Critically Ill Covid Patients: ICU bed, ventilator ever more elusive | The Daily Star
12:00 AM, April 22, 2021 / LAST MODIFIED: 02:28 AM, April 22, 2021

Critically Ill Covid Patients: ICU bed, ventilator ever more elusive

Only families with critically-ill Covid-19 patients know the pain of trying to find an intensive care unit (ICU) bed at this point. ICU wards are chock-full all over the city, while critical patients have their clocks ticking.

Unless one is an inpatient already, getting an ICU bed at a public hospital at the eleventh hour is a pipe dream.

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After talking to several such families outside the ICU at the Dhaka Medical College Hospital, one thing that became clear is many doors needed to be knocked upon before an ICU seat could be managed.

At the 10-bed ICU at Kurmitola General Hospital, 30-32 patients from the wards vie for a bed every single day, according to doctors there.

The only option left are the private hospitals.

The Directorate General of Health Services (DGHS) has listed 29 private hospitals with 476 ICU beds in Dhaka city that treat Covid-19 patients, but the actual number is a bit higher.

The relief of finally finding a bed, however, is insurmountable.

One would think that the patient has finally found safety. But then imagine the condition of the patient getting worse, the patient needing concentrated oxygen or intubation and the family discovering that the ICU bed given to them does not have a ventilator.

The search for another bed then begins all over again -- the same frantic phone calls to an endless list of hospitals, all of whom seem to have the same thing to say -- they do not have any beds empty, any ventilators free.

The World Health Organisation put invasive ventilators, continuous positive airway pressure (CPAP), bi-level positive airway pressure unit (BiPaP) and high-flow nasal cannulas in its list of priority medical devices a hospital must have to provide care to Covid-19 patients.

The situation is dire in ICUs for Covid-19 patients across most private hospitals in the country. There are of course exceptions with some of the oldest, legacy hospitals or franchise hospitals having as many ventilators as ICU beds.

Samorita Hospital, for example, has 12 ventilators and four high-flow nasal cannulas against 8 ICU beds. Comfort Hospital also had as many ventilators as ICU beds.

But The Daily Star visited over 16 private hospitals in Dhaka and found that the number of ICU beds do not match the number of life-saving equipment, like ventilators.

To be fair, the ventilator crisis is acute all over the world and the sheer scale of the demand was first felt when the pandemic began last year.

But then, a year has gone by and the reality still has not changed.

"We have 10 ICU beds for Covid patients, five ventilators and six high-flow nasal cannulas," said Mir Omar Faruk, manager (hospital and business development) of Hi-Care General Hospital in Uttara. Every day, the hospital receives up to 15 calls -- all seeking an ICU bed, but they can rarely be accommodated.

"A patient who has been trying for three days just got admitted," said Faruk yesterday.

Around the area lies Shin-Shin General Hospital, which has six ICU beds and two ventilators, but no high-flow nasal cannulas, said its manager Md Zahidul Islam. "If the patient suddenly needs a ventilator and one is not free, they ask us for options, we refer them elsewhere."

Also in the general vicinity, Crescent Hospital has 25 ICU beds, but only 10 ventilators and 10 high-flow nasal cannulas, according to the information desk of the hospital.

At Dhanmondi Clinic on Green Road, a large ICU exists with 17 beds, informed the department in-charge. However, the number of ventilators is seven while the hospital is stocked with five high-flow nasal cannulas.

At Cure Specialised Hospital on Bijoy Sarani, one can find eight ICU beds, but there are five ventilators and five high-flow nasal cannulas against those beds, said Rabiul Alam Shahin, the assistant director in charge of the hospital's administration.

When asked about the mismatch, he said, "We have closed off an entire operation theatre to accommodate this ICU simply thinking about the current crisis."

Every day, the hospital gets up to 20 calls. It cannot cater to the callers' needs. Last week, when the hospital was visited, there was a backlog of two patients from the ward.

New Life Hospital has 10 ICU beds with eight ventilators and four high flow nasal cannulas, said the hospital's manager (HR & Admin) Mostafizur Rahman.

On the other hand, Padma General Hospital's six ICU beds are equipped with four ventilators and three high-flow nasal cannulas, informed the hospital's manager Md Salim Reza. "We get up to 20 calls a day but it is impossible to help them. Once a bed empties, it takes a maximum of 2-3 hours for it to get filled up."

AMZ hospital has 10 ICU beds and eight ventilators and high-flow nasal cannulas. "We get over 200 calls every day from patients seeking ICU beds. Our wards have between 2-4 patients each day needing the ICU," said the person in charge of the information desk at the hospital.

Better Life Hospital has 24 ICU beds but has 12 ventilators and only two high flow nasal cannulas, said Tanvir Uddin Ahmed, the hospital's deputy director.

At Dhanmondi General and Kidney Hospital, seven ICU beds have five ventilators and two high-flow nasal cannulas, said their Director of Administration Shameem Mahboob.

"If a bed does not have a ventilator, it is not an ICU bed. There needs to be as many ventilators as beds," stated Debrata Banik, the president of Bangladesh Society of Anaesthesiologists, and professor at the department of anesthesia, analgesia and intensive care medicine at Bangabandhu Sheikh Mujib Medical University.

Almost all the private hospitals visited said that they do not stock more ventilators because not all intensive care patients need mechanical ventilators. However, many experts disagree.

"A patient can deteriorate at any time without prior notice. Not only must an ICU bed have a ventilator, there must also be spares in case one stops working," said Shahjad Hossain Masum, department in charge of the ICU at Kurmitola General Hospital.

"High-flow nasal cannulas are also necessary. First, we have to try to oxygenate the patient with non-invasive ventilation using high-flow nasal cannulas and when that fails we have to go for mechanical ventilation," said Banik.

The problem of not having enough high-flow nasal cannulas was acutely felt by the family of a female patient, who was receiving treatment at an ICU at the one of the hospitals mentioned above.

The patient -- who died on April 10 -- had to be intubated directly when her oxygen saturation levels fell because the ICU did not have enough high-flow nasal cannulas, alleged her family.

"We consulted external doctors to understand whether our mother really needed life support and all of them said she should have been given non-invasive ventilation first," said the son of the patient.

Since the patient's family requested anonymity, this report is also refraining from mentioning the hospital's name.

 

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