EXTRA intensive care beds could be made available for coronavirus patients if non-urgent cancer and complex surgeries are delayed, a critical care expert has said.
Dr Stephen Cole, president of the Scottish Intensive Care Society, said that social distancing policies could also help to reduce pressure on beds by leading to a drop in trauma injuries, such as car crashes, as people increasingly stay at home.
The Scottish Government has pledged to double the number of intensive care beds in NHS Scotland to 380 to cope with an expected surge in critically ill patients. The figures is based on pandemic plans drawn up more than a decade ago in response to swine flu and SARS.
However, Dr Cole estimated that around 114 to 133 of these would tend to be occupied at any one time by non-virus patients.
He said: “Of those 190 beds you’ve got 60-70% of them being used anyway, so that leaves you around 60 to 70 of the core beds available [for coronavirus patients] and an extra 190 in the surge capacity beds.
“Your ICU patients are usually acute medical patients who are unwell, but it also comprises some complex elective surgery which leads to ICU so that might be deferred.
“You could argue that trauma cases will reduce if people are travelling around less and isolating a bit more, so some more of those beds may become available.
“The other thing to say is that doubling capacity as they have requested is predicated on the deferral of all non-essential surgery, so that would be non-emergency surgery and non-time sensitive cancer surgery, to free up anaesthetists, theatre nurses and nurses to look after these patients.
“Not all cancers have the same urgency, so for example if you had a skin cancer you might be able to wait a few months to have something done without there being any change in activity.”
All ICU beds must be equipped with ventilators for oxygen therapy, sparking calls for increased production. The main suppliers for NHS Scotland are Dräger, GE Healthcare and Hamilton Medical.
“In my hospital we have some spare ventilators,” said Dr Cole. “We would also have to use theatre anaesthetic machines which can deliver ventilation, but are not quite as ideal to the task as intensive care ventilators.”
A spokeswoman for Dräger said: “We are seeing a significant increase in demand for our ventilators and the corresponding accessory products worldwide. In this situation, we at Dräger are doing everything in our power to fulfill our social responsibility.”
Health secretary Jeane Freeman said extra ventilators have been ordered and Scotland will have 700.
Engineers have cast doubt on the ability to speed up production of medical ventilators, however.
Professor David Delpy, a Fellow of the Royal Academy of Engineering, said that companies being asked to start making the machines may not work.
He said: “Since modern ventilators are usually electronically controlled with a variety of built-in sensors, there may be supply chain limitations on how rapidly one can ramp up production.”
It came amid warnings from the European Society of Anaesthesiology (ESA) that the continent was ill-prepared.
Professor Kai Zacharowski, president of ESA, said: “We cannot stop the virus, all we can do is try to stretch out the peak of cases that need intensive care, so that we will be able to treat as many seriously ill patients as possible. Unfortunately, as the experience in Italy is showing, there are going to be times when very difficult decisions have to be made about who gets treatment and who does not, based on the likelihood of survival.
“For the last decade across Europe we have been cutting down on hospital beds, including intensive care beds. Now we are realising that we don’t have enough. If we had arranged and distributed equipment at the right time, countries might have been able to avoid the situation in Italy. There has been a rush to order equipment such as ventilators, which companies are struggling to provide due to interruption in supply of parts from China.”
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