The pandemic pushed ICUs to the limit. The beds, today, are almost all occupied by critically ill patients who depend on mechanical ventilation.
“A much greater complexity of the staff and the need for much more critical, much more demanding monitoring. And this, obviously, changed the characteristic of the ICUs and transformed it into an environment close to a war environment”, reports Rafael Einsfeld Simões Ferreira, coordinator of medical degree from Centro Universitário São Camilo.
The Fiocruz study shows that, across Brazil, eight out of ten patients with Covid who depended on intubation died in 2020. More than the world average, around 60%. The North region had the worst scenario: nine out of ten intubates did not survive.
The mortality rate of ICUs varies according to the region of the country, from one hospital to another. That is why doctors advocate the creation of a single national protocol, with everything that is known about the disease after a year of pandemic. This could help to recover critically ill patients and restore the vocation of intensive care units, a place designed to save and not lose lives.
Knowing how to position the patient, assess the right time to intubate and extubate, and even the oxygen flow in the respirator, can make a difference.
“I think this is a central point that the country has missed – has been missing – an opportunity to implement what has been discovered and what has been shown to work. Instead, it is discussing therapies that don’t work, which no other country adopts. It is essential to establish national protocols and recommendations so that all units, even in the interior, even in smaller units, have access to the best practices “, defends Fernando Bozza, doctor and researcher at the Oswaldo Cruz Foundation.
What drives a Covid patient to intubation is a critical condition of hypoxemia, the lack of oxygen in the blood.
In the severe form of the disease, the coronavirus affects 50, 70, 100% of the lungs, which compromises breathing. As it travels through the body carrying a high level of carbon dioxide, the blood – more acidic – has an impact on the kidneys, liver, brain, heart – a systemic collapse that can be fatal.
Ednalva Salves Souza spent two months breathing by devices: “I went to the hospital on the 5th of July. I woke up on September 7th, the doctor asking me some questions. I didn’t know where I was, nor what I was doing, nor the I had. I didn’t know. I don’t remember “.
The supervisor of the intensive care unit of the Emílio Ribas Institute, Jaques Sztajnbok, says that the measure to reduce the mortality rate is before, outside the ICU: “There is no medical system in the world capable of facing this overwhelming wave of cases new ones that are presenting themselves to day-to-day hospitals. So, our only way out today is to avoid contagion. This mathematics that we have seen, with a lethality of 80%, it has to be changed. moment when we decrease the number of cases and adapt, from the professional technical point of view and of what equipment, these remaining units “.
The Ministry of Health reported that there is an updated protocol for the treatment of critically ill patients with Covid and that, together with representatives related to the medical profession, it draws up recommendations to optimize intensive hospital care for patients with the disease.
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