My father is a non-smoker with no previous lung injuries. His height is 5.6, and his weight is 58 kilograms. He was admitted to a hospital for COVID-19 pneumonia on 17 th of last month. At the time of admitting his chest computed tomography scan reading was 9, and CRP (C-reactive protein) was 32.9 mg/L. On the 26th of last month, he was discharged, we did not take Remdesivir, but as his oxygen saturation was maintaining at 91-92, the doctor prescribed Nintena (Nintedanib)150 mg, an anti lung fibrosis tablet for him (continuing till date). Sir, till today his oxygen saturation remains around 91 when he is lying on his back at night. While sitting and standing, his oxygen level oscillates between 94-96. Alarmingly sometimes, while doing breathing exercises and while walking, his oxygen level drops to 84-85 and recovers within a minute to 94-95. Sir, I want to know if this is normal and what could be causing these issues. Also, please suggest any test that could help us identify the underlying problem.
Welcome to icliniq.com.
I can understand your concern. According to your statement, your father has been suffering from COVID-19 pneumonia, and he has its associated complications or consequences since the last month. According to the CT (computed tomography) chest report (attachment removed to protect the patient's identity), your father had pneumonia due to the COVID-19 infection. CRP (C-reactive protein) was raised that time because CRP is an acute-phase protein and it becomes raised during the presence of any infection or inflammation in the body. Again, as your father had pneumonia due to COVID-19 and old age, so I think it was wise to give him antiviral medications like Remdesivir. I think antiviral medication will help him to cure his COVID pneumonia and prevent the COVID-19 associated with further complications or consequences. Most importantly, a repeat CT chest should be done after completing 14 day's treatment. But, according to your description here, a no-repeat CT chest was not done. Your father, at present, is suffering from exertional dyspnea, as he becomes breathless after light exercises like walking and this exertional dyspnea. First of all, a repeat CT chest should be done to reassess his lung status as well as pneumonia. If pneumonia persisted, then antiviral drugs should be started. I have also seen his prescription and all investigation reports. Continue his current using medications and do repeat CT chest.
Thank you doctor,
Sir, we did not give him Remdesivir. Also, I failed to mention that he does not feel shortness of breath. When we check in the pulse oximeter, we notice this fall in oxygen level. Other than that, he feels lethargic continuously, and sleeping even with medication is not happening. Should I be worried about hypoxia or lung fibrosis?
Welcome back to icliniq.com.
His oxygen saturation level is fluctuating, especially during or after exertion. So, monitor his oxygen saturation level routinely. Without a CT (computed tomography) chest, nothing is confirmed. Your father occasionally suffers from hypoxia as his oxygen saturation level declines below 90%. His occasional hypoxia may result from post-COVID-19 complications or consequences. Oxygen inhalation may improve his oxygen saturation level. According to international guidelines, oxygen therapy is indicated when the oxygen saturation level becomes below 92%. Antiviral medication should be given when your father was diagnosed as a patient with COVID-19 pneumonia. For now, complete bed rest is necessary. Your father becomes lethargic due to hypoxia or low oxygen saturation level. His oxygen saturation level should be maintained continuously above 95% and 97-98%. So, if needed, oxygen therapy should be started. Do repeat his CT chest, and it will tell us what to do next.
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