What happens to coronavirus patients when they are admitted to intensive care?

British medics were clear last night – Boris Johnson would not be in an intensive care unit unless he definitely needed to be.

The move marks a serious escalation in his treatment and will not have been taken lightly by his team of doctors at London’s St Thomas’ hospital.

‘The NHS, particularly in this moment, doesn’t give up intensive care beds just for people to be looked over,’ Reading University’s Dr Simon Clarke said.

So what is in store for a patient battling coronavirus who requires ICU treatment?

Medical teams treating the most seriously ill patients will work one-on-one in the wards and have a host of equipment to measure every aspect of people’s bodies from heartbeat and temperature to their exact blood oxygen level – a key indicator in coronavirus deterioration.

The PM said two days ago he was still suffering a high temperature

The PM said two days ago he was still suffering a high temperature

On Friday, the PM released a selfie video from self-isolation in Number 11 revealing he still had the symptoms of Covid-19

On Friday, the PM released a selfie video from self-isolation in Number 11 revealing he still had the symptoms of Covid-19

On Friday, the PM released a selfie-style video from self-isolation in Number 11 revealing he still had the symptoms of Covid-19

Police officers stand in front of Emergency Department outside St Thomas' Hospital in London

Police officers stand in front of Emergency Department outside St Thomas' Hospital in London

Police officers stand in front of Emergency Department outside St Thomas’ Hospital in London

What is an intensive care unit like? 

Patients on an ICU will be looked after closely by medics and will be connected to equipment by a number of tubes, wires and cables. 

There will normally be one nurse for every one or two patients patients.

Equipment used includes a ventilator (common among coronavirus patients), monitoring equipment, IV lines and pumps, feeding tubes, drains and catheters.

This equipment is used to monitor their health and support their bodily functions until they recover. 

Patients in an intensive care ward can often be sedated because some of the equipment used makes them uncomfortable. 

Intensive care units throughout the country have been put under immense strain by coronavirus, such that they have stopped or restricted visits. 

Source: NHS  

Even within ICU, some patients will be ‘better’ than others. Sources told The Times last night that Mr Johnson had needed four litres of oxygen, compared to 15l for some more desperately ill patients.

At one end of the spectrum, those being treated will remain conscious and ‘continuous positive airway pressure’ or CPAP treatment is used.

With this, patients are put in a hood or tightly fitting mask and oxygen is delivered at higher pressure to keep the airways open. This is especially useful for people suffering pneumonia, which sources denied was the case for Mr Johnson.

But at the other end of that spectrum, mechanical ventilation will be necessary – with the patient placed in a medically induced coma. Tubes will be placed into their windpipes to breath for them and their heart, lungs and other organs will be constantly monitored. Drugs and fluids, as needed, will be dispensed.

Derek Hill, Professor of Medical Imaging at UCL, said tonight: ‘A ventilator can be invasive, involving a tube being put down the patient’s throat, or non-invasive, for example, breathing through a specialised mask. Invasive ventilation tends to be recommended for COVID-19 patients.’

The ventilators – which use sophisticated software and sensors to adjust the levels of oxygen required – can be administered to a conscious or unconscious patient.

The Prime Minister may be put on an ECMO machine, a highly specialised device that is more sophisticated than a ventilator.

St Thomas’ is one of just six UK hospitals with a centre for adult ECMO – extra-corporeal membrane oxygenation. The machines, which take the blood out of the body to remove the carbon dioxide and replenish the oxygen, are used on patients whose lungs are not working properly.

The treatment costs an average of £45,000 a head, but makes recovery much easier because it allows the lungs time to heal.  

A busy intensive care ward at UCL, with facemask-wearing medics looking after patients in the London hospital amid the coronavirus outbreak

A busy intensive care ward at UCL, with facemask-wearing medics looking after patients in the London hospital amid the coronavirus outbreak

A busy intensive care ward at UCL, with facemask-wearing medics looking after patients in the London hospital amid the coronavirus outbreak

The BBC's Fergus Walsh showed NHS staff treating patients inside intensive care at University College Hospital in London

The BBC's Fergus Walsh showed NHS staff treating patients inside intensive care at University College Hospital in London

The BBC’s Fergus Walsh showed NHS staff treating patients inside intensive care at University College Hospital in London

An Italian patient receiving CPAP treatment, as seen in a Sky News report from northern Italy

An Italian patient receiving CPAP treatment, as seen in a Sky News report from northern Italy

An Italian patient receiving CPAP treatment, as seen in a Sky News report from northern Italy

Wherever course of action his doctors are using on the Prime Minister, medics said being on an intensive care ward – even being in a private room – would be frightening for a patient and could last days even if he is not hooked up to machines.

Intensive care units can be overwhelming places for both patients and their loved ones, although the highly transmissible nature of coronavirus means many hospitals have stopped or restricted visits.

Mr Raab, also First Secretary of State, is primed to take charge of the government's coronavirus response, but it is understood he is not a temporary prime minister (pictured at today's No 10 press briefing)

Mr Raab, also First Secretary of State, is primed to take charge of the government's coronavirus response, but it is understood he is not a temporary prime minister (pictured at today's No 10 press briefing)

Mr Raab, also First Secretary of State, is primed to take charge of the government’s coronavirus response, but it is understood he is not a temporary prime minister (pictured at today’s No 10 press briefing) 

Ambulances outside at St Thomas' Hospital in central London as Prime Minister Boris Johnson was moved to intensive care after his coronavirus symptoms worsened

Ambulances outside at St Thomas' Hospital in central London as Prime Minister Boris Johnson was moved to intensive care after his coronavirus symptoms worsened

Ambulances outside at St Thomas’ Hospital in central London as Prime Minister Boris Johnson was moved to intensive care after his coronavirus symptoms worsened

Downing Street infection timeline 

March 10: Health minister Nadine Dorries became the first MP to test positive for coronavirus, shortly after attending a Downing Street reception.

