Press "Enter" to skip to content

Improved ICU Care for Flu May Help Hospitals With COVID-19 Patients

Hospitals and intensive care units have undergone many improvements since the influenza pandemic in 2009, which may make them better equipped to deal with patients who have severe respiratory illnesses such as COVID-19, experts told MedPage Today.

These improvements start even before the patient enters the hospital, said David Weber, MD, spokesperson for the Society for Healthcare Epidemiology of America.

Citing one example, “instead of lying someone down on a stretcher with a mask, you can purchase a transport stretcher with a bubble over it with filtered air,” he said.

Weber also noted the advent of specialized treatment centers, such as certain “dual purpose” Ebola Treatment Centers designed for both contact disease and droplet/airborne disease, like COVID-19. He mentioned the University of Nebraska Medical Center, which is currently treating patients repatriated from the Diamond Princess cruise ship.

Some patients with COVID-19 may be treated in the ICU in the same way as severe flu, with extracorporeal membrane oxygenation (ECMO), where the technology has advanced dramatically since the last pandemic.

“In 2009, most places considered ECMO a four-letter word,” said Nahush Mokadam, MD, director of cardiac surgery at Ohio State University Wexner Medical Center. “Although very effective in children, the results were not universally reproducible in adults.”

ECMO was “not in widespread use” in 2009 and confined to only a handful of highly specialized centers, “about 10 in the country that routinely used it in adults,” Mokadam said.

“In the last decade, we’ve come a long way in changing that philosophy, outlook, and use of this life-saving technology,” he said.

Mokadam noted several developments that made it easier to use, including a better oxygenator and a smaller and more reliable pump. This made for a more portable system that didn’t have to be “rigged up in the back room by perfusionists” and the system was an “all in one package.”

“It made it more appealing to other centers, not just a handful of believer centers,” he said.

ECMO and specifically veno-venous ECMO is a last resort for patients with severe respiratory illness, such as influenza and COVID-19, as it’s geared “for people whose lungs have failed.”

“It’s the end of the line. It’s the very last thing we do,” Mokadam noted.

‘Steering Into Skids’

Even before the patient is hospitalized, clinicians already have a leg up compared to a few years ago, Weber said, thanks to the travel prompt now built into the electronic health record.

“[A patient] comes in for a blood draw, the first thing you ask is ‘Have you traveled abroad?’ That triggers something that says ‘Do you have respiratory symptoms?’ Then a [best practice advisory] pops up and says ‘Put a mask on the patient, put the patient in a private room. If you see the patient, wear a gown, mask, and shield,'” Weber said.

If a suspected case of any infectious disease is identified, it can prompt clinicians to contact the health department, infection prevention, and anyone else who may be taking care of the patient, he added.

In addition to updated CDC guidelines about personal protective equipment, including how to put it on and take it off, clinicians also have access to powered air purifying respirators, or PAPRs.

Environmental measures have improved, such as hospital-grade disinfectants labeled specifically with an emerging viral pathogens claim. Weber said that “we know what kills other viruses” similar to the COVID-19 agent.

And it’s not just the specialized treatment centers qualified to treat most patients with severe respiratory illness, Mokadam said.

“The modalities of support for people with life-threatening flu have evolved over time since the 2009 outbreak. Many centers have become much more savvy,” he noted.

In fact, many community hospitals now have the ability to treat patients with severe flu with techniques such as putting the patient prone, which involves “specialized beds that can turn a patient over while they have a breathing tube in,” Mokadam said. He also noted the availability of different types of ventilators that can support patients in different ways, such as chemically paralyzing them if their own muscles fight the ventilator.

“Historically, they would’ve sent the patient to a specialized center,” he said, noting that because community hospitals have the ability to treat patients with severe flu with therapies other than ECMO, it allows specialized centers to focus on treating sicker patients.

From a public health perspective, the whole diagnostic and therapeutic approval process has accelerated dramatically, Weber said, noting the “rapid process” of FDA and institution review boards.

“Even though a drug is only in trials, if I had a patient who needed it, I could call the drug company and get it through a compassionate plea basis,” he said. “It can be approved within hours. It’s faster than putting it on a plane.”

Weber also noted that since vaccine technologies are better, they can take months to develop instead of many years.

He said hospitals have gotten better at “steering into the skid” of an infectious disease outbreak, given the number of outbreaks over the years.

“If you drive on ice 20 times, you get better at it,” Weber said.