SICU provides critical care beyond the curve
Despite the decreasing number of COVID-19 patients in our hospitals, and many areas beginning to resume normal operations, the multidisciplinary team on one unit continues caring for some of the most critically-ill COVID-19 patients.
Faculty and staff on University Hospital’s Surgical Intensive Care Unit, or SICU, are caring for patients both newly infected and admitted, and those still in the fight for their lives months after being infected, in the wake of the devastating impact the coronavirus has had on their bodies.
A new patient population
Until March of this year, the 20-bed SICU, located on 5D, was a unit dedicated primarily to surgical patients requiring acute and specialty care. This included patients undergoing oral maxillofacial, ENT, transplant, OB/GYN and oncology procedures who were in need of pre- or post-operative critical care, or care for perioperative complications.
In March, a new patient population landed in the SICU – COVID-19 patients with severe pneumonia, acute respiratory distress syndrome, severe hypoxemia and septic shock – patients who may have been on the verge of death and whose only hope was the high technology critical care available on this unit.
The SICU team was accustomed to having a handful of patients on the unit requiring the life-saving support of ECMO (extracorporeal membrane oxygenation) for respiratory failure and CRRT (continuous renal replacement therapy) for kidney failure. However, nothing could have prepared them for the influx of critically-ill patients who would need these intensive therapies as a result of the COVID-19 virus.
“During the pandemic, half of our patients required ECMO, CRRT and other devices,” said Lena Napolitano, M.D., MPLAN medical director for the SICU. “Many of these patients were in septic shock and had multiple organ failure.”
ECMO and CRRT were needed for COVID-19 patients to support their failed organ (lung and kidney) function so their bodies could heal from the virus.
It takes a village
The nurses, acute care surgery faculty, respiratory therapists, technicians, residents, medical students and fellows on the unit all worked together to serve the quickly-expanding COVID-19 critical care population.
Jennifer Siev, B.S.N., R.N., clinical nurse supervisor for the SICU, said staff on the unit voluntarily worked hundreds of extra shifts, choosing to give back their vacation time to support each other and continue giving the best possible care to this patient population. She described the team as adaptable and flexible, rising to the challenges every day and working together to implement continuously evolving treatment plans as more was learned about the virus.
She is proud of how the team adjusted to new procedures, as well as policies and expectations that changed every day, sometimes multiple times a day.
“They definitely rose to the challenge, but the most inspirational part was the way other units networked with us to help meet patient needs,” said Siev.
“The pandemic surge was the largest challenge I personally have seen in the last 17 years,” she said. “Staff who’ve been here for more than 30 years say that this was the most difficult patient population with highest acuity the unit has ever seen.”
Siev credits the ECMO team, the SWAT team, and nurses from the Emergency Department, Pediatric Cardiothoracic Unit, Trauma Burn ICU, Central Staffing Resources and 4C for the role they played in supporting patient needs on the SICU. She is grateful for nurses who had not worked on the unit for years that returned to provide support during the height of the pandemic.
“We could not have made it without their help,” she said.
While the flattening of the curve in southeast Michigan has allowed many units to return to business as usual, that is not the case for the SICU team.
“Since we are the unit that takes adult ECMO patients for severe respiratory failure, not much has really changed for us,” said Siev. “The data might show decreasing numbers within the institution but we still have patients here today who were admitted COVID-19 positive and are now testing negative but are still incredibly sick.
“Although it’s encouraging to see the numbers going down, it’s important to remember that this is a new normal, probably for all of us, but especially in our unit.”
Napolitano said part of the unit has reverted back to a bit of a surgical ICU: “We’re also taking care of our surgical patient population, including general surgery, specialty surgery, liver transplant, and hepatobiliary patients, surgical oncology patients with large sarcomas, and OB/GYN patients with peri-partum hemorrhage.”
However, within the last two weeks, the team has begun to see new COVID-19 ICU patients who have been cannulated and placed on ECMO shortly after admission.
“We’re very fortunate that our entire SICU team takes the responsibility of caring for a patient that really is on the brink of dying and we are able to get many of those patients through to full, meaningful, quality recovery,” said Napolitano. “We celebrate those.”
Napolitano beamed as she talked about three patients on the unit who were on ventilators for three or four months, and on ECMO, who are now recovered and communicating with the team. She said they are talking, neurologically intact, have recovered from lung, heart and kidney failure and are grateful to be here and to be alive.
“We had patients on ECMO for a long time and we did not think they were going to make it at all,” said Molly Candy, B.S.N., a nurse on the SICU. “Now we’ve seen them walk off the unit, or get up out of bed, and we’ve heard their voice again.
“That has been the most rewarding thing ever.”