Frustrating. Traumatising. Exhausting. That’s how doctors and nurses in the ICU departments of the covid19 parallel health care system describe the conditions and circumstances they face working with ill patients daily.
Patients in these facilities are only admitted when they have low oxygen levels. Putting them on oxygen and then a ventilator, depending on their oxygen saturation, is done based on the clinical status of a patient, with their consent.
House officer at the Couva Medical and Multi-training Facility ICU Dr Thais Razark said many patients who come into ICUs are reluctant to accept they are sick enough to need medical attention, and insist they feel fine.
She said moving a patient from one level to another is a process of step-up management, which depends on how much oxygen they need.
Normal levels of oxygen saturation are 95 per cent and above.
“For example, a patient may come into the hospital accident and emergency department with a cough and shortness of breath. Their oxygen saturation may be 85 per cent on room air, so the doctors would put them on a facemask to receive supplemental oxygen. There are different face masks that can give different levels of oxygen support, with the highest level being a non-rebreather face mask (NRFM) that gives 15 litres per minute of oxygen. We have started using dual-therapy oxygen, where we use a NRFM and a nasal cannula.”
She said a team of doctors – house officers, registrars and consultants – decides how and when a patient needs more oxygen.
“If patients are on the highest level of oxygen, their oxygen saturations are still below the accepted level, and they are short of breath, we would start them on continuous positive airway pressure (CPAP) via the ventilator. This requires a facemask that is strapped onto the face tightly to create a seal, as air is pushed into the lungs to help them open up and improve their ability to breathe. CPAP is usually alternated with the NRFM and/or dual therapy.
"If they do not improve with this and become CPAP-dependent, meaning they cannot maintain their oxygen saturations without the CPAP, or despite the oxygen therapy their oxygen saturations remain low and their breathing rate remains high (short of breath), then we would opt for intubation, where the ventilator would be doing the work of breathing for the patient.”
She said the decision to be put on CPAP or intubated would be based on the clinical status of the patient, but it was ultimately the choice of the patient and done with his or her consent.
“Sadly, many patients are reluctant to attempt the CPAP, and often refuse intubation. They would insist that they feel fine and don’t need any medical attention – yet here they are in the ICU/HDU with low oxygen saturations.
"Many times, doctors and nurses have to beg patients and even hold their hands to go back on the CPAP, explaining over and over that it’s for their betterment. However, patients still refuse until it’s too late. We counsel them on intubation, and that it’s a very invasive procedure –
