Reinventing the ICU for COVID-19

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Reinventing the ICU for COVID-19

July 03, 2020
Business Affairs Ultrasound
Dr. Enrico Storti
Hospitals all over the world are working to rapidly expand their capacity to treat critically ill patients with COVID-19. To find out how hospitals on the frontlines of the pandemic are coping —and the lessons learned that could help other hospitals prepare—FUJIFILM SonoSite’s Chief Medical Officer, Diku Mandavia, MD interviewed Enrico Storti, MD, the ICU Director/Unit Coordinator of the Emergency Department at Maggiore Hospital in Lodi, Italy, located near Milan and the epicenter of the Italian COVID-19 outbreak.

Dr. Storti’s ICU has treated what is believed to be Patient One of the Italian outbreak and hundreds of other COVID-19 patients. In this article, Dr. Storti discusses how his team rapidly transformed their hospital’s ICU to deal with an unprecedented “mass casualty event,” what clinicians can expect when the pandemic reaches their hospitals, and the role that point-of-care ultrasound has played in triaging patients and providing more efficient care.

Dr. Mandavia: How are the people of Italy doing throughout this crisis?

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Dr. Storti: I've seen things that would have been absolutely unbelievable until three weeks ago. We have found ourselves in a mass casualty event. This is really the right definition because we were immediately forced to face a huge number of patients. Our emergency department [ED] on average has received 150, sometimes 200 patients per day. A large portion of these patients exhibited acute respiratory distress, and needed to be oxygenated. This has been a huge challenge for the ED and for the entire hospital.

We immediately understood that we couldn't cope with the situation like this in which there was a huge disproportion between resources and the number of patients and the intensity of their illness. We were forced to change our hospital rules and reshape our hospital staffing from the emergency department, passing through the stepdown unit, and reaching into the ICU—without the option of transporting these patients because all the nearby hospitals were completely overwhelmed.

Dr. Mandavia: How were you able to surge your ICU capability?
Dr. Storti: In the beginning, syringe pumps and other ICU items were insufficient because we only had instruments and ventilators for seven beds. We were forced to collect every ventilator inside the hospital. We used the OR [operating room] ventilators, and brought patients to the OR in order to give them the opportunity to be properly ventilated in a sort of ICU setting. Now the situation is a little more stable. Our Lombardy region welfare department managed to collect a large number of ventilators: We now have 24 ICU beds and 26 ventilators.

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