RT Book, Section
A1 ten Lohuis, Caitlin C.
A1 Meissen, Heather
A1 Casey, Katherine R.
A1 Coopersmith, Craig M.
A2 Lane-Fall, Meghan B
A2 Shapiro, David S.
A2 Kaplan, Lewis J.
SR Print(0)
ID 1204537610
T1 Family Presence on Critical Care Rounds
T2 After the ICU: Multidisciplinary Perspectives on Supporting Critical Illness Survivors
YR 2024
FD 2024
PB McGraw Hill
PP New York, NY
SN 9781260469257
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1204537610
RD 2024/09/11
AB Patient  Care  ReflectionIt  is  human  nature  to  yearn  for  safety,  protection,  support,  and  love  when  one  is  scared  or  sick—a  familiar  face,  the  touch  of  a  loved  one,  a  family  member’s  soothing  voice.  The  SARS-CoV-2  pandemic  with  its  associated  limitations  on  hospital  visitation  has  stripped  patients  of  these  vital  human  needs.  There  are  new  innovative  avenues  by  way  of  FaceTime  or  Zoom  calls  to  connect  patients  and  loved  ones  from  a  distance;  nonetheless,  there  is  no  substitution  for  in-person  human  presence.During  this  time  when  visitors  are  extremely  limited  and  oftentimes  not  permitted  within  hospital  walls,  the  bedside  staff  are  the  sole  bridge  connecting  patients  and  loved  ones.  Prepandemic,  it  was  a  common  sight  to  walk  by  a  critically  ill  patient’s  room  and  see  a  loved  one  perched  in  a  chair  with  their  hand  blanketed  overtop  the  patient’s  fingers.  Albeit  sometimes  in  silence,  hearing  the  hum  of  the  ventilator,  their  presence  provided  a  sentiment  of  comfort  and  familiarity.  The  pandemic  created  a  starkly  contrasting  reality.  Once  a  SARS-CoV-2  patient  becomes  ill  enough  to  require  ICU  care,  their  fear  is  borderline  insurmountable.  They  are  in  a  closed  room,  isolated  and  alone,  and  their  only  human  compassion  and  support  is  the  frontline  providers  at  the  bedside.  Suddenly  strangers  become  family,  and  the  importance  of  human  care  surpasses  that  of  medical  care.  Taking  the  time  to  sit  in  a  patient’s  room  and  quietly  keep  them  company  so  they  feel  safe  to  close  their  eyes  is  the  most  valuable  intervention  you  can  provide.Once  a  patient  deteriorates  enough  to  require  ventilator  support,  many  do  not  survive.  One  occurrence  that  has  been  pivotally  impactful  has  been  the  number  of  times  that  I  as  a  frontline  provider  am  the  last  person  to  speak  with  a  patient.  Generally,  SARS-CoV-2  patients  are  completely  lucid,  just  extremely  hypoxemic.  Once  the  hypoxemia  progresses  beyond  the  limits  of  noninvasive  oxygen  support,  intubation  is  the  next  step.  There  is  chaos  and  buzzing  activity  around  the  patient’s  bed  including  gathering  supplies  and  setting  up  machines  in  preparation  for  placing  the  patient  on  the  ventilator.  Meanwhile  the  patient  sits  in  the  hospital  bed,  terrified  of  the  uncertainty  and  staring  down  the  barrel  of  mortality.  Once  SARS-CoV-2  patients  get  intubated,  it  is  typically  a  tumultuous  and  long  recovery,  including  prolonged  periods  of  time  on  the  ventilator,  significant  muscular  atrophy,  and  almost  always  severe  encephalopathy.  Many  of  the  patients  suffer  complications  leading  to  death  or  never  wake  up  to  full  neurologic  functioning.  It  dawned  on  me  that  there  is  a  “golden  window”—this  period  of  time  just  before  intubation  may  be  the  patient’s  final  moments  awake  in  life.  Secondarily,  it  dawned  on  me  how  significant  it  is  during  this  “golden  window”  to  put  forth  great  effort  in  connecting  the  patient  with  the  family  via  telephone  or  video  call,  as  it  may  be  the  final  time  they  speak.  Honoring  the  “golden  window”  is  now  incorporated  into  my  intubation  checklist.In  a  time  where  it  is  extremely  busy,  hectic,  and  easy  to  get  frazzled  in  completing  innumerable  tasks,  the  SARS-CoV-2  pandemic  has  reminded  me  ...