Critical care may not be directly delivered by ICU medics if cases surge, doctor warns

The most critically ill coronavirus patients may not be treated directly by intensive care unit (ICU) medics due to staff shortages if cases exceed normal critical care capacity, a doctor has warned.

There is still capacity in existing hospital ICUs but medics say that staff shortages could become an issue if cases move into overflow critical care created to deal with the pandemic.

Dr Michael O’Dwyer, head of anaesthesia and critical care at St Vincent’s University Hospital in south Dublin, said that hospitals have increased ICU bed capacity but there may not be sufficient medical staff with ICU experience to manage the overflow of beds.

“There does seem to be a perception out there that if you just provide a ventilator and a bed, then you just have an ICU bed and that is not the case,” he said.

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“An ICU requires so much more than just a ventilator: it requires one-to-one nursing by an ICU-qualified nurse 24 hours a day.

“Whilst we can provide an area that has a bed and ventilator, the further we go out beyond what is our normal capacity, then that ICU care will be provided in a manner that is supervised by ICU as opposed to exclusively delivered by ICU individuals.”

ICU numbers

Prof Philip Nolan, chair of the Irish Epidemiological Modelling Advisory Group, told the daily Department of Health emergency health team briefing on Thursday that the number of patients in ICU had been stable at around 140 to 150 over recent days.

If the disease was suppressed that number should decline over the coming week or 10 days, he said.

Dr O’Dwyer said that the number of people on a ventilator nationally with Covid-19 has remained relatively static at about 115 over recent days.

The Department of Health has said there are about 312 ICU beds across the hospital system with the capacity to “surge” to 812 critical care beds if there is an increase in the worst affected cases.

These additional beds were contingent on the training of nurses and the availability of ventilators and oxygen, senior HSE official Dr Liam Woods has said.

There are still empty ICU beds available across the system to cope with a possible increase, though individual hospitals, including Dublin hospitals Beaumont, Connolly and the Mater, have been at or close to full normal ICU capacity.

Dr Michael Power, critical care consultant at Beaumont, said that the hospital was, like others, “managing the critically ill Covid patients well.”

Beaumont had ICU capacity available for critically ill patients presenting and there was also emergency ICU capacity available at the north Dublin hospital, he said.

“So far a good number of patients have been discharged home,” he said.

Social distancing

Dr Power said it was “vital” that the public continued to comply with social distancing and stay-at-home public health measures.

“It is vital at this stage to keep going and hold on and stay the course so the public health measures can have the good effect,” he said.

The State’s chief medical officer Dr Tony Holohan said that of the 263 recorded coronavirus-related deaths, as of Thursday, 30 people or 11 per cent, had died in ICU.

Of 242 people admitted to ICU during this outbreak, 153 – or 63 per cent – were still in hospital, 59 or 24 per cent had been discharged, and 12 per cent (30 people) had died.

Some 80 per cent, or 193 people, admitted to ICU had an underlying illness. The median age of ICU patients was 60.