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LETTERS TO EDITOR
Year : 2021  |  Volume : 15  |  Issue : 4  |  Page : 465-467

The balancing act of hospital medical oxygen demand and supply: The need of the hour in the COVID-19 pandemic


1 College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Correspondence Address:
Chitta R Mohanty
Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar - 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_404_21

Rights and Permissions
Date of Submission31-May-2021
Date of Decision31-May-2021
Date of Acceptance31-May-2021
Date of Web Publication02-Sep-2021
 


How to cite this article:
Radhakrishnan RV, Mohanty CR, Singh N, Chakola S. The balancing act of hospital medical oxygen demand and supply: The need of the hour in the COVID-19 pandemic. Saudi J Anaesth 2021;15:465-7

How to cite this URL:
Radhakrishnan RV, Mohanty CR, Singh N, Chakola S. The balancing act of hospital medical oxygen demand and supply: The need of the hour in the COVID-19 pandemic. Saudi J Anaesth [serial online] 2021 [cited 2021 Dec 5];15:465-7. Available from: https://www.saudija.org/text.asp?2021/15/4/465/325295



Dear Sir,

The unprecedented pandemic wave from COVID-19 had tested the capacity of many elite health systems across the globe to provide optimum usage of medical infrastructure, ICU beds, oxygen supply, and others.[1]

India, being the second-most populous country globally, is also battling the pandemic crisis with an enormous burden on healthcare establishments to provide even vital treatments such as medical oxygen.[1] The WHO had earlier outlined that about 15% of COVID-19 patients require oxygen support, whereas another 5% may require ventilator support.[2] As the second wave of the pandemic erupted in India since March 2021, the nation witnessed a steep rise in hospital demand for the supply of medical oxygen.[3] It is a basic obligation of every hospital to ensure a safe, adequate, uninterrupted supply of medical gases, significantly oxygen.[4],[5]

Hence, there is an indispensable need for every hospital to map out their oxygen requirement with their average and peak daily consumption based on the bed strengths, ICU, and ventilator facility to match it with the oxygen supply from various sources. Here we propose a hypothetical model to calculate the approximate oxygen requirement for a given hospital, based on the bed strength and capacities of critical care units to deal with the oxygen crisis effectively.


  Description Top


In most hospitals, the main oxygen source could be a cylinder manifold system, liquid oxygen system, or oxygen concentrator system. Suppose if the hospital having liquid medical oxygen (LMO) as the primary oxygen source [Figure 1] having a capacity of 20 K litre and 10 K litre, the available medical oxygen gas supply can be calculated as:
Figure 1: (a) The hospital Liquid medical oxygen plant (b). Hamilton-C3 ventilators

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20 K litre + 10 K litre = 30000 litre of LMO

One litre LMO can produce 842 litres of Oxygen gas at 95% purity.[4]

So, 30000 * 842 = 25,260,000 litres oxygen gas.

In a given scenario, if you have a 300 bedded hospital, having the following infrastructure facilities: 30 dedicated COVID-19 ICU beds with Hamilton-C3 ventilators, 20 High dependency unit beds with Hamilton-C3 ventilators, ten general ICU beds with Puritan Bennett™ 840 ventilators, ten emergency department beds with eXtend XT ventilators [Figure 2], and rest of 200 oxygen beds in various wards, with average oxygen consumption rate of 30% beds at 15 l/min, 40% beds at 10 l/min and remaining 30% beds at 5 l/min.
Figure 2: (a) Puritan bennett 840 ventilators; (b) eXtend XT ventilator

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The daily oxygen requirement can be calculated as:

Critical care beds: 30 COVID-ICU beds with HamiltonC3 ventilator (50 l/min flow rate), 20 HDU beds with HamiltonC3 ventilator (50 l/min flow rate), 10 ICU beds with Puritan Bennett™ 840 ventilators (100120 l/min flow rate), and ten emergency beds with eXtend XT ventilator beds (100120 l/min flow rate)[5]

i.e. 30 * 50*60 * 24 + 20 * 50*60 * 24 + 10 * 120*60 * 24 + 10 * 120*60 * 24 = 7056,000 litre oxygen.

Ward Oxygen beds: 60 * 15*60 * 24 + 80 * 10*60 * 24 + 60 * 5*60 * 24 = 2880,000 litre oxygen. So, the total hospital requirement = 9936,000 litre oxygen/day

So, as per the average daily consumption, the 30 K litre LMO will be sufficient for 2.54 days.

To conclude, accurate mapping of oxygen requirements will aid in early procurement and anticipation of shortfalls in the supply chain, thereby averting mishaps. The hospitals should have a primary, secondary, and reserve oxygen source in adequate volume with appropriate safety guidelines and at safe hospital locations to prevent any untoward incidents of supply failure, especially during natural disasters.[5],[6] A logbook to be maintained to record the daily oxygen consumption and oxygen reserve. Appropriate alarm systems to indicate pressure changes in supply systems, trained personnel for proper monitoring, periodic mock drills to ensure the efficiency of support, and failure systems are essential for safe, reliable, and uninterrupted supply of oxygen in hospitals.[4],[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kapoor G, Hauck S, Sriram A, Joshi J, Schueller E, Frost I, et al. State-wise estimates of current hospital beds, intensive care unit (ICU) beds and ventilators in India: Are we prepared for a surge in COVID-19 hospitalizations? MedRxiv 2020. doi: 10.1101/2020.06.16.20132787.  Back to cited text no. 1
    
2.
World health organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance, 2020, March 13 n.d. Available from: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf?sfvrsn=bc7da517_2. [Last accessed on 2021 May 19].  Back to cited text no. 2
    
3.
Why India ran out of oxygen despite boosting capacity more than 125%-DIU News n.d. Available from: https://www.indiatoday.in/diu/story/india-oxygen-shortage-boosting-capacity-covid-1801828-2021-05-12. [Last accessed on 2021 May 19].  Back to cited text no. 3
    
4.
Dorsch JA, Dorsch SE. Understanding Anaesthesia Equipment. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.  Back to cited text no. 4
    
5.
Mohanty CR, Bellapukonda S, Ahmad SR, Sarkar S. Seconds from disaster-crisis in critical care unit during tropical cyclone 'Fani.' J Clin Anesth 2020;60:72-3.  Back to cited text no. 5
    
6.
Mohanty CR, Ahmad SR. Drop in oxygen supply pressures: Misleading gas cylinder color coding to be blamed for nearing a mishap? J Clin Anesth 2018;50:46-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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