Quality care in COVID ICU patients-beyond medicine

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Indian Journal of Clinical Anaesthesia 2021;8(Special Issue):60–61
Content available at: https://www.ipinnovative.com/open-access-journals
Indian Journal of Clinical Anaesthesia
Journal homepage: www.ijca.in
Short Communication
Quality care in COVID ICU patients-beyond medicine
Anshul1, Abullais Raheeq Gowda1, Lalit Gupta
1,*
1Dept. of Anaesthesia, Maulana Azad Medical College, New Delhi, India
ARTICLE INFO
Article history:
Received 28-09-2021
Accepted 03-10-2021
Available online 21-10-2021
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We would like to draw the attention of medical
professionals towards the need to improve the perceived
quality of life of patients in COVID ICU and measures to
achieve it. Evidence suggests that due to negative impact of
COVID 19 on patients’ physical and mental health, it has
led to lower quality of their life.1Comprehensive health
and wellness of patient can be restored by small persistent
little acts of love, compassion, empathy and ensuring human
connections along with quality healthcare. Consequently,
improved quality of patients’ life will lead to overall
reduced morbidity, feeling of safety by patients and their
family members. It will also result in patients’ adherence
to treatment, perceived satisfaction and positive adaptation
despite adversity (resilience).2Moreover, it will instill hope
of survival and sense of wellbeing among patients and their
caretakers.
COVID ICU patients are usually ‘Happy Hypoxic’3
throwing a great challenge to the intensivist for choosing
appropriate mode of ventilation and hence oxygenation. The
main challenge faced by the intensivist is to decide which
device should be used to minimize patient’s discomfort.
Making patients’ mouth free by Intermittent alternate device
use, early use of HFNC, BiPAP, using nasal BiPAP mask
(instead of face mask) and avoiding collapse of airways
due to continued high FiO2by providing PEEP wherever
required can mitigate challenges during communication,
feeding, performing oral care, incentive spirometry and
* Corresponding author.
E-mail address:lalit.doc@gmail.com (L. Gupta).
proning, without hampering oxygenation. Providing bedside
defecation chair assistance will further help in avoiding
gaps in oxygenation and tackling increased oxygen demand
during walking for urination or defecation. Other methods to
improve patient’s perceived quality of care include avoiding
subcutaneous injection (low molecular weight heparin or
insulin) on abdomen to make proning less painful, providing
symptomatic care for headache, sore throat and oral ulcers.
Segregation of patients according to disease severity can
be done to decrease unnecessary stress. It may be better
to keep them away from bad news and data about deaths
due to COVID. Timely update of patient condition and
scope of improvement may be discussed with patient and
their family to establish shared decision making. This will
help to build trust between patient and treating doctor.
Feeding, good glycemic control and nutrition of patient is
of utmost importance. Regular chest and limb physiotherapy
by physiotherapists can be done and they may motivate and
teach patient about these exercises. Incentive spirometry and
balloon inflation exercises can give visible clue to patients
about their progress.
Additionally, COVID ICU patients are isolated.
Therefore, they have reduced access to support from
family, friends, and social support systems. Anxiety
about the health of family members adds to the distress
of patients. Maryam Shaygan et al.2found that online
multimedia psycho-education via cognitive behavioral
therapy, stress management technique, mindfulness based-
stress reduction, positive psychotherapy improve resilience,
https://doi.org/10.18231/j.ijca.2021.107
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Anshul, Gowda and Gupta / Indian Journal of Clinical Anaesthesia 2021;8(Special Issue):60–61 61
and reduce fear, stress, insomnia, irritability, low mood,
depression, anxiety. Positive psychotherapy exercises
included were ‘positive reminiscences’ (think about past
events that evoke positive emotions), ‘Hope, optimism, and
post- traumatic growth’ (think about times when important
things lost, but other opportunities arrived), ‘Gratitude
text exercise’. Hence, measures to optimize mental health
need to be taken. Hamideh et al.4found that allowing
family visits leads to lower heart rate, respiratory rate
and improved arterial oxygen saturation during visit and
within 30 min after the visit in Myocardial Infarction
patients. These physiological and psychological benefits of
family support can be harnessed in COVID ICU patients
for improvement of overall patient condition. Novel and
innovative ideas can be included to provide family support
to patients. This can be achieved by keeping mobile device
like smartphones and tablets with patient to facilitate audio
or video communication with their family.5Also at the
same time, we need to reassess the continued need for
restrictive family visitation policies.
Entertainment and distraction of patients from their
illness can be felicitated using audio-video provision with
multimedia of patients’ choice. Newspaper and magazine’s
availability will make their time less miserable. Spectacles
should be available with patient all the time. The treatment
of COVID ICU patient should include treatment of COVID-
19 with improvement of quality of patient life. As a good
Doctor will treat disease, but a great Doctor will treat the
patient having the disease.
1. Conflict of Interest
None.
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Author biography
Anshul, Senior Resident
Abullais Raheeq Gowda, Senior Resident
Lalit Gupta, Associate Professor
https://orcid.org/0000-0001-7291-
5961
Cite this article: Anshul, Gowda AR, Gupta L. Quality care in COVID
ICU patients-beyond medicine. Indian J Clin Anaesth 2021;8(Special
Issue):60-61.