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 Table of Contents  
ORIGINAL ARTICLES
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 133-135

Experience as anesthesia resident in intensive care unit during COVID-19 pandemic


Department of Anaesthesiology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India

Date of Submission07-Dec-2021
Date of Decision31-Jan-2022
Date of Acceptance01-Feb-2022
Date of Web Publication15-Jul-2022

Correspondence Address:
Gadde Srinivas
Department of Anaesthesiology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dypj.DYPJ_70_21

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  Abstract 

Anesthesiologists’ skills are successfully used in the process of distributing care in the COVID-19 pandemic. The first case of COVID-19 in India was reported on January 30, 2020. Since then, this disease placed the entire health system of the world under immense pressure. Approximately 4% of patients with coronavirus disease required ICU admissions. The government had canceled all elective procedures and ordered new ventilators and built new hospitals to meet this unprecedented challenge. The importance and the experience of anesthesiologists were greatly increased as they rose to the occasion and played an important role in handling the crisis. Residents were introduced to this new world of ICU. This time anesthesiologists acted as the specialized physicians with knowledge of the pathophysiology of organ systems both under normal and stress conditions. The virus is known to spread by aerosol or respiratory secretions of symptomatic patients where viral load is higher. So as health professionals, we were also at high risk; no matter how many precautions we took. Personal care of every affected person was very important. Management took proper care in providing us with all necessary paraphernalia for personal protection. The most significant emotional challenge was dealing with the families of the patients and making them understand that everything was done to offer their loved ones the best possible care.

Keywords: Anesthesia, COVID, experience, ICU, resident


How to cite this article:
Sathish A, Srinivas G, Nagpal A, Roy R, Vyas V. Experience as anesthesia resident in intensive care unit during COVID-19 pandemic. D Y Patil J Health Sci 2021;9:133-5

How to cite this URL:
Sathish A, Srinivas G, Nagpal A, Roy R, Vyas V. Experience as anesthesia resident in intensive care unit during COVID-19 pandemic. D Y Patil J Health Sci [serial online] 2021 [cited 2022 Aug 8];9:133-5. Available from: http://www.dypatiljhs.com/text.asp?2021/9/4/133/351085



In December 2019, China reported clusters of pneumonia in the city of Wuhan. Followed by then on December 31, the Centre for Disease Control and Prevention of China described a new coronavirus and announced the first stage of an outbreak. In addition to coronavirus SARS-COV and coronavirus MERS-COV, the world would be facing a new virus named SARS COV-2, which leads to severe acute respiratory syndrome and named by the World Health Organization (WHO) as the coronavirus disease-2019 (COVID-19).

The first confirmed case in India was reported on January 30, 2020 in Kerala. Later this disease was declared as a pandemic by WHO. Since then, this disease placed the entire health system of the world under immense pressure. As the infection spread, the number of infected patients requiring hospital admissions was overwhelming, displacing care for other groups. Many required intensive care unit (ICU) admission. In places, the number of patients requiring ICU admissions far exceeded the number of ICU beds and care providers normally available.

Approximately 4% of patients with coronavirus disease required ICU admissions. The government had canceled all elective procedures, ordered new ventilators, and built new hospitals to meet this unprecedented challenge. However, intensive care ultimately relies on human resources. There raised the duty and importance and the experience of an anesthesiologist who rose to the occasion and played an important role in handling the crisis

My experience with COVID-19 started in August 2020. Everything starting from there was a new experience and a different environment not only for me but for every resident. Senior anesthesiologists as intensivists remain at the center and guide us to enter the world of critical care. Anesthesiologists skills are successfully used in the process of distributing care in the COVID-19 pandemic. As COVID-19 has been described as a national emergency and an entirely new situation that happened in 100 years, handling this emergency required a lot of patience, skill, knowledge, and at the same time dedication. In such a difficult situation, anesthesiologists rose up to the occasion, used their knowledge and skill at the same time, described protocols, and started to manage the ICUs with suspected and confirmed cases of COVID-19. As an anesthesia resident, this was critical and more of a challenge.

I work at an institution with enormous resources. Even though, we were challenged in a way that nobody could ever have imagined or predicted. The patients requiring critical care doubled every single day and the resources available to us would not suffice. As all the elective procedures were canceled through a colossal logistical effort, our medicine wards, surgery wards, and the postoperative recovery rooms were all converted to ICU; just like they did in Massachusetts and Boston. At least one operating theatre complex with two operating rooms was dedicated only for emergency surgeries of COVID-19 positive patients. Every such ICU was provided with ventilators, monitors, oxygen sources, and all other necessary requirements within a matter of time.

