ICU Policies During COVID-19: Review and Recommendations, Lecture notes of Management Theory

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TABLE OF CONTENT

SL.NO. TITLE PAGE

NO.

ABSTRACT

**1. INTRODUCTION

2. OBJECTIVE OF THE STUDY
3. EVALUATION OF THE CASE
4. PROPOSED SOLUTION
5. CONCLUSION
6. RECCOMENDATION
7. BIBLIOGRAPHY**

ABSTRACT

SARS-CoV-2 has resulted in a global pandemic that is unparalleled in terms of magnitude, distribution, severity, and fatality. Because of the surge of patients with severe or life-threatening diseases, medical resources are sometimes insufficient to address the demands of all patients. As a result, doctors may be compelled to make difficult decisions about which patients to refer to the ICU. This publication is designed to provide conceptual support to all healthcare teams presently managing the COVID-19 pandemic on the front lines. Its goal is to aid clinicians in making ICU admission decisions and to help them provide consistent, high-quality care.

choosing independent which patients get life-saving consideration and which don't. The six explicit proposals for distributing clinical assets in the COVID-19 pandemic have been made in light of moral qualities like augmenting benefits, treating similarly, advancing and remunerating instrumental worth, and giving need to the most horrendously awful off. These proposals incorporate to amplify benefits (saving the most lives and at augmenting upgrades in people's post-treatment length of life in any event, when it expects to eliminate a patient from a ventilator or an ICU bed to give it to others out of luck); focus on wellbeing laborers for testing, PPE, ICU beds, ventilators, therapeutics, and antibodies; don't assign on a first-started things out served premise; be receptive to confirm; perceive research investment; and apply similar standards to all COVID-19 and non-COVID-19 patients. This report is planned to offer applied help to all medical care groups as of now participated in the forefront the executives of the COVID- pandemic. It explicitly targets doctors whose culture, preparing, as well as experience might not have set them up to the reflection fundamental the treatment-constraint dynamic interaction. This approach can't be a substitute to a contextualized and customized clinical dynamic that regards patient's inclinations and values, family inclinations, and a deliberative and consensual interaction inside the multidisciplinary group.

2. OBJECTIVE OF THE STUDY

 To study various admission policies in the ICU during covid 19  To study admission decisions to ICU during covid 19 outbreak  To study preparedness of the ICU during covid 19  To study training and healthcare worker assurance  To study critical care triage and allocation  To study various discharge policies in the ICU during covid 10  To study how bed shortage problems were handled

This study gives helpful understanding in depicting the probabilities of ICU confirmation and emergency clinic release as per age, orientation, and comorbidities among affirmed COVID- cases in India. A web-apparatus is additionally given to permit the client to appraise these probabilities for any mix of these covariates. These probabilities empower further comprehension of the clinic interest as indicated by understanding attributes which is fundamental for medical clinic the board and valuable for fostering an immunization procedure.

4. PROPOSED SOLUTION

4.1 In a pandemic, general ICU rules apply:  Critically sick patients in the emergency department or general ward must be sent to ICU as soon as possible.  Complete the ICU Admission Checklist  An intensivist should oversee patient care in the ICU on a daily basis.  A 24-hour, seven-day-a-week intensivist model is not recommended in Pandemic.  According to the local surge capacity plan, we recommend optimizing ICU nursing resources with nursing patient ratios of 1:1 for ventilated or multiple organ failure patients and 1:2 to 1:3 for other ICU patients in severe shortage. Patients are admitted to the ICU if the prognosis for recovery and quality of life is acceptable, taking into consideration criteria such as age, and gender. 4.2 ICU covid-19 discharge criteria  Vital signs and other hemodynamic indicators that are stable without the use of an intravenous inotropic or vasopressor. If an ICU bed is required during the crisis, patients receiving low dose inotropic support (less than 5 mcg/kg/minute of Dopamine) may be discharged earlier.  Normal or baseline consciousness level  Normal airway patency, normal work of breathing, and stable respiratory state If the patient was on mechanical ventilation, at least 24 hours after extubation.  Cardiac dysrhythmias are absent or under control.  A patient on chronic mechanical ventilation does not require frequent suctioning. For a patient with a tracheostomy, there is no need for frequent suctioning.

