Critical care has attained so much importance with the advent of the Covid pandemic. The Government and NGOs have been trying al they can to improve critical care capacity to combat the COVID pandemic.
Critical care had its beginning during another epidemic caused by Polio virus in 1952. Many patients who had respiratory paralysis were given assistance to breathe with a machine called iron lung from which the modern ventilators evolved.
During the earlier days, doctors specilazing in anaesthesia were managing the patients who required some sort of ventilator assistance. Later on, the department of critical care established itself into a separate speciality, caring for the critically ill patients.
Doctors, nurses and other healthcare workers need special training to be eligible to work in ICUs. Critical care doctors are generally called Intensivists. In India, doctors need to undergo a three-year training after MD to become qualified Intensivists. They are trained in monitoring the function of each organ and also in using life support equipment like ventilators, dialysis machine and so on. They are also trained in resuscitation of patients.
Here let me tell you about some of the concerns one may have when their dear or near ones are admitted for care in intensive care units.
What is the difference between various ICUs like cardiology ICU, neuro ICU, multidisciplinary ICU, etc?
ICUs can generally be organ-specific, like cardiology, neurology etc managed by the respective speciality doctors, or a multidisciplinary unit, usually managed by an Intensivist.
When patients are in ICU with a single organ problem, they are admitted in the concerned ICU. But when they have multiple organ involvement, they need care in a multidisciplinary unit. In such cases, a patient is admitted in MDICU under an Intensivist, who coordinates the care along with other speciality inputs if required.
What are the facilities in a MDICU?
It depends on the level of care provided by the unit. In a tertiary care center, all facilities for resuscitating a patient will be available. Monitors which can provide accurate minute to minute data of a patient’s vital organ functions, pacemakers, ventilators, machines which can provide renal replcement therapy, methods to regulate temperature of a patient etc will also be available. Also, the unit will be manned with staff who can manage critically ill patients; experienced nurses, paramedics are important.
Staff in a multidisciplinary unit
The unit is headed by an Intensivist. The team includes doctors nurses, nursing assistants, nutritionist, respiratory therapist, clinical pharmacist, counsellors, infection control nurses etc. In addition, the services of other specialities are taken as and when required.
Why is critical care incurring heavy bills to patients?
Unlike a general ward, the square feet /patient in an ICU is more in a ward that can admit 18 to 20 patients. If it is an ICU, only 10 patients can be admitted. The monitors and ventilators are costly equipment and hence their usage charges are also high. Many of medicines used are high-end antibiotics. Drugs to maintain organ function will add to the cost. Lot of gloves, aprons, disposable pads are required by each patient and all these together make the cost of care comparatively high in an MDICU.
Why is there a visitor restriction in ICU?
ICU is a place where lot of activities happen round the clock. Presence of more people inside can hinder the critical work. Also, many patients are immuno compromised, which could put them at a risk of infection. Also, patients’ privacy is important. These are the reasons why there is a visitor restriction in ICUs.
But now a days, so as to improve the satisfaction of patients and relatives, extended visiting hours are allowed in many hospitals.
Can a patient refuse a treatment like ventilator support or other special care if he/she is in ICU?
The right to make a decision to avail a treatment is with the patient. A doctor can advise a patient on the benefits and risks of treatment. Based on this, a patient can go for an informed consent. The patient also has the right to take a second opinion if he desires so. He can ask for a medical report for the same
Does any harm occur to patients when they are in ICU?
No. They are taken care of very well. A doctor is in charge of about 10 patients. As per standards each ventilated patient will have the service of one nurse. Also, for general wellbeing, light is adjusted for each patient so as to resemble normal day and night variations. Their mental wellbeing also is taken care of. They can listen to music or TV if health permits.
Facilities ensured in times of the Covid pandemic
During the Covid surge, more wards were converted into ICUs . Doctors from other departments are given training in ICU care and posted in the ICU under the supervision of ICU doctors. The same thing is being done for nurses and other staff too.
Oxygen cylinders were procured to meet extra requirements. In order to preserve oxygen, stringent measures were taken to reduce wastage.
What are the chances of a patient to recover from Covid if admitted in ICU?
It depends on many factors. Only about 10 -15% of COVID patients require ICU admission. Of those requiring ICU admission, almost 60% will improve, but if their disease worsens and needs ventialtion then the chances of recovery may be approximately 30%.
What other treatments can be offered in Covid?
If a patient with Covid pneumonia worsens in spite of maximum support on ventilator, ECMO can be used. It is available only in a few centers currently. ECMO has a success rate of 40 to 50% in Covid treatment, which is very significant considering the fact that they have high mortality without ECMO.
Critical care units have saved many lives during the Covid pandemic, and it is essential that we prepare ourselves for any forthcoming challenge by equipping ICU units and also training adequate manpower.
Dr Deepak. V, MD,EDIC, the author of this article, is a Deputy Director-Clinical Services & Co-ordinator Critical Care, at KIMSHEALTH, Thiruvananthapuram.