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Coronavirus: Why are patients put into intensive care?

Consultants explain what happens when coronavirus patients are admitted and how doctors work to help them recover.

Image: Protecting the organs and giving fluid and nutrition are two reasons patients are given intensive care
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The symptoms of coronavirus can vary hugely from person to person, but those most badly affected will require intensive care in hospital.

Among them is Prime Minister Boris Johnson, who was admitted to ICU (Intensive Care Unit) after his condition worsened.

But what are the reasons for moving a coronavirus patient from a ward to ICU? And what sort of treatment do doctors and nurses provide?

Sky News has spoken to a number of consultants.

Boris Johnson in the first video he posted to Twitter after testing positive for coronavirus
Image: Boris Johnson in the first video he posted to Twitter after testing positive for coronavirus

What has to happen for you to end up in intensive care?

Patients end up in intensive care when COVID-19 makes it very difficult for them to breathe, which in worst cases can cause them to develop pneumonia - fluid on the lungs.

They also may require sudden access to equipment to aid breathing that is not available on general wards.

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Mervyn Singer, professor of intensive care medicine at University College London (UCL), told Sky News that being placed on an intensive ward meant the patient needed "greater support and monitoring".

"In a general ward, the doctors cannot offer the kind of expertise needed and don't have the equipment to place someone on a ventilator," he said.

London doctors and engineers have unveiled a prototype ventilator that's simple enough to mass-produce in a fortnight, soon enough for the expected surge in coronavirus patients.
Image: Ventilators are used on coronavirus patients who have the most difficulty breathing

Will a patient in ICU definitely be put on a ventilator?

No.

There are less invasive methods by which their breathing can be assisted - starting with an oxygen mask and then potentially more specialised types of non-invasive support such as a CPAP (continuous positive airway pressure).

CPAP breathing aids, described by Professor Singer as a "very tight and pressurised mask", have been developed by UCL and Mercedes for use in treating coronavirus patients.

Derek Hill, professor of medical imaging at UCL, said they bridge the gap between an oxygen mask and ventilation.

However, data from the Intensive Care National Audit & Research Centre (ICNARC)* shows that 63% of COVID-19 patients do receive ventilation within 24 hours of admission.

Undated handout photo issued by University College London of a volunteer patient demonstrating a continuous positive airway pressure (CPAP) breathing aid that can help keep Covid-19 patients out of intensive care which has been developed by mechanical engineers, medics and the Mercedes Formula One team with a team from University College London (UCL) and University College London Hospital (UCLH). PA Photo. Issue date: Monday March 30, 2020. See PA story HEALTH Coronavirus. Photo credit should read: James Ty/UCL/PA Wire..NOTE TO EDITORS: This handout photo may only be used in for editorial reporting purposes for the contemporaneous illustration of events, things or the people in the image or facts mentioned in the caption. Reuse of the picture may require further permission from the copyright holder.
Image: The continuous positive airway pressure (CPAP) breathing aid

What does a ventilator do?

They do the majority - or all - of the patient's breathing for them.

When a patient is put on a ventilator, something called an endotracheal tube is guided through the mouth and into the windpipe. Patients are given anaesthetic or sedation for this procedure.

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Coronavirus: The infection numbers in real time

Dr Ron Daniels, an intensive care consultant from University Hospitals Birmingham NHS Trust, told Sky News that ventilators are in high demand at the moment.

"We wouldn't normally use these resources for someone about whom we weren't pretty concerned," he said.

Patients can also be fed at the same time through a tube going into their stomach via their nose.

Doctors have also found that patients can benefit from being placed on their tummy while being ventilated, as it can assist with the distribution of oxygen around the body.

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What are the medical objectives in ICU?

The goals of those caring for coronavirus patients in intensive care are:

  • Protecting the organs
  • Trying to maintain good kidney and heart function
  • Giving fluid and nutrition
  • Trying to prevent secondary complications like new infections

All these things can happen when the lungs aren't working properly.

Coronavirus UK tracker: How many cases are in your area – updated daily
Coronavirus UK tracker: How many cases are in your area – updated daily

Secondary infections are a risk for those who suffer pneumonia as a result of COVID-19, and so medics will use antibiotics and other anti-viral medication to counter that threat.

Professor Singer said that while "respiratory failure" was the primary condition of a COVID-19 patient in intensive care, doctors must also work to prevent a "domino effect" of other organs being compromised.

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Inside Naples' model hospital

What treatments do patients receive besides being put on oxygen?

Dr Simon Clarke, a microbiologist from the University of Reading, told Sky News that hospital patients would normally also be supported with fluids and drugs such as paracetamol to help tackle symptoms.

Treatments are designed to try to help prevent what is known as a cytokine storm - a severe auto-immune reaction.

Urgent care doctor Kishan Rees told Sky News the cytokine storm happens when "the body's natural defences are overwhelmed and the body shuts down with multi-organ failure".

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'We're really climbing towards that peak'

How long can someone be in intensive care?

Patients given CPAP can see a turnaround in their condition in two to three days, according to Professor Singer.

But those patients who need to be placed on a ventilator tend to be in intensive care for 10 to 14 days, and some receiving treatment for coronavirus can be ventilated for up to three weeks.

Other illnesses have seen people ventilated for months, Professor Singer added - but that has not been the case anywhere in the world with COVID-19.

"Clearly if you can avert the need for ventilation, from my experience it's better for the patient," he said.

Health Secretary, Matt Hancock at the opening of the NHS Nightingale Hospital at the ExCel centre in London, a temporary hospital with 4000 beds which has been set up for the treatment of Covid-19 patients. PA Photo. Picture date: Friday April 3, 2020. Split into more than 80 wards containing 42 beds each, the facility will be used to treat Covid-19 patients who have been transferred from other intensive care units across London. See PA story HEALTH Coronavirus Charles. Photo credit should read: Stefan Rousseau/PA Wire
Image: NHS Nightingale Hospital at the ExCel centre in London will treat intensive care patients

What happens after treatment?

The ICNARC (Intensive Care National Audit & Research Centre) has recorded outcomes for 690 COVID-19 patients - of whom 346 patients have died and 344 were discharged (1,559 are still in care as of 3 April).​​​

Those who are critically ill and are discharged can take several weeks or even months to fully recover.

Post-intensive care syndrome are problems that persist after treatment and can include physical, cognitive and psychological issues that can take a long time to clear up.

Dr Carl Waldmann, an intensive care consultant from Royal Berkshire Hospital, told Sky News: "All patients that have been in intensive care do require longer than usual to be allowed to go back to work.

"It is recognised that you need a gradual return - we do need to assess them and make sure they are fit and well mentally and physically before we say they can go back to work."

*Data covers the first reported 2249 intensive care patients with confirmed COVID-19 in the UK.