Six states in the country currently have an ICU capacity of less than 10% because of an influx of COVID patients. Kentucky is one of them. So what is the reality if you end up needing the most critical care for the virus? Dr. Kevin Hatton, Clinical Professor of Anesthesiology and Surgery and the Vice-Chair for Anesthesia Research at the University of Kentucky takes us to the frontline of the ICU.
KC: Dr. Hatton, within the purview of what you're able to share, can you give listeners insight as to what you're actually looking at if you end up in the ICU, or, God forbid, on a ventilator with COVID?
Dr. Hatton: So I think many people that are not familiar with modern healthcare or are not nurses, physicians, or others that are actively engaged in what patients in the ICU undergo. I think it's probably important that patients and their families understand what modern healthcare looks like. And admittedly, this is entirely related to trying to get the best outcomes out of patients. But I find that many patients and their families have this vague idea of, quote, life support and the reality is that that's an enormous gradation of what we can offer to patients to try and keep them alive.
Most patients, as you've pointed out, will require mechanical ventilation, which is typically given through a breathing tube placed through the mouth. It’s a plastic tube a little smaller than a snorkel if anyone has ever had that. But it goes into your windpipe, which is very different than a snorkel that's connected to a machine that blows air into the patient's lungs. And there are many different settings. There's a very sort of a gentle setting, and then there's a very, very, very severe setting based on how affected the lungs are.
And many patients in the ICU, particularly during this COVID surge, require very, very high ventilator settings.
The ventilator settings, by and large, are not painful, but we frequently do have to deeply sedate patients, almost putting them into what might be thought of as a medically induced coma just so that they can get an adequate amount of oxygen into their bodies. I think many people don't realize that this medically induced coma that is sometimes required is not good for a patient, is not good for their long-term ability, but it's necessary.
They lay in bed, they don't move, they can become very deconditioned. Their muscles can atrophy, and it puts them at risk for many other types of long-term complications. So there are short-term problems from modern health care, and there are long-term problems from modern healthcare, all designed around keeping the patient alive. And I think that sometimes these problems get lost in families.
So patients are on the ventilator. Patients are placed in a medically induced coma. Patients may be put in a prone position where they're lying on their belly and then turning onto their back. This requires, like six or seven different health care workers to do. We can't just ask a patient to flip over. This requires a lot of health care workers. Just the turning back and forth can be risky and problematic for patients, and not all patients can even tolerate it.
Patients will require feeding tubes to keep them fed during this time period, and if their oxygen levels can't be supported even with this amount of work, then some patients may require what we call Extracorporeal Membrane Oxygenation, or ECMO for short, which I think some people have started to see in social media’s descriptions of. This is a very, very specialized kind of care that's provided to patients and only provided in very specialized centers, but it basically takes blood out of the body, puts it through a special machine that adds extra oxygen in, and removes carbon dioxide. So replacing some portion of lung function and then puts the blood back into the patient's body.
KC: Are these treatments done at the same time?
Dr. Hatton: It’s not an either-or, it’s an and. If your lungs are so bad that the ventilator does not work, then in selected patients, we can offer ECMO. We know that only about half the people at best that get put on ECMO will survive. And if you do survive, you will need approximately one month before you can be removed from ECMO and several more weeks before you can be removed from the ventilator. So once you get into that position, it's probably six to eight weeks at best before you're back off the ventilator.
If you survive.
KC: So ECMO is not just a one-time treatment.
Dr. Hatton: It runs continuously 24-7. The other thing is that we currently have a waiting list. Our waiting list is about 20 patients deep.
KC: Of COVID patients?
Dr. Hatton: Of COVID patients whose lungs are so bad that the ventilator doesn't work and that physicians call us and say, this person needs ECMO. Please help us. And we say we have used all of our machines, but we will happily put you on the waiting list and get back to you when we have a machine available for you.
KC: Dr. Hatton, do you think we're at a stage where we're so used to seeing things on the screen, be the TV screen or in the movies where terrible things happen and then they're out for 30 minutes and then they're up and everything is fine. Do you think there is a disconnect with the reality that what you just described and what people really think would happen if they were to get severely ill?
Dr. Hatton: I think that's an excellent observation that TV and other venues for entertainment are not accurate reflections, for the most part, on what happens from patients who suffer cardiac arrest and are immediately back awake or patients who are put on the ventilator and then you know are awake just a few minutes later. The entertainment industry is entirely that right? Entertainment. And it's based in fiction and fantasy and is not a reflection of health care. My family laughs at me all the time because I sort of throw my hands up in quasi discussed every time I watch TV and something like that happens. It's the reality of the world we live in. And you're 100%correct. There is a significant disconnect.
