Redefining Critical Care – Saving Lives Right before the End line

The Doctor who is trained in intensive care after his basic training in Anaesthesiology or Internal Medicine or Pulmonology has to take care of critically ill patients. Critical Care Specialists are highly trained experts in emergency life-saving measures and management of severe complications which arise from different diseases.

Intensive Care Unit provides critical care and life support for injured and acutely ill patients. Typical patients include those with severe infections, heart attack, brain stroke, poisoning, snake bite, pregnant women with severe health issues like uncontrolled blood pressure, neurological problems, post-surgical patients (like after major cardiac or brain surgery). Apollo Hospitals have the largest number of intensive care beds in the country, which is highly sophisticated and has state of the art facilities.

Demystifying the Experience

How patients get admitted to the ICU?

Initially, patients come to the Emergency Room and get the initial resuscitation and are shifted to ICU. Emergency at Apollo is highly advanced with qualified ER physicians round the clock. Apollo Hospitals is the pioneer of modern-day emergency care in India with scientifically driven protocols to provide uniform care for all sick patients.

What should the family of the patient expect?

Any ICU should have good protocols to manage any critical illness, advanced monitoring of patients, good infection control protocols to prevent hospital-acquired infections and tracking all quality parameters.

Who are the members of an ICU team?

A good ICU team contains Intensivists, Consultants from various specialties, highly skilled Nurses, Physiotherapists, Pharmacists, Dieticians, Medical Social Workers and other Paramedics.

What are multi-organ failure and Multi-organ Support therapy?

A patient in sepsis or trauma may develop multiple organ failures like respiratory, liver, kidney and heart failure. In the ICU, lungs are supported by either non-invasive or invasive ventilators. In severe conditions, the blood may need to be oxygenated outside the body using a special procedure called ECMO. Kidneys are supported by dialysis. All the organs are supported until their recovery.

Why is ICU care expensive?

As it involves multiple investigations to diagnose the illness, drugs which might be costly, organ support to revive the failing organs and multispecialty approach for better patient care. High initial cost generally comes down over passage of time.

Why is infection control important for an ICU?

It is to prevent the growth of multidrug-resistant organisms which adds to the cost and increases mortality. A special Infection Control team thrives to maintain the standards by auditing and meetings. Hand washing is an integral part of safe medical care.

What can the family expect when visiting the ICU?

The family has expectations about a complete update on the health of their loved one from the treating team. They have a detailed counseling of the plan of care and expected outcome and attenders can ask any queries during that period.

Since critical care is dynamic, the situation may change quickly. Sometimes this can lead to a need to treat the patient with more invasive devices. The doctors and nurses are always keeping the interest of the patient first. In this process, the patient may appear to have a lot of bruises, look bloated, have lines and tubes in the mouth and other places. Patients are often sedated to keep them pain-free and this may make them not respond to the family.

What does the ICU team expect from the patient’s family?

Intensive care is a team effort between the patient, their family and the ICU team. This involves getting an accurate history of the events leading to critical illness as well as avoiding too many visitors to maintain infection control. The ICU is a busy place and interruption should be avoided as much as possible. The counselling should be attended by the same family member for continuity. Sometimes patients are too sick to be revived and hopefully advances in science over time can ensure survival.

What is Tele-ICU and how does it work?

In most small towns and villages critical care specialists, intensivists and other higher specialties are not available. Using internet-based audio-video calling, clinical management of their ICU patients can be done. A team-based approach giving required suggestions to the remote site team and continuous monitoring of vitals is done by the critical care intensivist and specialized nurse from the Command Centre (Tele-ICU) round the clock. It has been shown that outcomes are better and safety improves.

What is the future of critical care in India?

Automation, use of miniature monitoring devices and extensive use of ultrasound and other equipment to get patient data quickly and accurately is already improving critical care. The future involves the ability to provide critical care anywhere and to everybody. Increase in availability of trained critical care nurses and doctors is being promoted by organizations like the Indian Society of Critical Care Medicine.

The use of standardized protocols will also simplify care. The use of newer medicines and procedures is also improving healthcare for all.

What makes ICUs at Apollo different?

Apollo Hospital being JCI accredited, their ICUs meet international standards in terms of infrastructure and medical expertise. At Apollo, they possess ‘speciality specific’ ICUs managed by highly trained and experienced critical care physicians and nurses. Their Advanced Critical Care Unit provides best in class technology to ensure patients are safe and monitored continuously.”

Dr. K. Subba Reddy

MD, PDCC, IDCCM, IFCCM, EDIC

Sr. Consultant, Critical Care

Apollo Hospitals, Jubilee Hills