COVID-19 & Tele-ICU

What role did tele-ICU play in meeting the challenges of the COVID-19 pandemic?

The global outbreak of COVID-19 has highlighted the essential role that new technologies can play in the provision of critical care in the 21^st century.  Tele-ICU has enabled clinicians to treat critically ill COVID-19 patients without risking exposing themselves or those around them to the highly contagious illness. It has also given smaller, outlying hospitals unprecedented access to quality intensive care management, provided by highly trained critical care specialists. The COVID-19 pandemic has also drawn attention to the severe shortage of critical care physicians, which had been recognized as a problem even before the pandemic.

The urgent need for technology

The rapid spread and the severity of Covid-19 have wreaked havoc on the world’s medical systems. The influx of critically ill patients requiring ICU care including intubation and complex management overwhelmed many facilities, many of which were already overburdened and thinly staffed even before the epidemic.

The situation was dire in some large, urban hospitals and was even worse in many rural hospitals. These smaller hospitals lack the expertise needed to care for complex, critically ill patients and therefore, usually transfer such patients to larger, more-adequately staffed and equipped facilities. However, during the COVID-19 crisis, they had no choice but to keep many of these patients in their facilities because the larger hospitals were unable to accept transfer patients. Available ICU beds became a prime commodity, as did life-saving equipment such as mechanical ventilators.

Leapfrog impact of remote ICU

Telemedicine’s role during the Covid pandemic is two-fold: connecting clinicians with bedside providers (such as nurses and non-intensivist physicians, such as hospitalists), and patients, as well as strengthening frontline bedside teams, both irrespective of location. In addition, the challenge of the epidemic underlines particular areas in which tele-ICU has become critical care’s future. What is this future? The ability to leverage up-to-the-minute virtual technology to treat ICU patients. This technology reinforces the standard care by virtually linking highly trained specialists with ICUs. The tele-ICU staff also employ best practice protocols, manage ventilators, respond instantly to cardiac life support requirements, and are able to assist in managing aberrant situations such as a sudden influx of patients.

Telehealth during the COVID-19 Pandemic

ICU telemedicine has been an invaluable resource during the COVID-19 pandemic. Some of its most valuable contributions have been:

• Ventilation Management: Ready availability of the expertise necessary for proper utilization and adjustment of mechanical ventilation. The complexity and severity of COVID-19 patients’ respiratory illnesses often require use of cutting edge and novel techniques to assure adequate ventilation and oxygenation while minimizing lung injury. Using high-definition audio/visual equipment, virtual tele-ICU specialists can provide bedside caregivers with real-time support and take over many of their bedside tasks. They are able to adjust ventilator settings and evaluate the patients’ responses to the changes. This also serves to minimize bedside providers’ exposure to potentially infectious patients.

• Enhanced Cardiac Life-Support: Having instant access to an intensivist during management of a cardiac arrest can make the difference between life and death. The Tele-ICU clinician can often assist the bedside nurses in initiating Advanced Cardiac Life Support measures before hospital providers arrive in the room, especially when responders must first put on personal protective equipment before entering the room. Having the tele-ICU specialist assisting with the resuscitation effort often reduces the number of care team responders required in the room, thereby decreasing exposure risk for the hospital staff.

Isolation Demands Reinvention: Controlling the pandemic with general lockdowns and with social distancing has led to an increase in feelings of isolation and loneliness, resulting in a notable increase in the incidence of, especially among the elderly. This loneliness and isolation is especially prevalent among hospitalized COVID-19 patients whose isolation precautions preclude family visits and limits the number and length of direct interactions with hospital staff. Telemedicine capabilities have enabled tele-ICU nurses to fill in the gap with more-frequent video check-ins and have also been adapted for use by social workers, chaplains and other staff to facilitate emotional support for the patients while minimizing infection risk to the hospital staff.  telepsychiatry has also become an increasingly important tool in this struggle.

COVID and beyond

Throughout the pandemic, many patients in the ICU have received the care they need thanks to tele-ICU solutions.

Telemedicine companies, including RemoteICU, are playing a significant role in creating new paradigms for the use of remote technology in the provision of critical care. Hospitals can instantly receive the support of intensivists thereby improving treatment quality and efficacy, not only during the COVID-19 crisis but continuing well beyond.