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CO2 narcosis in a COVID-19 patient in prone position due to twisting of reservoir bag of a non-rebreathing mask: a case report

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Kumar N., Kumar A., Singh P. K., Kumar N., Kumar S.

We know that oxygen therapy plays one of the important role for treating hypoxemia and it is widely used across a whole range of specialties and it involves administration of oxygen at concentrations greater than that in ambient air. We are reporting the first case of twisting of reservoir bag on using non-rebreathing face mask for providing supplemental oxygen in awake prone position in a 60 year old male tested COVID-19 positive. To prevent this twisting we recommend if a manufacturer do slight modification in making of these non-breathing face mask by adding a 1-2 cm L- shaped Plastic connector to the neck end of the oxygen reservoir bag. The sudden deflation of these reservoir bag not only increase the dead space, decrease alveolar ventilation but substantially compromised the gas exchange. So any twisting of these non-rebreathing face mask should be avoided. This twisting may compromise the patient condition due to rapid increase in PaCO2 and detrimental in patients with restrictive airway disease. On keeping the patient in prone position the twisting of the reservoir bag frequently occurs and this simple and useful modification may be beneficial for supplementation of oxygen therapy to COVID-19 patients requiring high fractional inspired oxygen concentration.

Physiological mechanism of resistant hypoxemia during dialysis of COVID 19 patient: a case report.

86%

Kumar A., Kumar A., Kumar A., Sinha C., Kumari P., Singh P. K.

Critical Care Innovations

2021

vol. 4

issue 3

15-19

Chronic kidney disease (CKD) is characterized by loss of kidney function and generally it is associated with several alterations in pulmonary functions, including restriction, obstruction, and impaired diffusion capacity. It became challenging to maintain oxygenation in a CKD patient associated with COVID 19 on non-invasive ventilation (NIV). In patients with end stage renal disease (ESRD), several factors likes, fluid overload, anaemia, immune suppression, extraosseous calcification, malnutrition, electrolyte imbalance, and acid-base disorder affecting the lungs indirectly. Here we are reporting NIV failure in two COVID 19 patients during dialysis. Both patients were stable on NIV before starting dialysis and underwent oxygen desaturation and shifted to invasive mechanical ventilation during hemodialysis. The possible mechanism of the oxygen desaturation is alveolar hypoventilation in the absence of hypercapnia, which may be due to the removal of CO2 from the body by some route (dialysate) other than the lungs.

Przewlekła choroba nerek (PChN) charakteryzuje się utratą funkcji nerek i generalnie wiąże się z kilkoma zmianami w czynnościach płuc, w tym ograniczeniem, niedrożnością i upośledzeniem zdolność dyfuzyjnej. Podczas wentylacji nieinwazyjnej (NIV) u pacjenta z PChN związanego z COVID 19 wystąpiły problemy z utrzymaniem odpowiedniego utlenowania. Pacjenci ze schyłkową niewydolnością nerek wyróżniają się kilkoma czynnikami, takimi jak: przeciążenie płynami, anemia, immunosupresja, zwapnienie pozakostne, niedożywienie, zaburzenia równowagi elektrolitowej i zaburzenia kwasowo-zasadowe pośrednio oddziałujące na płuca. Zgłaszamy niepowodzenie NIV u dwóch pacjentów z COVID 19 podczas dializy. Obaj pacjenci byli stabilni na NIV przed rozpoczęciem dializy lecz ulegli desaturacji, wymagając przejścia na inwazyjną wentylację mechaniczną podczas hemodializy. Możliwym mechanizmem desaturacji jest hipowentylacja pęcherzykowa przy braku hiperkapnii, która może być spowodowane usunięciem CO2 z organizmu inną drogą (dializat) niż płuca.

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2 Critical Care Innovations

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2 Singh P. K.

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1 Kumar S.

1 Kumari P.

1 Sinha C.

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CO2 narcosis in a COVID-19 patient in prone position due to twisting of reservoir bag of a non-rebreathing mask: a case report

Physiological mechanism of resistant hypoxemia during dialysis of COVID 19 patient: a case report.