Resuscitation: what is it, what care, what chance of survival?

There intensive care may be necessary in case of shock, coma, kidney failure, heart or infectious disease, haemorrhage, intoxication, respiratory failure or severe trauma. Patients are in serious condition which requires a increased and continuous monitoring. But what does “being in intensive care” mean? What care is given? What devices are used? How long can we stay in an intensive care unit and what are the chances of survival ?

resuscitation is a medical specialty which has existed for fifty years. “Put simply, resuscitation is the service of a hospital in which we will hospitalize the most serious patients, those whose life is in immediate danger, who need more care and more monitoring“, defines Professor Jean-Michel Constantin in a video produced by the French Society of Anesthesia and Resuscitation (SFAR). A resuscitation service has:

• of a human environment who takes turns day and night to monitor the patients. This medical team is unique and perfectly adapted to the management of life-threatening pathologies
• of a technical environment to ensure the monitoring and safety of patients, which can be done through various assistance techniques (artificial respiration, dialysis, gastric tube, infusions, catheters, scope, etc.) and continuous monitoring devices to monitor the evolution of the main functions of the organism and the state of the patient.

There are specialized intensive care units for newborns (neonatal resuscitation), pediatrics (pediatric resuscitation), neurosurgery patients (neuro-surgical resuscitation) or patients undergoing cardiac or thoracic surgery (surgical resuscitation). Moreover, right next to the intensive care unit, there is often a continuing care service which is the intermediary between a resuscitation service and a conventional service. In continuous care, we will place patients coming out of intensive care or patients whose condition is too severe to be in a conventional service, but not serious enough to remain in intensive care.

There is no minimum age to be hospitalized in intensive care.

We are going to hospitalize the most acute patients in the intensive care units, for whom we need to ensure vital functions and have increased monitoring. This concerns:

• Ipatients with serious illness or likely to become so (as is the case for Covid-19 patients, but also during septic shock, acute renal failure, acute respiratory failure, after cardiac arrest, etc.)
• patients with severe trauma (for example, road accident victims)
• patients who have undergone major and complicated surgery (such as heart or digestive surgery)
• patients in a coma.

These patients are not placed in a traditional medicine service because they may require a complicated and demanding therapeutic strategy, very aggressive, invasive or multipurpose treatments and continuous monitoring by a resuscitation team. They are placed here because on the one hand, intensive care physicians are the only ones who can administer very broad treatments which concern most pathologies. On the other hand, it is in this department that we have the most nurses in relation to the number of patients. In France, a nurse (or a nurse) takes care of an average of two or three patients maximum and a caregiver on average of 4 people. Note that there is no minimum age to be hospitalized in intensive care.

“The resuscitation medical team is made up of medical resuscitators, certain anaesthetist-resuscitators and certain emergency physicians” specifies an anesthetist-resuscitator in Lille. They are present 24 hours a day, 7 days a week.. Daily care is provided by a versatile paramedical team made up of intensive care nurses, caregivers and physiotherapists. During the stay in intensive care, various workers ensure comprehensive and multidisciplinary care of the patient. The resuscitation team can also call on other medical specialists or other surgical teams to participate in medical decisions. Every day, additional and radiological examinations can complete the treatment. Finally, psychologists, social workers, administrative agents and representatives of worship can intervene in an intensive care unit and are available to support patients and their loved ones.

What we are going to do in intensive care is that we are going to buy time, we are going to offer organ replacement.

In intensive care, as in all services, we will administer symptomatic treatments, in other words that treat the disease. But since the patients admitted to intensive care are in serious condition, there is no time to wait for the symptomatic treatment to take effect. “What we are going to do in intensive care is that we are going to buy time and we are going to offer organ replacement: that is to say that when an organ does not do its job, we will replace it. For example, if the lung is damaged, we will put in place a ventilator which will help the patient to breathe while the antibiotics take effect. If the kidney is damaged, a dialysis, if it is the heart that is dysfunctional, amines are administered“, explains Professor Jean-Michel Constantin. Overall, the medical team will put in place treatments that will keep patients alive while symptomatic treatment works. These particularly aggressive treatments require the parallel administration of “comfort treatments” such as sedatives to minimize patient pain.

In normal times, intensive care units are open to the patient’s family and friends. However, visit times are limited so as not to “fatigue” or overwork the patient in intensive care. In the context of the Covid-19 epidemic, visits are not normally permitted but “some exceptions may be allowed sAccording to the services, the doctors, the patient’s condition. In general, the lack of time to welcome families, get them dressed and undressed, the lack of means of protection (masks, overalls) and the risk of contamination of friends and families during visits make these visits very rarely allowed” explains an anesthetist-resuscitator from Lille. For a patient at the end of life, only one person can be authorized. But neither minors nor people with symptoms suggestive of a coronavirus infection (cough, fever, difficulty breathing, etc.) can claim it.

The average patient spends 5 to 8 days in an intensive care unit, but this time is obviously variable depending on the patient’s state of health. Certain serious forms of coronavirus infections require hospitalization in intensive care for 3 to 4 weeks, a particularly long period which may in particular explain the saturation of certain hospitals.

According to a decree of public health codean intensive care unit in France must have at least 8 beds (6 by way of derogation) “and up to more than 50 beds for certain CHRUs” specifies the anesthetist-resuscitator of Lille.

What are the chances of getting out of intensive care? “It is very difficult to answer this question. We don’t have a crystal ball. Nevertheless, we know a little about the chances of survival according to the severity score [un indice établi à partir de paramètres cliniques et biologiques corrélés] defined at admission to intensive care. But those are just statistics. More interestingly, we can watch the evolution of the patient over several days. Depending on whether the patient’s condition improves or deteriorates, we will have a slightly more precise idea of ​​the chances of survival. But it is on a daily basis that we will be able to re-evaluate them and estimate a trend“, explains Professor Constantin. Whether the chances of survival are good or bad, the medical team is obliged to be transparent with the patient and his relatives.