A Patient was admitted on 16th February 2021 with History of fever and shortness of breath in one of our Spoke Tele-ICU units in a peripheral area
Findings on Admission: -
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Found to be COVID-19 positive.
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Was very restless having breathing difficulty
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temperature recorded 100F
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had a high heart rate of 135/min
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But the most worrying was HYPOXIA (low oxygen levels): SpO2 82% on room air with a Difficulty in breathing (respiratory rate of 41/min)
First Line of Treatment
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After patients’ admission in ICU the resident doctor on duty after initial evaluation raised an alarm to the eNext ICU Command Centre.
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Immediately the critical care specialist from eNext ICU Command Centre,intervened and started further evaluation and advised to send few initial investigations (like Complete blood counts, liver and kidney function tests, blood gas analysis i.e., ABG) and started supportive therapy as per ICU protocols and latest CoVID treatment protocols (in the form of fluid bolus, Antibiotics,Vasopressors, IV steroids, IV antivirals).
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Despite early intervention, Patient’s vitals kept on deteriorating (fall in blood pressure drowsiness, fall in oxygen levels, Restlessness,) ABG showed Respiratory and Severe Metabolic Acidosis and hypoxia.
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The big challenge that remained was putting the patient on ventilator support. The team in the ICU was wary of managing a CoVID positive patient on ventilator and the relatives were unsure. But after counselling of the family by the critical care specialist from eNext ICU, and discussion with the treating team, patient was intubated and put on ventilator support.
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CBC
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LFT
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KFT
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CHEST X-RAY
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LDH
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FERRITIN
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D-DIMER
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CRP
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IL-6 were sent, which were markedly raised.
Base Line Investigations
Management Outcome
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The close coordination and supportive management between the eNextICU Team and the spoke hospital team continued day after day and night after night. After initial stabilization an HRCT chest was done shows bilateral interstitial pneumonia of viral etiology with a CT severity index (10/25). Post intubation cultures sent were negative. Due to aggressive management and collaboration of eNext ICU and spoke ICU Team, vital parameters started stabilizing. With the progressive improvement in arterial blood gases and PO2, Ventilator support and oxygen requirements kept on coming down. After a successful weaning trial, the patient was Extubated to BiPAP (NIV support), on advice from eNext ICU Command Centre, Antibiotics were deescalated and patient continued to be managed on intermittent NIV and Non-Rebreathing Mask. Finally, after a total 3 weeks stay in ICU the patient was shifted to the ward and subsequently got discharged and went back home in a healthy condition with stable vital parameters.
Impact of Tele-ICU on This Management
The core of Tele –ICU is about collaboration, coordination, close monitoring, implementation of a common plan and Follow ups. This case is a testimony to the fact that if all these are followed diligently, good outcomes are a reality. The highlights of the case are as below:
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Early aggressive management of Covid-19 positive patient as per latest Covid-19 guidelines.
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Early initiation of IV steroids and IV antivirals.
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Early intubation and ventilatory support.
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Care and management of ventilated patient under the close watch of the eNext ICU team
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Guidance of spoke ICU team by eNext ICU on protocol-based treatment.
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Aggressive and timely management of patient prevented development of permanent complications.
