Humanizing ICU Coronavirus Disease 2019 Care

To date, coronavirus disease 2019 (COVID-19) has caused >987,000 deaths worldwide. A substantial proportion of patients with COVID-19 require the highest level care in ICU. In most hospitals, ICUs have been forced to significantly modify their usual work routine treat severe patients. many cases, tripled or even quadrupled capacity, which placed an enormous burden on health-care professionals and hospital managers. are highly technical spaces that never considered “patient-friendly,” especially for critically ill patients, although this begun change recent years due growth efforts “humanize intensive care” Europe. Importantly, response from relatives, friends as well positive. The measures restrictions were implement during current pandemic, together omnipresent fear overload staff, severely undermined advances field emergency care. midst outbreak, it is important reflect what happened identify aspects amenable improvement, turn will help optimize patient Clearly, essential consider both physical health emotional well-being these 60-year-old male presented fever respiratory symptoms at ED University Hospital del Mar (Barcelona, Spain) April 9, 2020. We performed a polymerase chain reaction test check presence coronavirus. result was positive, admitted inpatient ward started conventional oxygen therapy. Due progressive worsening oxygenation levels, transferred, 72-hours after admission, ICU start ventilatory support high-flow nasal cannula. On 14, required orotracheal intubation invasive mechanical ventilation. patient’s clinical course similar our hospital. He experienced development ARDS high prone positioning, protective ventilation, cardiovascular monitoring, analgosedation, nutritional support. also complications associated infection treatment previous complications, among other issues. Then, condition progressively improved, we proceeded withdraw sedation awaken patient. At point time, environment differed greatly more humanistic conditions had prevailed years. Six months ago, would awakened next his wife and/or children sound familiar voices. participated twice weekly music therapy sessions able begin walking around unit walker lift, if he still attached monitoring By contrast, faced very different conditions: closed door, covered equipment (no visible faces), no family members any time. However, heard same sounds, concerns fears, may pronounced. introduction humanize revolutionized critical 2018, initiated program denominated “Humanizing Parc de Salut Mar” (HUCIMAR), includes bundles improve mental families, staff. HUCIMAR allows us offer high-quality, personalized survivors serious illnesses who extended stays Some multidisciplinary therapies offered include 24-hour open door policy close members, early mobilization by physiotherapists, staff-assisted walks, environmental noise control ensure quality nighttime rest, therapy, widespread availability televisions clocks all rooms, architectural improvements provide people-friendly spaces. Regrettably, be interrupted pandemic. case described earlier, withdrawal weaning ventilation occurred stages deescalation Catalonia number diagnosed falling weather improving. Our began make video calls permitted limited visits members. After tested negative COVID-19, team, based consensus agreement entire department, decided restart one remarkable therapeutic activities program, call “healing seafront walks.” located coast Barcelona, sea directly across street entrance. Moreover, because ground floor hospital, just short, quick walk seafront, despite inconvenience high-performance bed. period time ICU, opportunity go outside key emotional/psychological turning patient, case, hospitalized nearly 2 (50 days). spend outdoors natural such Barcelona popular tourist sites city, middle pandemic particularly special. providing frequent status updates telephone, informed them going “seafront walk” first outing scheduled. When day arrived, confirmed, accordance protocol, necessary materials available (eg, ventilator, tubing, transfer medication, airway mask bag, mask, cylinder) team (including physician, nurse, physiotherapist, orderly) prepared. met exit 2-minute trip seafront. Their feelings emotions, staff’s immense satisfaction, attentive, gaze nearby pedestrians captured photographs (Figs 1, 2) went viral shown main media social networks. Those reveal force confront new reality: vulnerable COVID-19. pictures capture universal impact leaving images remembered history. crossing city bed view powerful. reason implications.Figure 2ICU resting (courtesy David Ramos, Getty Images).View Large Image Figure ViewerDownload Hi-res image Download (PPT) era beginning, living virus treating come. These enter worries derived reports about mission goal intensivists not only excellent medical through appropriate supportive but strive continue implementing promote humanization