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).