Some thoughts from my nights in a new COVID ICU:
1) We are mostly being transferred patients with single organ (i.e. respiratory) failure from other ICUs to offload those units. These patients have been intubated for many days if not weeks. Weaning is slow going

2) The shortages of critical analgesics and sedatives means we are using drugs less well suited to the purpose. Using second (third? fourth?) line meds hampers our ability to quickly wean sedation when oxygenation has improved, further prolonging time on the vent #GetMeMeds

3) Relatedly, in order to limit the # of times nurses and providers enter the room, we have moved away from our usual plan of IV pushes for analgosedation and toward IV drips because pushes require nurses to enter the room more frequently #GetMePPE

4) These practice changes lead to more time on the vent, which in turn means more time to develop complications. Obvious point but important. More HAIs, more deconditioning, more delirium. I have two rising hyperbilirubinemias on my service concerning for acalculous cholecystitis

5) SO MUCH clinical understanding comes from being at bedside, and critical care involves making small adjustments with frequent reassessment. That’s tough when you have to limit adjustments and reassessments to conserve PPE! We need A LOT of PPE to do our job, not a tiny ration

(Yes, we have tried to get longer IV and vent tubing to bring pumps and vents outside the rooms to facilitate these adjustments, but we’re running out of that too #GetMeTubing)

6) Difficult to discuss goals of care with patients without their loved ones by their side to support them. And heartbreaking to call families to tell them things are not headed in the right direction. This point brings tears to my sleep-deprived eyes so I will move on

7) I love this work. It’s been amazing to go through something that—while difficult—is so affirming. Not everyone feels this way, which makes their contributions that much more profound. I could probably do without the risk of contracting a deadly virus, but you can’t win ‘em all