The painful decisions of triage in ICU


Najjua Zulkefli Seth Akmal

DOCTORS have no choice but to choose patients who can recover from Covid-19 as beds in the intensive care unit (ICU) are full, said experts at Hospital Kuala Lumpur.

ICU intensive care specialist Dr Koo Thomson said critically ill younger Covid-19 patients and those with no comorbidities are now prioritised for admission into the ICU ward due to the limited number of beds available.

He said they were still seeing a high number of ICU referrals, despite new Covid-19 cases hovering at above 5,000 cases daily, after hitting a high of 7,000 plus earlier last month.

Every day, the unit, which can accommodate up to 72 critical patients, receives referrals of between 10 and 20 Covid-19 patients. This current predicament is despite HKL converting the ICU into a Covid-19 special ward last April, with 72 beds instead of 30 previously.

“Every day the ICU bed is full, if a patient is discharged or dies, the bed is taken by another patient in a few hours,” he told The Malaysian Insight.

Clearly, critically ill patients of Categories 4 and 5 do need intensive treatment, such as oxygen assistance to breathe due to damage to organs such as the lungs, liver and heart. However, the lack of beds has forced doctors to prioritise younger patients and patients with no other illness.

Once patients are admitted to the ICU, their condition will be monitored and treatment using breathing aids as well as several procedures, he said. It includes intubation, which is the process of inserting a tube through the airway or by tracheostomy, which is by punching a small hole in the throat of the patient.

In addition, patients are also placed in a prone position for at least 16 hours to allow the lungs to receive more oxygen and medication.

A total of 4,744 patients were discharged yesterday, lower than the new cases of 5,218 patients, and 90% recovered out of a total of 739,266 cases so far. - June 29, 2021.


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