Just finished overnight call in the ICU. I started my shift at 7pm managing the OR ICU.
This is a different makeshift ICU than I had worked in previously. Like I mentioned in a prior post, critically ill patients are being taken care of in multiple areas around the hospital that normally aren't used as ICU's because of the huge volume of patients requiring critical care and mechanical ventilation. This new ICU is four of the operating rooms (OR's) each housing two patients to a room, being mechanically ventilated using anesthesia machines. Anesthesia ventilators are the ventilators that anesthesiologists use to breath for patients during surgeries. These ventilators are different from the ventilators typically used in an ICU. Anesthesia ventilators are not really built to breath for patients over a long period of time. They don't have all of the different ventilation modes that are often required to optimally ventilate patients with complex lung problems. However when the hospital ran out of the ventilators normally used in the ICU, because of the large number of patients requiring breathing assistance, the anesthesia machines are the next best thing. So I begin my shift in a place that is very familiar to me, the operating rooms. I get report from the physician managing these patients during the day and he tells me a few hours earlier he had successfully removed the breathing tube from one of the patients who is now breathing on his own. This patient is a fifty-one year old man who was intubated two weeks ago. In the past week the ICU team had removed the tube two other times, however the man's breathing had deteriorated both times and required reintubation and mechanical ventilation.
So this is his third attempt to remain off the ventilator. I have two residents working with me to manage the patients in this ICU and from report the other patients are critically ill but stable. I ask the residents to divide the other patients on this unit and I go to see the patient that recently was removed from the ventilator. When I enter his room I can see he is very tenuous in terms of his breathing. He's working very hard to breath on his own and I worried that he would tire and require reintubation and mechanical ventilation. I call the respiratory therapy department and ask them to bring a CPAP machine. Most of you have likely heard of CPAP. It is a noninvasive way to help a patient breath by pushing oxygen in to a patients nose and mouth as they take a breath. It helps to decrease the effort the patient must expend to get an adequate breath. I mostly leave the management of the other patients on the unit to the residents knowing they will call me if they need help so that I can watch this man very closely. At the end of my shift, 7 this morning, this man remained off the ventilator and breathing on his own. It is the first patient I have personally seen get off the ventilator. I'm praying he can stay off, only time will tell. I'll keep you updated, send him good thoughts.
There's another remarkable thing I want to address in this post. The nurses taking care of the patients in this OR ICU are all OR nurses! Two nurses in each OR, I spoke briefly with each nurse after my shift. None of these nurses had recently worked in the ICU or even on the regular wards . The newest OR nurse had worked in the OR for 3 years and the most experienced OR nurse had been in the OR for over twenty years and yet they all were now taking care of critically ill patients, on ventilators, with complex drips, tube feeds, central line care etc. They had been transitioned to this new role out of necessity about two weeks ago when the number of critically ill COVID patients had overwhelmed the staffing capability of critical care nurses. Given the shutdown of the OR's with the exception of emergency cases, these OR nurses were available and they STEPPED-UP! They told me how overwhelming this new role was initially, but I will say they are now performing like seasoned veterans! It's fantastic! Shout out to the OR nurses! That's all for now--I'm going to bed!
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