COVID19 Intensive care choices

[Old Greg]

Are all ICU patients ventilated?

No, but the overwhelming majority will be on admission, or with the plan to ventilate on admission. Patients will often stop being ventilated before discharge from ICU, but some will remain ventilated on transfer to a unit such as HDU.

[Lance]

Imagine a tramp is in intensive care with COVID. All other intensive care beds are full. A young doctor is in urgent need of care. Do you remove the tramp to die or leave the doctor to die?

they will use a triage process to decide.
Like they always have done.

[NotAllThere]

The ethical response if the alternative is murdering someone else. But in practice, the tricky ethical decisions tend to be more on deciding which patients to admit to ICU. Denial of admission to ICU on the grounds of futility is common enough in the UK, more so than in countries with more ICU beds per capita. It is one of the reasons why the UK has had comparatively low deceased organ donation rates - patients who are likely to die with the potential for organ donation are less likely to be admitted to ICU (denial being on the grounds of futility).

If things get bad, decisions may need to be made as to which patient would benefit more from the ‘last’ ICU bed.

Deciding who gets the last bed is entirely different from turfing out someone who's already got one, which is the original scenario.

[Old Greg]

they will use a triage process to decide.
Like they always have done.

Not if someone is already in the bed and needs the bed.

[minestrone]

No, but the overwhelming majority will be on admission, or with the plan to ventilate on admission. Patients will often stop being ventilated before discharge from ICU, but some will remain ventilated on transfer to a unit such as HDU.

So you have both the tramp and doctor ventilated?

Have you ever been told not to make clinical decisions Greg?

[Hobosapien]

Not if someone is already in the bed and needs the bed.

Convert it to bunk beds.

Fit enough to climb into bed then you don't need a bed. Catch covid-22.

[Old Greg]

So you have both the tramp and doctor ventilated?

Have you ever been told not to make clinical decisions Greg?

It’s just a conversation, Minny. Take a look at the ICNARC dataset if you’re bothered.

[minestrone]

It’s just a conversation, Minny. Take a look at the ICNARC dataset if you’re bothered.

You've never used that defence before.

I googled and it's 150K homeless. 350k Doctors. I've read dozens of articles about ethnic NHS staff being in hospital, but never a homeless person.

Doctors pull favours. They got a professor out of bed to do my wife's caesarean, the doctors in the hospital were sidelined. I get a professor to review my asthma.

It's not a fair system as you present.

[Old Greg]

You've never used that defence before.

I googled and it's 150K homeless. 350k Doctors. I've read dozens of articles about ethnic NHS staff being in hospital, but never a homeless person.

Doctors pull favours. They got a professor out of bed to do my wife's caesarean, the doctors in the hospital were sidelined. I get a professor to review my asthma.

It's not a fair system as you present.

I didn’t present it as a fair system when it comes to decisions re admission. I said that people don’t get removed from ICU care if they need it, for the purpose of admitting another patient. If you have evidence that it has happened, report it to the police.

[minestrone]

So you get told not to make clinical decisions.