Covid-19 and intensive care

David Metz | 7th April 2020 | Feature post

The current coronavirus epidemic is putting hospitals under severe pressure and is leading to a substantial number of deaths. This is an occasion to consider making (if you have not done so already) a Living Will, comprising an Advance Decision to Refuse Treatment and an Advance Statement of Preferences and Wishes. To expedite the process, we have prepared a short document specifically for the Covid-19 epidemic. This allows you to state your wishes for treatment should you not be able to participate in decisions due to acute illness. There are a number of options: to remain at home, rather than be taken to hospital; if in hospital, not to have mechanical breathing support, or not to have  non-invasive ventilation, or not to have full ventilation.

Mechanical ventilation involves being connected either via a tube through your mouth or nose passing into your windpipe (endotracheal tube) or using a tracheostomy (which involves the ventilator tube passing directly into your airway through a surgically placed hole in your neck) . This process requires individuals to be deeply sedated, that is, placed into an induced coma.

Full (invasive) mechanical ventilation has serious side effects, which include, aside from the risks of other organ failures, the likely development of new infections and significant muscle weakness.  It usually takes months to years of rehabilitation to get back to anywhere near baseline physical function.  As one gets older, has pre-existing medical problems or frailty, it is increasingly difficult to return to the level of function that you had before.

A review of Canadian experience of mechanical ventilation was published in 2017, so reflects general experience of this treatment, prior to its use for coronavirus illness. For patients who stay longer in intensive care than a week and survived, there were long term muscular weaknesses that could lead to chronic disability, including inability to walk, cognitive disfunction and depression. This could have serious consequences for caregivers, both physical and psychological burdens.

A report in the Guardian summarises recent UK experience of lengthy recovery from coronavirus infection.

The Royal College of General Practitioners has issued advice about Advance Decisions in relation to Covid-19.

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