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PGI uses postural therapy for early patient recovery

Technique involves frequent change in position to drain mucus from lungs

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Naina Mishra

Tribune News Service

Chandigarh, April 25

The Post Graduate Institute of Medical Education and Research (PGIMER) has started using the age-old technique of postural therapy (also known as postural drainage) for early recovery of Covid hypoxemia (a condition where the blood oxygen level is low).

This therapy is being performed right from the beginning when the patient is admitted so that his/her condition does not worsen during illness. It involves changing the position of the patient from time to time to drain mucus from the lungs.

Most people infected with the SARS virus develop pneumonia, which causes one or both lungs to fill with pus and fluids, making breathing difficult. Prof GD Puri, Head, Department of Anaesthesia & Intensive Care & Dean (Academics), explains, “For patients with hypoxemia, there are many physiologic benefits of postural therapy. The timely change of position results in a more homogenous distribution of stress in lungs. Thus, it may prevent them from developing frank respiratory failure.”

“For this reason, patients admitted with hypoxemia should be encouraged to adopt different defined positions. Changing patient position changes may be used as rescue therapy in those with escalating oxygen requirement,” said Dr Puri.

Whenever a positive patient is admitted with moderate symptoms, the PGI’s Covid hospital’s main focus is to try that patients do not come on a ventilator. Dr Puri said, “Once a patient gets on a ventilator, things get more complicated as the patient gets bedridden. The treatment gets labour-intensive as more nursing staff have to be deployed and there are more chances of infection.”

The benefits of postural therapy include better matching of pulmonary perfusion to ventilation, better recruitment of dependent areas of the lung and improved arterial oxygenation.

‘Multiple tests being run on patients’

The primary focus of the institute to uphold the medical condition of patients from worsening by detecting the signs of deterioration early and thus the staff are actively involved in running a series of tests and monitoring vital signs of the patient.

Dr Puri explains, “There are methods devised wherein we can diagnose sick patients much earlier before their condition starts deteriorating.”

“We are remotely monitoring the condition of patients via a CCTV control room. A number of blood tests are also being run on patients to find out whether their condition will deteriorate,” he added.

‘Ensure prior screening before sending patients’

Dr Jagat Ram, Director, PGI, brought to the knowledge of the UT Administrator that non-critical patients were being sent to the institute without prior checking for Covid. The Administrator directed the Principal Secretary, Health, to take up the matter with the neighbouring states and to ensure that necessary screening was done before such patients were treated in our hospitals. He expressed apprehension that if major hospitals of Chandigarh became a hub for infection, then the entire health management system would get crippled.

Preparedness to check pandemic

  • By February 2020, existing facilities at the PGIMER were scaled up and screening of patients with flu-like symptoms was enhanced in emergency alongside initiating the strengthening of Communicable Diseases Ward. A core committee was constituted and it was decided to designate dedicated Covid hospital here.
  • The other important issue of procurement of standard PPE kits, N95 masks and triple layer masks, etc, as per the laid down standards was also streamlined. It was a tough task to ensure constant supply of the important safety equipment in the view of the lockdown.
  • With a surge in the number of cases as well as those of SARI, ILI, the protocols were again modified and it was ensured that proper PPE kits/N95 masks were given.
  • Screening OPDs were opened in the new OPD blocks, Advanced Paediatric Centre, Advanced Cardiac Centre, Advanced Trauma Centre in addition to the Emergency Complex which was already functional. The PPE kits, N95 masks are provided to all categories of frontline warriors working in high risk areas.
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