In ICUs, there were three shifts and 4 days of duties per week. It was an 8 h shift and every night duties were followed by an off day. Our typical duty day starts at 6:45 am if it is a morning duty so that we can take enough time for proper donning and also get enough time to take handover from our previous colleague who was in the duty before us about the patients. We were given proper training in donning and doffing before our duties started. We entered the ICU after doing proper donning and also after covering our face with an N95 mask followed by a surgical mask. Wearing personal protective equipment (PPE) for a complete 8 h was exhausting. We could not feel anything; we were sweating profusely and would be feeling tachycardic as the temperature of our body shoots up. But we all did it like thousands of other doctors across the country for serving the patients.

Each ICU was given to one senior resident and one junior resident and two entire ICUs were managed by senior anesthesiologists as intensivists. As juniors, we were always under the constant guidance of our seniors. Residents were introduced to this new world of critical care. This time an anesthesiologist acted as the specialized physicians with knowledge of the pathophysiology of organ systems under both normal and stressful conditions

The COVID-19 cases were managed as acute respiratory distress syndrome (ARDS) here in our hospital. We started with sending daily blood investigations, arterial blood gas (ABGs), and chest X-rays. Procedures such as central line and arterial line insertions were done in the ICU daily. We were given training in that and got the opportunity to do it as routine procedures in COVID-19 ICU. For patients going into renal failure or acute kidney injury, hemodialysis catheter insertion along with hemodialysis was also done in COVID-19 ICU. We were also given prior training in using video laryngoscopes. As it is the safest method to reduce our own exposure while doing intubation. Almost all emergency endotracheal intubation in COVID-19 ICU was done using video laryngoscope. All the endotracheal intubation for mechanically ventilating the patients was done on daily basis under proper guidance and supervision. Mechanical ventilation recommendations for COVID-19 patients are the same as for a patient with ARDS. All ventilated patients were kept in pressure-regulated volume control (PRVC) mode (if intubated), biphasic positive airway pressure (BiPAP), and continuous positive airway pressure (CPAP) modes. Even emergency tracheostomies were also done; almost all patients were advised to lie in a prone position. The most significant emotional challenge was to make the families of the patients understand that every best possible care was done to their loved ones. We had to be a connecting bridge between patients and their families. We made sure that the right information about the patients was informed to their kin at the right time. Daily counseling through phone, some in person, was carried out and also consents for the procedures done in ICU were also taken. As residents, it was our daily routine and responsibility to do. And as human beings, it was emotionally challenging for each one of us.

The virus is known to spread by aerosol or respiratory secretions of symptomatic patients where viral load is higher. So as health professionals, we were also under a lot of risks no matter how many precautions we took. Even residents, intensivists, and supporting staff also turned positive. It was a difficult situation seeing our own friends, seniors, teachers, colleagues tested positive. Our entire emergency department turned positive during this course of care and was forced to shut the entire emergency medicine ICU. At that time anesthesia department took control and started taking in emergency patients requiring ICU admissions. The staff who were tested positive were all isolated; many of them required hospital admissions. Some of them were also admitted to ICU. But they were also given the best quality care, treated symptomatically and almost all of them came out of the perilous situation successfully.

Personal care of each person was very important. Management took proper care of that by providing us with necessary PPE kits, N95 masks, sterile gloves. They also made sure that each person working hard in that difficult time got proper healthy meals at the right time to boost up the immunity. We were given healthy meals even in the early morning hours and late nights. We were also advised to take tablets hydroxychloroquine, vitamin C, and Zincovit as prophylaxis

My most vulnerable moment during this experience in pandemic occurred when I had seen a 29-year-old young doctor who served in the COVID duty during the early months came to our ICU in severe ARDS. We intubated the patient, provided him with high dose of steroids, antibiotics, thromboprophylaxis, ionotropic support, and everything. But nothing could not save his life. Experiences like these remind us that doctors are also humans, and they need time to step away and de-stress just like anyone else, although that was not exactly possible during the pandemic. As soon as I stepped into my home, I took a bath and slept, like all my colleagues and so I did not get time to absorb all those emotions which we experienced throughout the day.

Coordinating and preparing for a pandemic is not simple. The vulnerability that doctors might feel also has a lot to do with the fact that COVID-19 is a new disease, and all they have to work on at present are some options for symptomatic patients. There is no ultimate cure, so as doctors all they can offer is devoted care, companionship to a degree and repurposed drugs that may or may not work depending on the prognosis of the patient. We always have to expect the worst. In a way, we, as doctors, felt as helpless as the patients but what we had to do was work together as a team, learn from each other, make our patients comfortable, treat them as much as we can and assure them that we are here for them. For each one of us, that was more than a duty, it was a gift to help and to bring hope to people. Our message must always be resiliency amid adversity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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