COURTESY TOI APR 28

Plasma patient is still critical, placed face down to boost his oxygen intake
Sumitra.DebRoy@timesgroup.com

Mumbai:

More than 48 hours after the city’s first patient was administered plasma therapy, his condition continued to be critical on Monday, although there were hints of marginal improvement on a few clinical parameters.

Doctors at Bandra’s Lilavati Hospital turned to prone positioning—placing the patient face down—which seemed to increase oxygen supply to his lungs.

The 53-year-old, who had come to the hospital with a positive report on April 20, went on a ventilator after developing acute respiratory distress syndrome (ARDS). The man has been on life support for six days now and doctors maintained his condition was “very critical”. He was transfused the first dose of 200ml plasma from a recovered patient on Saturday night.

“He is still very critical at the moment. We wanted to give him some more plasma but thought we would watch his condition for a day,” said Dr V Ravishankar, COO, Lilavati. “We will have to give it some time to know whether plasma therapy has worked. From newer antivirals and antibiotics, we are trying everything possible to save him. We tried prone positioning as well. His oxygenation improved to some extent in the prone position,” said Dr Ravishankar.

Flipping the patients, or placing them on their stomach, said doctors, opens up parts of the lungs which were otherwise struggling to get oxygen. Intensivist Dr Pravin Amin said in cases of severe ARDS, prone positioning is frequently applied in the ICUs, adding it worked during the H1N1 pandemic as well.

“It has been around for a few years but requires a fair bit of skill and attention. At least six to seven people are needed to do it even as one person has to ensure that the tube going to the patient’s lung is not affected,” he said.

Dr Rahul Pandit, intensivist at Fortis Hospital, said they have tried prone positioning even with hypoxic patients or those with lower oxygen levels.

Meanwhile, BMC authorities said so far they have had four plasma donors. “We are encouraging more patients to donate,” said an official from BYL Nair