Formulation of an oxygen policy to ensure adequate supply of oxygen reserves during the second wave of COVID-19 pandemic.

The second wave of the coronavirus disease 2019 (COVID-19) pandemic has wreaked havoc with healthcare systems in India as well as in other parts of the world. The health care systems across the world were suddenly overburdened, due to the rapidly increasing oxygen demand for supporting COVID-19 patients who could not maintain their blood oxygen saturation on their own. Majority of the institutions, states, and countries could not keep up with this sudden surge in oxygen demand and found themselves face to face with an oxygen crisis of epic proportions. Oxygen is critically important for saving lives in emergencies, resuscitation of critical patients, trauma settings, and diseases that primarily affect the respiratory system, like pneumonia. Despite being in the list of essential medicines by World Health Organization,1 the importance of oxygen is usually forgotten due to it being easily available naturally in the environment. Eighty percent of the patients admitted in the United Kingdom due to COVID-19 required supplemental oxygen at higher-than-normal doses.2 The mere thought of oxygen being in short supply, and requiring rationing is alarming, but this is exactly what several health systems had to undergo during this pandemic. The combined efforts of the union government, local administration, and health institutions to maintain adequate supplies of medical grade oxygen during this pandemic proved fruitful, but the demand supply ratio was always under pressure.3 These strenuous circumstances have taught us that even with our best efforts the supply of oxygen would always be precarious, if healthcare providers, individually and collectively, do not find solutions to our increasing demands by implementing protocols for the judicious usage of oxygen. Being a large public sector hospital in the most populous state (Uttar Pradesh) of India, with a bed capacity of more than 3000 beds, and a dedicated COVID-19 facility of more than 900 beds, managing oxygen supplies was not easy during the recently crested second wave of the COVID-19 pandemic. The primary supply of oxygen in our institution is through a vacuum insulated evaporator liquid medical oxygen (LMO) vessel system, with cylinder manifolds as the secondary and backup (reserve) supply. During the second wave of the pandemic, the increasing demands of oxygen at our institution were maintained with the collective efforts of the hospital administration and government agencies.4 Additionally, efforts were done to formulate an “oxygen policy” to check the rising demands, and ensure judicious use of the rapidly diminishing oxygen reserves that we had at our disposal. Here, we try to highlight some of our oxygen conservation strategies that helped us achieve a state of balance in terms of demand and supply of oxygen during the stressful time of the second wave of this pandemic. • Daily oxygen consumption details were traced, and analyzed for the last few months and anticipatory storage of LMO was done to tackle the peak of the pandemic. • Estimation of predicted oxygen requirement, which depends upon several factors, was done daily by collecting the following data a) Number of oxygen beds (isolation and intensive care unit beds); b) Total occupancy of beds (Total number of patients on oxygen support); c) Oxygen devices used on patients (like Nasal cannula/prong, Facemask, non-rebreathing mask, non-invasive ventilation, high flow nasal cannula, and invasive ventilation) which give an idea of oxygen consumption in liters per minute (LPM); d) Number of hours per day on oxygen support.