[ad_1]
LAST WEEK, the HSE said hospitals had begun to move toward their intensive care scaling capacity as the number of Covid-19 patients requiring advanced care increased.
Last night 330 fully staffed intensive care beds were open, of which 310 were occupied, including 195 by Covid-19 patients.
The system may grow to 350 ICU patients, providing the same level of care as traditional intensive care settings, but is now rapidly approaching that number as the situation is likely to deteriorate further over the course of this. week.
Let’s take a look at what that means for the healthcare system, for doctors treating patients, and for those who are admitted to the hospital and can become seriously ill.
Permanent capacity vs. surge capacity
The permanent capacity of the ICU in public hospitals is around 286 beds, although this may vary depending on the levels of staff available.
The system can be expanded to provide critical care for 350 patients. This augmentation capacity was used during the first wave, when the permanent capacity was 255 and hospitals came under pressure with large numbers of patients becoming critically ill in hospital.
It requires the use of resources in the hospital that are generally used for other purposes such as anesthesia rooms or postoperative beds.
Speaking last week, HSE Clinical Director Dr. Colm Henry said that hospitals using this augmentation capacity “can continue to provide the same quality of care” as a traditional ICU setting.
The training was conducted during the first wave, and since then, to ensure that there were more permanent staff fully trained for the additional permanent ICU capacity of 286 beds. But once the system reaches its scalability, beyond those 286 beds, it relies on redeployment of non-ICU staff from other services to help provide patient care.
“This has been worked with our critical care community, critical care program and critical care leaders across the country,” said Dr. Henry.
“Clearly, we would be in a better position and it would be much better if we never had to expand the capacity of intensive care to go into increase, if the Covid-19 disease had not reached the level that it has. But I would rather have developed an emergency activity and relocated staff to emergency beds than have no emergency facility. “
Dr. Henry said it is “better than the alternative”.
He said permanent ICU staff are overseeing and overseeing the care provided to patients, with the help of staff who have been reassigned. While these additional staff are not fully trained ICU staff, they do have transferable skills, such as OR nurses.
Dr. Ian Counihan, respiratory consultant and Covid leader at Our Lady of Lourdes Hospital in Drogheda, told RTÉ Today with Claire Byrne that the hospital has moved into the second phase of its emergency plan.
“We remove patients who do not have Covid from the ICU, because many patients in the intensive care unit have Covid, as a way to protect them,” he said.
These patients, he said, have been transferred to another unit where they are connected to ventilators and are monitored.
Louth has the second highest 14-day incidence rate in the country after Monaghan.
“We currently have ten patients in the ICU, eight of them have Covid. We have capacity in our surge planning for up to 24 ventilated patients. “
Dr. Counihan said that, like other consultants across the country, he had noticed a change in the demographics of admissions compared to the first wave.
“There is a large group of younger people who are admitted with Covid pneumonia, patients in their 20s, 30s and 40s in the hospital on oxygen. Certainly over the last week we have also seen an increase in the number of patients who were between 70 and 80 years old and who had many comorbidities, just because they were older and more likely to have other medical problems. “
Covid-19 patients in ICU
Talking to TheJournal.ie On the Explainer podcast, Dr. Catherine Motherway, an ICU consultant at Limerick University Hospital, described how the decision to transfer a patient to an intensive care unit is made.
“The patients who are admitted to the ICU are generally patients who are very, very short of breath. It is very difficult for them to breathe. Many of them have significant chest pain, but their predominant symptom is shortness of breath, “he said.
In the first instance, we asked many people to try to lie on their stomachs, it is called “self-proclamation awake.” And on top of that, we put a tight-fitting mask on their faces to give them high levels of oxygen under pressure, and that oxygen is pretty hot. I don’t know if you’ve ever been to a country where it’s very humid and very hot, but what we try and do is get them to breathe warm and humid oxygen so they can continue without having dry secretions. It is an uncomfortable process.
“We have had some patients in our unit, who have done it for up to four weeks, lying face down most of the time. That sometimes, for many patients, means that we give them more oxygen and we can avoid having to ventilate them invasively. “
He said that if invasive ventilation can be avoided, patient outcomes are good.
No news is bad news
Support the magazine
your contributions help us continue to deliver the stories that are important to you
Support us now
“Obviously if that doesn’t work, we put patients to sleep and put them on an invasive ventilator. Then when they wake up, they may or may not, hopefully, have delusions, but if they do, we try to guide them, ”he explained.
As they wake up the tube is down their throat and it’s unpleasant, but we do our best to make this tolerable for them. In fact, we use a lot of medications to try and improve tube tolerance, which is uncomfortable.
Advanced care outside the ICU
Of the nearly 2,000 Covid-19 patients currently in the hospital, more than 400 are receiving high-grade ventilation and ventilation both inside and outside the ICU.
Health officials have said that for every patient in the ICU with Covid-19, there is at least one other patient in a ward who is receiving advanced, but non-invasive, respiratory care. These patients are very ill and if their health deteriorates further they may require a transfer to the ICU.
Dr Motherway said that Covid wards in hospitals, where most patients with the disease are being treated, are “under real pressure.”
“We have many people in the hospital with Covid, for various reasons, and they need oxygen, they need care and attention, some of them are older patients who have symptoms,” he said.
While the system is now below that 350 cap on augmentation capacity, a significant increase in the number of people requiring intensive care over the next week could put pressure on even augmentation resources.
The HSE has said that patients will, of course, continue to receive the best care that healthcare workers can provide if, in the worst case, the entire system exceeds that scalability.
This did not happen in Ireland in the first wave, but it did happen in other countries and officials have said that this is probably why their patient outcomes were worse than ours. Once the capacity of 350 beds is exceeded, it is difficult to provide the same quality of care as in a traditional ICU setting.
It also forces the healthcare workers who treat them to make tough decisions.
Professor Clíona Ní Cheallaigh, consultant in infectious diseases and internal medicine at St James Hospital, recently said that she and her colleagues are “terrified” of finding themselves in a situation where people who would normally be sent to ICU cannot be transferred because there are no intensive care beds.
“That didn’t happen in the first wave, and we’re really concerned that if that happens that’s very difficult to handle psychologically,” he said.
Some of the things we’ve talked about is that we’ll meet with our intensive care colleagues in the morning and go through the list. You never want to make the decision about intensive care when someone crashes in front of you, you should make that decision days in advance if you can, so you can do it in daylight and with peace of mind.
“So we will come together as a group and try to make those decisions as a group, rather than as individuals for many reasons. It is much safer psychologically as a group, and also from a medical point of view, it is safer as a group. “
[ad_2]