KC: If you are sick with COVID to the point that you are getting these types of treatments, you may be there for a while. Am I accurate?
Dr. Hatton: If you require these kinds of treatments, you're going to probably be in the ICU about a month. You're going to be in the hospital several months. You're going to then require additional months of rehabilitation, probably as an inpatient rehabilitation, you may require a long-term breathing tube. You may require a long-term feeding tube. You may not be able to walk for many months, maybe even as much as a year. You may never get back to normal life.
KC: What's the correlation between the number of patients you're seeing who need this level of care to vaccinated compared to unvaccinated?
Dr. Hatton: So I think the current data is something like 85% of our hospitalized patients with COVID are unvaccinated. Something like 95% of our ICU patients are unvaccinated. 100% of our patients on mechanical ventilation and ECMO support are unvaccinated. The correlation is very clear, very strong, and it is indisputable that vaccination dramatically reduces your risk of requiring ECMO, the ventilator, the ICU, hospitalization, and all of the negative ramifications of all of those things.
KC: Dr. Hatton, what's been the toll on you and your staff?
Dr. Hatton: You know, we are several weeks into this with no end in sight. I think there are two scary things. The first is that we are all exhausted. In fact, quite honestly, we were all exhausted before the most current surge happened. And this is just another layer. I’m asking all of my physician colleagues,me included, we are doing almost twice as many shifts as we normally would. The nursing staff is exhausted, and when we say exhausted, we don't just mean physically, we mean emotional, spiritually drained.
Every time I have to go into the hospital above and beyond, my normal calling is a day that I can't be with my family, my wife, and my kids, and I'm losing out on being a person. I'm missing out on my life to help people. And I know that that's part of my calling and part of my job, but it feels so needless above and beyond what I normally do. And that's okay. I've made that decision for me, but it's hard when I see my colleagues who have young children at home, right of their own, and they're doing more and more and more, and that's great for the patients. But I know that that means that they're doing less and less and less for their own families and their own well-being in their own lives. And the long-term ramifications of that are unknown but to me are heartbreaking.
KC: And many, as you just mentioned, with young children who cannot be vaccinated, yet there must be that added level of fear of potentially being a carrier.
Dr. Hatton: I'm fortunate enough. I have two teenage boys. Maybe some of your listeners wouldn't say that's very fortunate. But I have two teenage boys that were vaccinated within the first few days of them being able to because of their age. So I can't honestly imagine what that concern, that anxiety for folks who have children that are too young to be currently vaccinated. You're right. That must be an extra layer of stress that I can sort of think about, but I can't actually live in because I don't.
KC: What message do you have to anyone who's listening now who has been putting it off for whatever reason to get them to make that final drive to go get that shot?
Dr. Hatton: I think for many people, vaccination is not just about them, but it's about the people around them. If you're not getting vaccinated yet, because of whatever reason that's related to you, think about the effect that that has on the people around you, not just your family but everyone else in your community and the health care workers and the people related to health care workers and the people related to the people related to everyone else. We all live in a community that's intertwined, and it's easy for each of us individually to think that this disease is only going to affect me or a limited number of people.
But the reality is that because we're all interconnected in some way, it affects us all in some way. Know that this disease has the potential to be very severe, potential to be lifelong debilitating and not just for you, but for those people around you, those you love, those you interact with and those that you don't yet know, but will, unfortunately, get to know you and your family very well.
KC: Dr. Hatton, how would you compare the situations you're seeing now in the ICU to pre Delta and pre vaccinations?
Dr. Hatton: For us at UK, this is for sure the worst it's been. It is as bad as it was in December or January, probably honestly, a little worse. December and January were very hard times for us. This is as bad or worse. The disease is as severe in the unvaccinated as it ever has been. And the really scary thing is that although we hope that it will start to get better in the next few weeks, the reality is we don't know, and we're already reaching our limits in terms of bed space, nursing capacity, physician capacity supplies capacity, and we're making good progress towards keeping people alive, but at significant long term cost to them and to health care workers.
KC: And we're still in a situation where some people are dying without any family in the room. Correct?
Dr. Hatton: We do allow some families in, but you're right. There is a significant curtailing of visitation. And there are people that are dying without the ability to have family present. No patient dies alone. They may die without their family.
KC: So your staff is having to pick up that end, too.
Dr. Hatton: Yes, ma'am. Those of us who are already exhausted are having to pour even more in to make sure that people don't die. Alone.
KC: You've been listening to Dr. Kevin Hatton with anesthesiology and surgery at the University of Kentucky. Our sincere thanks to him and all the men and women who are working on the front lines, doing everything they can to save lives during this pandemic. I'm Karen Czar. And you've been listening to ‘One on One’ with WUKY.