invasive ventilator
You must follow the steps before using a non-invasive ventilator.
– A lung technician / nurse is important in setting up the device and instructing the patient on how to use it. In the case of Covid-19, the patient’s basic vital values must be monitored regularly.
– Do not set up NIV yourself unless you are familiar with the devices, circuits, masks, etc., and know how to safely set the patient up for NIV.
-Leakage, pressure damage to the nasal bridge, claustrophobia, and dryness of the throat are common problems associated with the use of masks. Medical intervention is required for the patient to be able to use the device comfortably.
-The patient must be advised beforehand and have the opportunity to practice breathing with the ventilator. The technician can either hold the mask in place or help the patient have it in place.
– Regular cleaning of the mask and tube is a must to avoid infection.