Why intensive care is like a concert

With every breath Boris Johnson takes being analysed by twenty-four hour news channels, it is time to demystify the intensive care unit (ICU). Rather than being a static place, the ICU is more like a system. Think about the last time you went to a music concert. It may have taken place in a grand theatre, but it was the combination of the musicians, their instruments, the audience and the conductor that made the experience work. So too in the ICU.

Although the physical walls need to be standing, it is the teamwork between the nurses, the doctors, the physiotherapists and countless others, using machines and drugs at just the right time, in the right patients, that saves lives. Once in the concert hall, the ICU offers three things – monitoring, treatments and care.

Using infrared emitting devices on your fingertip we can measure the oxygen linked to your blood every second of every day. Thin plastic tubes in your arteries allow blood samples to be taken painlessly, showing the dissolved gases and salts in your body. Monitoring with this detail allows treatments to be used at just the right time to make them as effective as possible.

These treatments used for Covid-19 typically support the lungs, the heart or the kidneys. Sometimes breathing ever higher percentages of oxygen by inflamed lungs, from the 21 per cent in the air to nearly 80 per cent by a mask, still cannot be absorbed into the blood. Different face-masks, blowing in air under pressure, may help and may prevent the need for a ventilator. Yet, for a tiny minority of patients with Covid-19, even with the best treatments given at the right times, very inflamed lungs need more help.

Going onto a ventilator typically needs anaesthetic drugs which temporarily take away consciousness and other muscle relaxant drugs. These allow a small flexible tube to travel through the mouth, into the windpipe and be connected to a breathing machine. These “invasive” ventilators can squeeze in air under more pressure in different patterns. Turning people onto their front can further help the lungs expand in just the right places, changing blood flow to better pick up more oxygen.

Although treatments are important, so too is care. We no longer call it the ITU (intensive treatment unit) but rather the ICU (intensive care unit). We recognise it can be scary for patients and families to go through these experiences. The team is there to explain what is happening, use painkillers and sedatives at the right times to reduce any distress, as well as try their very best to keep families updated. Even if treatments stop working, care does not.

I’m writing this just an hour away from where the founder of the NHS, Nye Bevan was born. He famously said: “The purpose of power is to give it away.” Yes, ICU is an important part of addressing Covid-19, but the real power lies in the measures that you and your family can do to reduce transmission. Over the course of my medical career, I may have saved hundreds of lives. You, by reading this, have the power to save many more. What is amazing is you don’t need ventilators or drugs or an ICU. You simply need to stay at home, wash your hands and listen to the public health advice.

You have that power. Thank you for using it.

As told to Bill Gardner, Senior News Reporter

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