The Intensive Care Unit in the “COVID-19 Era”
“Intensive care therapy in these testing times is not about waiting for the storm to pass but learning how to dance in the rain.”.
We are in the midst of a global pandemic caused by coronavirus disease 2019 (COVID-19). Thirty-three percent of infected patients with coronavirus manifest severe acute respiratory illness and invariably need intensive care unit (ICU) admission. ICU preparedness for this pandemic poses unique challenges for the ICU requirements that include infrastructure, staffing, infection control, and in-depth knowledge of management. Appropriate management and minimizing risks to health care workers (HCW) should feature high on institutional protocols to protect and have adequately trained front-line workers. These protocols include infection control policies, dissemination of information to HCW, resuscitation and code blue protocols, advanced ICU services including extracorporeal membrane oxygenation (ECMO) along with psychological, and emotional support services to prevent burn-out of HCW in these potentially high-risk areas. The Society of Critical Care Medicine has formed an ICU preparedness checklist that encompasses review of preparedness, logistical capacity, triage, staffing capacity, equipment requirements along with channels of communication to safely handle these patients and mitigate infection spread among HCW.
Novel respiratory viruses such as the coronavirus require effective preventive strategies to maintain staff safety. Use of N95 masks, personal protective equipment (PPE), and negative pressure rooms is recommended when aerosolizing procedures such as endotracheal intubation, bronchoscopy, and tracheostomy are performed. Ethical considerations and guidance for providing cardiopulmonary resuscitation (CPR) outline three recommendations that encompass goals of CPR, do not actively resuscitate (DNAR) status, and safety of HCW during CPR. Termination of resuscitative efforts and guidance on postresuscitative care have been extensively debated. In this editorial, we highlight the clinical modalities of this novel disease along with logistical solutions to handle the crisis situation that has arisen in its wake.
02 November 2020 (online)
© 2020. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound ISCU. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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