recommend that equity across medical care frameworks, showed by the utilization of uniform strategies, is significant. An absence of consistency between medical clinics in a comparative area or offering comparable types of assistance can bring about unjustifiable variety and unfortunate results. Furthermore, an absence of clear direction across a medical services framework might prompt local area clinicians making inconsistent medical clinic references in view of suppositions about the probability of patients getting ICU care. Forestalling such disparities in practice is vital. While the rules likewise propose that non-earnest consideration be diverted to more dire and COVID-19-related care, concerns have been raised over the effect this is having on the excess of patients who are not getting care or not getting to administrations as they regularly would. It is important that all patients requiring care can get to and get care that is protected, viable, productive, evenhanded, patient-focused, and ideal We attempted a thorough assessment of existing and as of late evolved rules for triaging ICU confirmations during the COVID-19 pandemic. A few rules inferred that they would be altered as situation transpire and different rules might be distributed at the appointed time. While individual rule content might develop, the sorts of measures and standards we have distinguished will be less powerless to change. Via illustration, since undertaking this pursuit, Azoula and partners as of late examined neighborhood direction from the COVID-19 Indian locale region. The topics thought about help those distinguished in this survey and feature a large number of the elements. The rules give little data on the manner by which they were created and the proof behind the recommendations. Thus, we can't distinguish 'best practice'. Nations and wards have different moral qualities and social standards, which are reflected in the direction. Not all rules were unequivocal, which may to a limited extent reflect social contrasts and political aware nesses. Some direction has been converted into English, which might have brought about a deficiency of subtlety or lucidity. Where direction was not unequivocal, we have expressed this and demonstrated our agreement understanding. The standards and topics that we recognized are basically the same as the prescribed things to remember for an emergency convention for fundamentally sick patients in a pandemic or general wellbeing crisis as recon retouched by the American College of Chest Physicians Consensus Statement. However, the Statement doesn't suggest utilization of SOFA score prohibition edges on the grounds that the score's predictive capacity changes across populaces. Moreover, the

Statement incorporates rules for youngsters, yet not many of the rules we evaluated examined kids, which might mirror the low incidence of basic COVID-19 sickness in children. Two prior rules from North American states (New York6 and Maryland23) on triaging during general wellbeing crises had comparable attributes to the Kansas and Swiss rules. They utilized an unequivocal moral guideline (boosting lives saved), confirmation and release rules (counting the SOFA score), and emergency councils.

6.3. ICU broad recommendations for outreach:  Outreach ICU, Rapid response team to be used for early examination of acutely unwell non-ICU patients; this will aid in early identification of ICU eligible patients and avoid unnecessary ICU admission; it will also promote early action that prevents patient health worsening.  ICU consultant on-call teams help with ICU transfers and lower critical care readmission rates.  No ICU Admission for a patient who refuses cardiopulmonary resuscitation and has a low chance of recovery.  ICU Outreach can start a DNR policy in the ward and encourage it.  Monitor ICU patients for 24-48 hours after release to minimize readmission rates.

7. BIBLIOGRAPHY

 Medicine SSOIC. Recommendations for the admission of patients with COVID-19 to intensive care and intermediate care units (ICUs and IMCUs). Swiss Med Wkly. 2020;150:w20227.  Vincent J-L, Creteur J. Ethical aspects of the COVID-19 crisis: how to deal with an overwhelming shortage of acute beds. Eur Heart J Acute Cardiovasc Care 2020;9(3): –52.  Kirkpatrick JN, Hull SC, Fedson S, Mullen B, Goodlin SJ. Allocating scarce resources and triaging patients during the COVID-19 pandemic. J Am Coll Cardiol. 2020;S0735- 1097(20):35223 –2.  Vergano M, Bertolini G, Giannini A, et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resourcelimited circumstances: the Italian perspective during the COVID-19 epidemic. Crit Care Lond Engl. 2020;24(1):165.  Joebges S, Biller-Andorno N. Ethics guidelines on COVID-19 triage-an emerging international consensus. Crit Care Lond Engl. 2020;24(1):201.  Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of covid-19. N Engl J Med. 2020;382(21):2049 –55.  Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020:1 –34.  Truog RD, Mitchell C, Daley G. The toughest triage — allocating ventilators in a pandemic. 2020;382(21):1973 –75.  Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506 –17.  Pochard F, Grassin M, Azoulay E. Ethical principles for everyone. Ann Intern Med. 2001;134(12):1152 author reply 1152-1153.  White DB, Braddock CH, Bereknyei S, Curtis JR. Toward shared decision making at the end of life in intensive care units: opportunities for improvement. Arch Intern Med. 2007;167(5):461 –7.