COVID19 : Enquiring well-being of patient in ICU or Ventilator

COVID19 patients - especially severely affected in Lungs are admitted to ICU and put on Mechanical Ventilator sometimes if the condition worsens. Ventilator machines help patients to maintain the oxygen level by pumping the very saturated oxygen measured by FiO2.

During this time, it feels like we can only pray for the patients easy and fast recovery, but there are still some parameters that you should keep asking to the doctors to actually understand about the condition of patient -

Enquire about the improvement in lung infection -

Figure out the FiO2 value, SpO2 value, lungs X-Ray

FiO2 - 0.2 to 1.0 -- Higher the FiO2 supplied from Ventilator machine worse the condition of the patient.

1. This is Oxygen enriched air - more oxygen than available in the atmospheric air or 21%
2. Ranges between 0.21-1 i.e 21% - 100% ,, this means the air being given to patient has oxygen saturation more than 21% of oxygen saturation in the Air.
3. Ventilator pumps enriched Air Oxygen from Ventilator to the patient,, 
4. 100% or FiO2 = 1 means that patient is on full ventilator support, and the air given to him has 100% of Oxygen.
5. FiO2 should decrease gradually from 100% to 50% or from 1 to 0.5 to switch off the ventilator machine while patient should maintain sufficient SpO2 values as described below.

SpO2 - Should remain more than 95% all the time, higher the value better is the condition.

1. This is the oxygen concentration maintained by lungs in the blood. 
2. This value should remain more than 90% all the time. 
3. If patient is maintaining more than 90% oxygen concentration in his blood on lower FiO2 value approx 0.2 - 0.5 , then patient is out of danger and might safely be move out of ventilator. 

Lungs X-Ray -  

• Looking at the improvement using Lungs X-Ray is not much useful during this moment as X-ray would get clear by the time patient would already be surviving without the mechanical ventilator machine.

Supine or Prone Position - 

Details here. Figure out from the hospital if the patient is put on bed in a supine position or in the prone position. Prone positioning help patient regain and maintain the oxygen level better, patient is put on the bed stomach side down and back portion up for the prone position. If they haven't put the patient in a prone position, check for the reasoning from the Hospital side. 

Suction -

In case if cough or mucus is accumulated there over the lungs, it needs to be removed via the suction process. Make an enquiry to ensure that same is being done.

Enquire About The BP and Heart Conditions -

Norad Support - 

1. Doctors might tell you that they are using Norad support for maintaining the BP. 
2. This means patient's BP is going down without the medicine supplied by Norad machine. 
3. Medical staff might tell you that they are running Norad on 5ml/hr to maintain the normal BP. 
4. Higher the value of Norad support (goes up to 30) to maintain Normal BP, severe is the condition of the patient.
5. If doctor is telling you that they have removed the Norad that means patient is maintaining the BP by himself and is out of danger for now from the BP side.

Figure out ECG and ECHO are doing fine - don't think that they take these reports of a patient on ventilator.

ADR - this is another support using which they maintain the heart and pulse rate.

Enquire About The Kidney Function -

Figure out if the Urine is being discharged normally for the patient. Also ask doctor about the creatinine levels. Creatinine should remain under 1.5 limit. Creatinine is a poisonous substance being produced in blood and Kidney removes it completely with the Urination. 

Sometimes ICU staff uses Dytor or Inotropes to improve the urination of the patient. 

Enquire About the Liver Conditions - 

Keep checking for Bilirubin levels and that no "Jaundis" is being formed in the patient's body.

Enquire if Blood Thinners (AntiCoagulant) are being supplied to the patient -

Patient in ICU or Ventilator is given the Blood Thinners (also known as AntiCoagulant) to ensure that blood remains thin, as patient is not moving therefore there is a high chance that blood clotting might start happening deep inside the veins. This condition is called "Deep Vein Thrombosis aka DVT" . This is a fatal condition as it might start deteriorating other vital parts of the body. Medical staff should use "DVT Pump" to keep the body massaged and keeping the blood flow in control without the coagulation or clotting inside the body. 

Anticoagulants such as heparin or warfarin (also called Coumadin) slow down your body's process of making clots. Antiplatelet drugs, such as aspirin, prevent blood cells called platelets from clumping together to form a clot.

Others:

Medical Summary - for 2nd/3rd opinions

Ask Hospital to keep issuing you a medical summary every 24hrs min, detailing the patient condition, test reports, medicines provided and other vitals. You may use the same for 2nd and 3rd opinion from other medical practitioners and hospitals.

Antifungal Medicines - For high-cost medicines, advisable to check from outside Pharmacies

For a person there for a prolonged period on Ventilator, hospital give them Antifungal Medicines, in our case the medicine name was "Tocilizumab Monoclonal Antibody Medicine".  This was a high-cost medicine costing around 40K per vial, and they used 2 vials of this medicine. A consent was also taken from thee attendant. Although, when enquired outside the hospital, same medicine was available in 10K. This was a huge difference, so it make sense for such costly medicine to make available for your patient from outside pharmacies.

TLC - 

Keep an eye on TLC count in Blood Report as high amount i.e. greater than 10,  it leads to the fatal sepsis condition. Sepsis and TLC is explained on this page here

Tracheostomy Ventilator

You need to figure out if Hospital is giving ventilation open mouth or from the Tracheostomy. 

It involves creating an opening in the neck in order to place a tube into a person's windpipe. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs.

A tracheostomy provides an air passage to help you breathe when the usual route for breathing is somehow blocked or reduced. A tracheostomy is often needed when health problems require long-term use of a machine (ventilator) to help you breathe. Read this as 10d+ on the ventilator with open mouth, then doctor might suggest for the Tracheostomy procedure.

Central Line --

This is the next level of Vigo, to ease out the process of injection. A consent is taken by the Hospital from the attendant before this purpose. 

A central venous catheter, also known as a central line, is a tube that doctors place in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly.