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Case Study

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Jun 21 2023
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Introduction: In resource-limited settings, access to specialized critical care expertise and equipment can be challenging. Tele-ICU, a remote monitoring system that utilizes telecommunication technology, offers a viable solution to bridge this gap by providing virtual critical care support to patients in distant locations. This case study presents a scenario where Tele-ICU played a pivotal role in the successful management of a critically ill patient with inflammatory lobar pneumonia.

Case Presentation: Patient ABC, a 42-year-old male, presented to the hospital with acute onset shortness of breath, accompanied by dry cough and general weakness. On examination, the patient was found to have inflammatory lobar pneumonia.

The patient’s condition rapidly deteriorated, Intensivist from command center advised to put on mechanical ventilation for airway protection with VCV FIO2 80%, PEEP 6, TV 420, RR 16. Laboratory results indicated significant elevation in liver enzymes (SGOT 296 & SGPT 597).

Management and Tele-ICU Intervention: Tele-ICU monitoring allowed for continuous remote assessment of the patient’s condition. The intensivists from command center, working in collaboration with the on-site healthcare team, provided crucial guidance and interventions.

Medical management of TELE-ICU:

  • Antibiotic Therapy: The doctors prescribed appropriate broad-spectrum antibiotics based on the suspected microbial etiology of the pneumonia. The choice of antibiotics was guided by evidence-based guidelines and regular monitoring of culture reports.
  • Mechanical Ventilation: The patient received advance oxygen to maintain adequate oxygenation and alleviate the symptoms of shortness of breath. On 3rd day Tele-ICU advised patient for weaning with C-PAP MODE FIO2 40%, PEEP 5, TV 400, RR 16
  • Chest Physiotherapy: Doctors employed chest physiotherapy techniques, including percussion and postural drainage, to help clear pulmonary secretions and improve ventilation.
  • Medications: The doctors administered medications, such as hepatoprotective agents and antiviral drugs, to address the underlying cause of the liver enzyme elevation and promote hepatic recovery. Throughout the management, regular updates of lab reports were obtained, which collectively demonstrated a decrease in SGOT (84) and SGPT (130) levels, indicating positive progress.
  • Nutritional Support: The placement of a Ryles tube was advised to provide adequate nutritional support to the patient, ensuring optimal recovery and liver function.

Outcome: As the patient’s condition improved, the decision was made to extubate the patient successfully. On the fourth day of hospitalization (27-05-2023), the patient was shifted out of the ICU. The combined efforts of the on-site healthcare team and the remote Tele-ICU Intensivists resulted in improved pneumonia management and a significant reduction in liver enzyme levels.

Conclusion: Tele-ICU monitoring, combined with the on-site healthcare professionals, is a valuable tool in managing complex cases like inflammatory lobar pneumonia. The collaboration between command center Intensivists and the spoke-site team resulted in timely interventions, effective pneumonia management, and successful survive. This case study highlights the importance of leveraging Tele-ICU to overcome resource limitations, improve patient outcomes, and save lives in resource-limited settings.

Posted inCase studies Clinical Case Study
Tagscasestudy criticalcare eICU asia eICU India inflammatorylobarpneumonia tele radiology telehealth india telehealth solutions TELEICU teleicu india teleicumanagement teleicumonitoring

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