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International research team publishes a set of guidelines to care for ICU COVID-19 patients

An international team of researchers led by members at McMaster University has published a set of guidelines for healthcare workers to help them better treat intensive care unit (ICU) patients with COVID-19.

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The Surviving Sepsis Campaign COVID-19 panel has released a set of 54 recommendations on several topics related to the treatment of the disease such as infection control, laboratory diagnosis and specimens, the dynamics of blood flow support, ventilation support, and therapy.

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“Previously there was limited guidance on acute management of critically ill patients with COVID-19, although the World Health Organization and the United States Centers for Disease Control and Prevention have issued preliminary guidance on infection control, screening and diagnosis in the general population,” said first author Waleed Alhazzani, assistant professor of medicine at McMaster.

The team explains that such “large clinical practice guidelines” typically take one or two years to develop but that, given the urgency of the situation, the team assembled this body of recommendations within 18 days. The guidelines should be useful to health care workers on the frontline, allied health professionals, and policymakers involved in the care of patients with COVID-19. Its authors included members from Australia, Canada, China, Denmark, Italy, Korea, the Netherlands, United Arab Emirates, United Kingdom, United States, and Saudi Arabia.

“Everyone worked hard to make this guideline available to the end user rapidly while maintaining methodological rigour.”

The 54 recommendations put together by the team include four best practice statements, nine ‘strong recommendations’, and 35 ‘weak recommendations’. The four best-practice statements are as follows:

  • Healthcare workers performing procedures that have the potential of generating aerosols — intubation, bronchoscopy, and open suctioning among others — on patients with COVID-19 should wear fitter respirator masks such as N95, FFP2 or equivalent, not surgical masks, in addition to other personal protective equipment.
  • Such procedures should only be performed in a negative pressure room if such installations are available. Negative pressure rooms are designed to prevent the spread of pathogens from room to room.
  • Intubation of such patients should be performed by personnel with experience in airway management to minimize the number of attempts and thus, the risk of transmission.
  • Adults with COVID-19 who are being treated with non-invasive, positive pressure ventilation or high flow nasal cannula should be closely monitored for worsening respiratory status and intubated early if needed.

The panel says they will issue further guidelines and update the existing ones in the future as the situation evolves.

The paper “Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)” has been published in the journal Critical Care Medicine.

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Understanding Patient Care Ethics

patient_careThere are few careers that are more rewarding than one that is in the medical sector. While healthcare professionals are able to care and offer support to countless individuals, however, they are also faced with challenging ethical questions each and every day. It is because of this that those working in the medical field have subscribed to a body of ethical statements which work to benefit their patients. In examining the “Four Principals” approach to patient care and healthcare ethics, as well as some of the other standards adopted by medical professionals, you can gain a more comprehensive understanding of how to provide the best care for the patients that you encounter while on-the-job.

The “Four Principals” 

One of the most common frameworks utilized in the analysis of patient care ethics is the “Four Principals” approach. These moral principals were originally developed by Tom Beauchamp and James Childress. As a rule, in order for a medical practice to be deemed “ethical”, it needs to respect all four statements, which include:

  • Autonomy – This principal states that patients have total autonomy of thought, intention, and action with regards to making decisions about health care and the health care procedures being presented to them. In other words, patients have the right to choose or refuse their particular treatment. In order for autonomy in the decision-making process, patients must be able to make their choice without any coercion or coaxing from a medical professional. The patient must also be provided with all of the information required to assist them in making a completely informed decision. This includes an explanation of all risks and benefits, as well as the likelihood of a procedure’s success.
  • Justice – The idea of justice pertains to the fair distribution of health resources. Simply put any of the burdens or benefits of new, experimental, or scarce medical treatments must always be equally distributed among all groups in society. These treatments or procedures must also uphold the spirit of existing laws.
  • Beneficence – Here, healthcare professionals are required to always act in the best interest of a patient. Another way of saying this is that all procedures and treatment plans must be provided with the intent of doing good for the patient involved. This requires physicians and other medical workers to develop and maintain all of the skills and knowledge to provide the best care for patients. As such, continued education and training would fall under the umbrella of this concept.
  • Non-Malfeasance – The final of the “Four Principals” requires that a procedure or treatment does not cause any harm to the patient involved, or to any others in society. All factors, including the physical, emotional, and psychological effects of the procedure must be carefully considered.

Additional Key Ethical Values for Patient Care

In addition to the “Four Principals”, many healthcare providers put emphasis on numerous other values for the ethical treatment of patients. Some of these principals may include:

  • Respect – All patients are entitled to competent care that provides compassion and respect for basic human rights and dignity.
  • Honesty – Medical professionals must be dedicated to upholding the standards of professionalism through being honest in all patient interactions and striving to report any healthcare providers who may prove to lack in character or competence by engaging in fraud or deception.
  • Privacy – Those working within the medical sector are required to respect patient confidences and privacy within constraints of the law.
  • Citizenship – Healthcare professionals shall respect the law, while also recognizing their responsibility to seek changes in laws which may be contrary to the best interest of patients.

The Role of Ethical Principals in Patient Care

Unfortunately, values and principals like those mentioned in the preceding sections do not provide medical workers with absolute answers for handling any particular situation. Instead, these values act as a guidebook, and create a useful framework for understanding moral conflicts that may arise. When situations occur that cause a conflict in moral ethics, you may find that there is no solution that is 100% correct.  In fact, there may be cases in which the moral values of health care providers may actually be in conflict with one another, or wherein a physician’s ethics clash with a patient’s family members. Here, the basic pillars of the medical ethical code will help you to find the most reasonable and morally upright way to address the problem. Although it can be frustrating for medical professionals to make decisions outside the realm of absolutes, a thorough understanding and evaluation of patient care ethics can help you to make choices with more confidence.

For healthcare workers, growth and learning never end. As you move forward on your journey toward caring for patients, you’ll find that your ability to build on this initial guidebook and make your own ethical decisions during times of moral crises will sharpen exponentially.

image source: dlsii.com