Treatment of COVID-19:
At present there is no explicit antiviral or other types of treatment suggested for the COVID-19, furthermore, there is no vaccine presently existing. So, the way of treating the patient or the treatment option is symptomatic, as well as the oxygen (O2) therapy appears to be the first option for addressing respiratory mutilation Clerkin, K et al (2020). So the invasive mechanical ventilation (IMV) as well as NIV (Non-invasive ) mechanical type of ventilation might be indispensable in the cases of the respiratory collapse intractable to theO2( oxygen) therapy. Over again, the intensive care is required to pact by means of those of the intricate forms of this infectious disease Lim, J et al (2020). With reference to ARDS (Acute respiratory distress syndrome) treatment, gathering acquaintance on those of pathophysiology of damage to lungs, have steadily induced the clinicians to appraisal of the strategies required for managing the respiratory failure Cai, Q et al (2020). ARDS which is induced from COVID-19 (CARDS) is not a ”usual” ARDS. This characteristic related to the disease is of elementary consequence as well as has possibly pessimistically exaggerated the remedial approach in the premature stages of the pandemic. Certainly, in spite of the start of pandemic, near the beginning IMV used to be considered as a better option for CARDS as in the pneumonia associated with COVID-19 and distinctive ARDS respiratory mechanics with the features as it abridged lung conformity (i.e., ability to stretch as well as expand lungs) cannot be establish Yoon, S et al (2020). In contrast, in CARDS, good pulmonary conformity can be established therefore, it is considered that CARDS can be treated well with IMV.The non-invasive ventilation (NIV) as well as high flow nasal oxygen therapy (HFNO), according to the experts’ board, they consider that these are performed through the systems through high-quality border fitting that do not generate prevalent dispersal of the air that is exhaled, furthermore, its exploit can be considered at the squat peril of airborne spread Kupferschmidt, K et al (2020). The patients having the oxygen saturation (SpO2) as less than 93-94 percent or having the respiratory rate which is greater than 28-30 per minute and those facing the dyspnoea (difficult breathing) they must be given the oxygen as by the 40 percent Venturi mask Cunningham, C et al (2020). Following the 5- 10 minutes re-evaluation, stipulation the clinical along with instrumental depiction has enhanced then the patient may continues the management as well as May undergoes the reassessment during 6 hours. If the treatment shows no progress, or else new aggravation, the patient then undergoes the treatment which is non-invasive, in case it is not contraindicated Ye, Q et al (2020).
Since the process has a bigger hazard of the aerosolization, it ought to be used in those of the rooms having negative pressure. It is indicated when it is quite hard to maintain the oxygen saturation (SpO2) >92 percent or there is no improvement in dyspnoea via the standard oxygen therapy Bloch, E et al (2020). The setting of the procedure is as that 30 to 40 litter per minute and when the fraction of inhaled oxygen (FiO2) is about 50 to 60 percent then it is regulated according to the clinical response. The patient may be switched to the non-invasive ventilation (NIV) if there is no improvement in the symptom following one hour with the oxygen flow > 50 liter per minute with the fraction of inhaled air as (FiO2) > 70 percent Paranjpe, I et al (2020). The HFNO can also be used as for the continuous positive air pressure (CPAP) breaks or in the critical patients. The procedure is contraindicated in the patients as those having hypercapnia (high level of carbon dioxide in blood) Mehra, M et al (2020).
This process is acting as it has a key role in the management of the COVID-19 related respiratory failure. It is done as the helmet is considered to reduce the hazards of aerosolization during the procedure. The process of NIV as if it is to be done with the face mask the use of the expiratory valve is incorporated as well as the tubes through the exhalation port ,furthermore, it then put an antimicrobial strain as on expiratory valve is suggested Touret, F et al (2020). The process of CPAP starts with those of 8 to 10 cm of water along with FiO2 as 60 percent. It is obligatory to not to craft numerous alterations in first 24 hours and following at least 4to6 hours if the patient is stable remove it as for about one hour and permit to take small quantity of fluids but it must be continued during night Guastalegname, M et al (2020). The process of Mechanical ventilation ought to be done with the lesser tidal volumes as 4- 6 ml/kg PBW (predicted body weight) as well as lesser inspiration pressures, attainment of the Pplat (plateau pressure) < 28 - 30 cm H2O. Positive end expiratory pressure (PEEP) has to be elevated as achievable to sustain the driving pressure as squat as feasible (< 14 cmH2O) Colson, P et al (2020). Furthermore, disconnections as of the ventilator have to be prohibited for avoiding the loss of PEEP as well as atelectasis. In conclusion, the exploit of the paralytics is not suggested except if PaO2/FiO2 < 150 mmHg. The flat ventilation as for about > 12 hours per day, along with use of the traditional management of fluid approach in support of ARDS patients devoid of tissue hypo- perfusion must be emphasized Rothan, H et al (2020). Particular safety measures are obligatory all through the process of intubation. This process ought to be done by the professional operator who must uses the (PPE) personal protective equipment like N95 mask or FFP3, defensive goggles, disposable double socks, disposable gown along with gloves. If feasible, (RSI) rapid sequence intubation must be done Grein, J et al (2020). In this the Preoxygenation as giving 100 percent oxygen for about 5 minutes ought to be done through (CPAP) continuous positive airway pressure process. HME (Heat and moisture exchanger) have to be placed connecting the mask with circuit of fan or else may be flanked by the mask with the ventilation balloon Beigel, J et al (2020).