March 27: Prime Minister Boris Johnson and Health Secretary Matt Hancock both release Twitter videos saying they have coronavirus and are self-isolating.

Hours later, chief medical officer Professor Chris Whitty revealed he was self-isolating with symptoms.

March 30: The PM’s top adviser Dominic Cummings was revealed to be self-isolating with coronavirus symptoms.

April 2: Matt Hancock returns to work after seven dies in isolation and making a recovery.

April 3: Boris Johnson releases a video from his Number 11 flat saying he is continuing to self-isolate as he is still suffering a temperature.

April 4: Carrie Symonds, the PM’s pregnant fiancée reveals she has been self-isolating at her Camberwell flat.

April 5: The PM is taken to St Thomas’ Hospital as a precaution. 

April 6: The PM is moved to intensive care after his condition spiralled.

Prof Chris Whitty also fronted the press conference after his period in isolation. 

Linda Bauld, a public health professor at the University of Edinburgh, said: ‘The admission of the Prime Minister to intensive care is of huge concern and illustrates just how indiscriminate this virus is.

‘Anyone anywhere, including the most privileged in our society, can be affected and can become seriously ill. It is imperative now, more than ever that the rest of us comply with government guidelines to stay at home and not put others at risk.

‘All our thoughts will be with the Prime Minister and his family, and the many other families who are facing similar circumstances with critically ill relatives.’

St Thomas’ is a major teaching hospital that specialises in critical care.

It is situated on the Thames opposite the Houses of Parliament and has two intensive care units that house 19 permanent beds. St Thomas’ also specialises in heart and lung surgery, obstetrics and gynaecology and children’s medicine.

Once a patient no longer requires intensive care they can begin what is often a long road towards a full recovery, although sometimes there are lingering problems.

Health experts say that as a general rule patients will need a week of convalescence for every week that they are in intensive care.

And they agreed tonight that the PM’s admission to intensive care means he is ‘extremely sick’.

The Prime Minister was transferred to the ICU at St Thomas' Hospital in London at 7pm this evening

The Prime Minister was transferred to the ICU at St Thomas' Hospital in London at 7pm this evening

The Prime Minister was transferred to the ICU at St Thomas’ Hospital in London at 7pm this evening 

Armed police patrol St Thomas' hospital, where the PM is in intensive care

Armed police patrol St Thomas' hospital, where the PM is in intensive care

Armed police patrol St Thomas’ hospital, where the PM is in intensive care 

Your questions answered as Boris Johnson is moved to intensive care in his battle against coronavirus

Why did Mr Johnson first go to hospital?

He was admitted to St Thomas’ in London at around 8pm on Sunday, ten days after testing positive. Doctors advised him to seek treatment as his ‘persistent symptoms’, including a cough and a temperature, had not improved. His slow recovery is a red flag for complications including pneumonia. No 10 said it was a ‘precautionary step’ so Mr Johnson could have routine tests, which are likely to include procedures which can only be done in hospital.

What happens in intensive care?

Downing Street said the Prime Minister remained conscious last night and was moved to intensive care ‘should he require ventilation’. 

There are two types of ventilators used: non-invasive ventilation and invasive ventilation. Non-invasive ventilation means the patient stays conscious and is given a specialised mask which pumps air at high pressure into the lungs. 

These are called continuous positive airway pressure machines. If this does not work, patients are intubated – have a tube put down their throat into their airway – and placed on an invasive ventilator. They have to be placed in a drug-induced coma and paralysed while the mechanical ventilator takes over their breathing. ICU ventilators have built-in sensors to adjust the amount of oxygen the patient needs.

How common is it to be hospitalised and how high risk is he?

The Prime Minister, 55, is one of 17,911 people to have been admitted to an NHS hospital with coronavirus so far. 

Latest research estimates between five and ten per cent of those who get the virus end up in hospital. The older you are, the more likely you are to need hospital treatment. 

A study found that eight per cent of people in their 50s with the virus need hospital treatment and 0.6 per cent die. Mr Johnson has no known underlying health conditions. But he has struggled with his weight and in December 2018 revealed that he weighed 16 and a half stone. 

Obesity is a risk factor for complications and men are more likely to be hospitalised than women.

How long could he stay in intensive care?

Some patients spend just a day there before recovering and going to a general ward. Others have spent more than three weeks in intensive care units.

What initial tests and treatment did he have and why?

Coronavirus is a respiratory disease so initial tests will have focused on establishing how badly his lungs were damaged. Most patients admitted to hospital with coronavirus have difficulty breathing and get oxygen support. 

Mr Johnson’s oxygen saturation levels will have been monitored by a sensor clipped to a fingertip. Doctors will also have scanned his lungs. 

Other tests establish if major organs have been affected by a lack of oxygen. This includes an ECG and blood tests for the liver and kidneys. 

Patients have their white blood cell counts monitored to show immune response. 

His move to ICU suggests these key measures, most importantly oxygen levels, were continuing to deteriorate yesterday.

What treatment could he receive?

The highest level is mechanical ventilation, which requires patients to be fully sedated. There are no established drugs for coronavirus and antibiotics do not work on viruses.

Could continuing to work make it worse?

The Prime Minister did not take any time off and vowed to continue leading the Government from his hospital bed. 

But this went against NHS advice urging those with coronavirus to get plenty of rest and sleep. 

Exhaustion is a common symptom of coronavirus. Previous studies have shown that a lack of sleep and high stress can suppress the immune system.

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