Mindray 16 May 2022
Critical care medicine has come a long way in this country. Every day new critical care units are opening up. The single most challenge, which is becoming an impediment to good critical care delivery to the patients, is the lack of trained critical care doctors and nurses.
This situation is further compounded in tier two, tier three cities. Another challenge is the lack of standards of critical care units in our country.
Anybody can put up ICUs equipment in any area and label it as a critical care unit. While we have standards for labs and blood banks, but not for ICU, which is such an important area of the hospital. But emerging healthcare companies like Mindray, which has a global and Pan India presence have a huge product portfolio that addresses the challenges.
Lack of digitalization and overreliance on manpower is another challenge that impacts the growth of critical care in this country.
We all know that skilled manpower in the form of trained doctors and nurses is the most important challenge in critical care. Digitalization and innovations like tele ICUs can go a long way in solving many of these problems. In ICUs, the intensivist relies a lot on lifesaving alarms and early warning signals. Through digitalization and tele ICUs a remotely situated critical care specialist can monitor and give junior doctors & nurses a lot of advice in managing critical care patients. This not only improves the quality of care but has also been proven to decrease mortality. I can envisage that most of the critical care units in tier 2 and tier 3 will be managing their patient via digitalization or tele ICUs in the near future.
The ICU is the last defense in saving lives. We were eager with Mindray’s latest “M-Connect”. It is an IT solution that provides a universal centric monitoring platform, which seamlessly integrates medical devices, using a standard interface to connect with the 3rd party information system. A connected workflow helps analyze and prioritize patients more quickly, alleviating pressure on busy clinicians and emergency medical personnel to ultimately reduce the risk for patients and in turn save lives.
Anytime anywhere critical care by a trained an intensivist is the most important factor, which can decrease mortality in our ICUs. Digitalization of the ICUs and tele ICUs can not only achieve these clinical benchmarks but also help improve the skill set of junior doctors and nurses. Digitalization can help achieve easy implementation of critical care protocols and good clinical practices like infection control bundles and other things. Through the the same platform, evidence-based treatments can be initiated in remote parts of the country, particularly in Tier 2 and Tier 3 cities.
Mindray has very prominent solutions which actually, make it more accessible in terms of making this anytime, anywhere technology through their Advanced IT Platform where information seamlessly can flow from any remote places. Critical care specialists can access vital information from life-saving devices like ventilator, syringe pump, patient monitors or another third party device thus ensuring better patient care even at remote location.
Gathering authentic data and using it for early clinical decision-making can be of great help as far as managing ICU patients is concerned. Intensive care is all about proactive care and monitoring. Life and death in an ICU can be defined in a span of a few minutes. If the critical care specialists can get a set of early warning signs, they can intervene quickly in the form of prevention & treatment of life-threatening conditions. Early warning signs can also help in giving more precise and accurate treatment anytime anywhere.
Acclimating to digital technology is beneficial for healthcare, which offers a very broad the base of data and treatment options with greater efficiency to patients. Efficient patient management also reduces the lengths of stay (LOS), which negatively impacts hospitals, too. Length of stay directly impacts bed management and load on staff and the hospitals may not be able to meet the needs of other patients. Real-time data availability through digital technology not only reduces LOS but also ensures better patient management.
Mechanical ventilation has been a life-saving modality in critical care units. Mechanical ventilation has advanced a lot since the the inception of polio days, various advancements have happened during the last two decades. These include advanced ventilatory strategies for ARDS, newer modes of ventilation, and the concepts of compliance, PV Loops, and Scalars. Understanding the physiology of the patient and machine is still a crucial factor in determining the outcomes of a mechanically ventilated patient.
All these things actually make a big difference in the ICU environment, which helps the clinicians to make their action plan accordingly and drive it evidence-based.
Unfortunately, the training of our doctors and nurses on the ventilatory concept is inadequate. But the scenario has changed post-COVID, as both government & private health care players are keen on opting for equipment, which has advanced ventilatory mode and supports training. Advisory and early warning signs are pivotal for any ICU, we have to move to a more proactive ICU model, where any change in the clinical status of the patient can not only be prevented but also treated fast.
At Fortis Memorial Research Institute, we have digital ICUs for the last 10 years and have been able to run one of the most transparent and quality-driven critical care units in the whole country. Our team of critical care specialists can give advice and early warning signs on their devices, be it a laptop or any handheld device, and prevent complications from happening rather than treating them.
Clinical indications of advanced modes are to improve patient-ventilator synchrony and provide better respiratory monitoring in the assisted modes of mechanical ventilation.
Newer and advanced modes of ventilation have helped to improve outcomes, patient-ventilator interactions, and patient care. Interactive graphics and newer weaning tools have contributed to a better understanding of respiratory physiology and how different ventilation strategies impact the respiratory system. PV Loops effectively represent a relationship of flow and pressure with a close understanding of the mechanics of breathing and changing compliance. PV loops are the gold standard for measuring direct, real-time cardiac function.
Clinical advisories for infection prevention and control in healthcare facilities impact morbidity, mortality, and quality of care. New guidelines by the government have been revised from time to time, especially during the pandemic time. These advisories have been adapted to hospital-specific situations and patient profiles. They have helped in setting global standards for controlling infection and found useful to improve the overall quality of healthcare delivery. Studies have shown that in a large number of patients admitted to critical care departments, life-threatening changes were observed and documented up to 8 hours before the admission. These observations and decisions arising from such early manifestation could improve care and resuscitation outcomes because most further deteriorations and even death can be prevented with early intervention.
EWS protocols advocate a system to standardize the assessment and response to acute illness. It is recommended to use EWS during the initial prehospital and/or hospital assessment of a patient throughout the patient’s hospital stay. EWS should only be used as an aid to clinical decision-making. Aiming to Wcreate safer patient environments, many manufacturers incorporate automated early warning scoring notification systems in a wide range of patient monitors, from low to high acuity. By including this EWS system, such high-end products contribute to safer and more efficient patient management by anticipating potential complications and improving workflows.
The Glasgow Coma Scale (GCS) is an Assessment function of Coma and Impaired Consciousness. Three aspects of behavior are independently measured: eye-opening, verbal response, and motor response. The scores are added together to indicate the patient’s level of consciousness. GCS is highly effective for adults and pediatric patients in correlation with an observation of clinical signs and symptoms.
Mindray’s high-end monitors come with built-in clinical application tools like EWS, GCS and HemoSight, which assist in critical ICU environment
HemoSight, helps healthcare professionals to enhance hemodynamic monitoring, support diagnosis, and therapy decisions more efficiently with ease. The PulmoSight technology from Mindray high-end SV 600/800 ventilator gives real-time feedback on lung condition, e.g. lung compliance, resistance, ventilation delivery, via graphic representation. These parameters are unique and can help the a clinician with more precise information than getting an intervention.
PulmoSight is graphically represented by dynamic lung display with brightness and darkness of the lung diagram represents the inspiratory and expiratory processes. It reflects the patient lungs function and ventilation condition as well, such as the patient’s lungs compliance, airway resistance, over-inflation, breathing system status and airway blockages etc.
Recent innovations in AI have been implemented in patient monitoring equipment in which clinical assistive applications with colored graphics showing the real-time status of patient, parameters have been praised by many clinical experts. Such applications not only include grouped numeric displays of parameters but accompany dynamic graphic displays giving a clear view of a patient’s status enabling practitioners to make clinical decisions faster and more accurately. Such tools present real-time patient status throughout the treatment process enabling accuracy and optimizing treatment therapy.