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What’s Up Doc column: What’s it like in the COVID-19 ICU?

Dr. Jeff Hersh
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Telegram & Gazette

Columns share an author’s personal perspective.

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Q: What’s it really like in an ICU caring for COVID-19 patients?

A: My disaster response team and I have just returned from a two-week deployment helping out in a hospital overwhelmed with COVID-19 patients. The hospital has two intensive care units (ICUs), one they dedicated to COVID-19 patients and the other for non-COVID-19 patients requiring ICU care (although it was common the COVID-19 ICU had to “take over” some of the beds on the non-COVID-19 ICU side). I helped care for the patients in their 10-bed COVID-19 ICU. Our team also supplemented the staff in the Emergency Department (ED), including helping care for the patients “boarding” there (when there are no appropriate beds in the hospital for a patient requiring admission, for example when a patient needs ICU care but the ICU is full, the patients often remain in the ED and are cared for there until a bed becomes available).

The staff in this relatively small hospital has been working incredibly hard to keep up with the patient care demand during the pandemic. We were able to help for a couple of weeks, hopefully giving these dedicated healthcare providers a small reprieve and allowing them to recharge a bit.

All ICU patients are sick, otherwise they would not require ICU care, but the patients in the COVID-19 ICU were all incredibly sick. At any given time, over three quarters of our patients were intubated (had a tube going through their mouth into their breathing pipe, with a ventilator machine helping breathe for them). About half had developed kidney failure (COVID-19 is a devastating disease affecting many organ systems) and were being supported with dialysis (where some of their blood is taken from a blood vessel in their body and pumped into a hemodialysis machine that can filter it, mimicking many of the functions the kidneys perform, and then the blood returned to their body). And about half of the patients required “pressors,” medications to help increase the heart’s output and the patient’s blood pressure.

The deployment was physically demanding. We worked 12-hour shifts, and when you add in the time for report (where the outgoing shift tells the incoming shift how the patients are doing, what is being done for them and what occurred during their shift), a brief team meeting (so we could keep up with what we were all doing as we worked different shifts and in different departments, and our paramedics, respiratory therapists, pharmacists and the entire support staff were doing other clinical work, as well as administrative work to support the team) and our commute, days would often stretch to 13-14 hours; a very busy 13-14 hours.

The deployment was also emotionally and psychologically challenging. A patient died in the ICU almost every day, some days more than one. There were essentially always other patients being “boarded” in the ED, so whenever we did have a bed open up it was soon filled by a patient requiring our care.

On one of our “good days” we were able to extubate (remove the breathing tube and have the patient breathe on their own) two patients who, a couple of days later were improved enough to leave the ICU and continue their care on the regular floor, although two other patients whose breathing we were supporting in other ways to help them avoid needing to be placed on a ventilator “crashed” and required intubation and mechanical ventilation.

Although I am a physician, I spent a lot of my time doing what I could to help the nurses and paramedics provide care. This reinforced something I have known since the beginning of my medical career: nurses are the key professionals delivering patient care, and there is no way to describe how challenging their job is.

Two take home messages:

• Please do your part to help stop the spread of this virus. Socially distance, wear a mask (see last week’s column), wash your hands and, if you may have been exposed to the virus or are symptomatic, stay home (unless you need to seek emergency medical care).

• Thank a nurse today for what they do every day.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.