Doctors frame ICU guidelines

Special task force of Indian Society for Critical Care Medicine is putting together a document to guide docs on treatment strategies if there is a surge of patients

Published: 17th March 2020 11:57 AM  |   Last Updated: 17th March 2020 11:57 AM   |  A+A-


For representational purposes

Express News Service

NEW DELHI: India’s top critical care specialists have come together to roll out guiding principles that doctors across the country may adopt if confronted with burgeoning demand for intensive care unit facilities in case the novel coronavirus begins to spread into the community.

A special task force of the Indian Society for Critical Care Medicine (ISCCM) — that includes doctors from several government and public institutions like AIIMS-Delhi, Tata Memorial College-Mumbai, Gangaram Hospital-Delhi and others — is putting together a document to guide doctors on treatment strategies, critical care and allocation of limited resources in case there is a heavy surge of patients.

The development comes even as the government has said there is no community transmission yet, but top government officials such as Indian Council of Medical Research chief Dr Balram Bhargava do admit that it is “inevitable” while at the same time assuring that the government is trying hard to “flatten the graph”.

“We are coming up with tensive guideline because it’s a new virus we are dealing with and no doctor in India knows what to do in a situation like this,” said Dr Yatin Mehta, head of the task force and chairman of critical care and anaesthesiology at Medanta Hospital,  Gurugram, where 14 Italians are under treatment.

“The guidelines will guide doctors at every step — from the time a patient arrives at the hospital to his/her complete stay — and help them take decision in case they are dealing with high patient load with scarce resources,” he said, adding that the task force is in touch with the Ministry of Health and Family Welfare and ICMR.  

So far, government has not done any disease modelling to estimate total likely cases or fatalities for India, but a statement by the Jan Swasthya Abhiyan on Monday predicted that the disease could potentially infect 30 to 50% of the current adult population in the country.

“Even with a lower case fatality rate of 1% to critical care requirement of 4%, the weakened public health systems would be overwhelmed and this would lead to millions of excess deaths in the coming year,” the statement said.

ICSSM, meanwhile, said it is hoping for the best but preparing for the worst. “Since its mainly doctors and healthcare professionals who have to deal with the situation at ground-we have to lay out strategies for them,” said Dr Dhruva Chaudhary, ISCCM president and critical care specialist with University of Health Sciences, Rohtak. 

The drafting of the guidelines was necessitated by experiences in several badly hit countries like Italy and Iran where doctors in the overwhelmed intensive care units were left grappling with tough ethical questions like whom to save and whom to leave to die.

As per the World Health Organisation data, the infection that has now been declared as pandemic causes mild illness in 82 % but severe illness in 15% and critical illness in 3%. Those categorised as critical need ventilation and oxygen support. The overall death rate due to the infection has been reported at 3.4 per cent and 15 per cent people categorised as “serious cases” end up dead.


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