Bitter experience helps French ICUs cope with latest wave of viruses

ROUEN, France (AP) – Slowly suffocating in a French intensive care unit, Patrick Aricique feared he would die from his diseased lungs which felt “completely burnt from the inside, burned like the cathedral of Paris”, as doctors and the tired nurses worked the day. and at night to keep critically ill COVID-19 patients like him alive.

A married couple in the same intensive care unit died within hours of each other as Aricique, feeling as fragile as a ‘soap bubble about to burst’, also battled the coronavirus. The 67-year-old retired building contractor attributes a divine hand to his survival. “I saw archangels, I saw little cherubim,” he said. “It was like communicating with the afterlife.”

For their part, there were French healthcare professionals who, forged on the bitter experiences of previous waves of infection, now fight relentlessly to keep patients awake and off mechanical ventilators, if possible. They treated Aricique with nasal tubes and a mask that bathed his swollen lungs in a constant flow of oxygen. It spared him the discomfort of a thick ventilation tube deep in his throat and heavy sedation that patients often – sometimes, rightly – fear will never wake up to.

If mechanical ventilation is essential for some patients, it is a less systematic approach today than at the start of the pandemic. Dr Philippe Gouin, who heads the intensive care unit where Aricique underwent treatment for severe COVID-19, said: “We know that every tube we insert is going to bring its share of complications, extensions of stay and sometimes morbidity.

About 15% to 20% of his intubated patients do not survive, he said.

“It’s a milestone that weighs on survival,” said Gouin. “We know that we are going to lose a certain number of patients that we will not be able to help negotiate this shift.

Switching to less invasive respiratory treatments is also helping French ICUs avoid collapse under yet another crush of coronavirus cases. Overloaded by a more contagious variant of the virus that has ravaged neighboring Britain, the third wave of infection in France has pushed the number of COVID-19-related deaths in the country to more than 100,000 people. Hospitals across the country are once again grappling with the gruesome math of making room for thousands of critically ill patients.

“We have a continuous flow of cases,” said Dr Philippe Montravers, head of the intensive care unit at Bichat hospital in Paris, who is again fitting patients into intensive care units in Paris. fortune. “Each of these cases are absolutely terrible stories – for the families, for the patients themselves, of course, for the responsible physicians, for the nurses.

Sedated patients kept alive with mechanical ventilation often occupy their intensive care beds for weeks or even months, and the physical and mental trauma from their ordeals can take months longer to heal. But 13 days after being admitted to intensive care in the Norman cathedral city of Rouen, Aricique was sufficiently recovered for another critically ill patient to take his place.

A non-invasive nasal ventilation system delivering thousands of liters (hundreds of gallons) of vital oxygen every hour helped him through the worst of his infection, until he was well enough for the patient to get through the worst of his infection. flow is reduced to a trickle and stands upright. , his New Testament bible at his side. Savoring a breakfast of omelet and red cabbage to start regaining strength, Aricique said he felt resuscitated. A nurse released him from the drops that had been stuck in his arms, putting the tubes in place like bowels.

Going around the young doctors and nurses in the trailer, Dr Dorothee Carpentier allowed herself a mini-celebration as she walked past Aricique’s room, having declared him fit to leave the hospital. The patient in the next room could also leave, she decided. She described the impending departures as “small wins” for the full 20-bed service, a temporary facility in what was previously a surgical unit and is now fully converted for C0VID-19 care.

“I imagine they will be filled again in the morning,” Carpentier said of the two vacated beds. “The problem with this third wave is that there is no stop button. We don’t know when this will start to slow down. “

Further down the hall, a 69-year-old woman placed face down on her stomach struggled with the effort of breathing with an oxygen mask and was dangerously approaching the point where doctors would decide to anesthetize and intubate. Nurse Gregory Bombard recruited the visiting woman’s stepdaughter in an effort to avoid this next step, making her understand the importance of sticking to the mask.

“Morale is so important, and she has to take this turn,” Bombard said. “We are doing what we can. They have to make the effort to win too, otherwise they will lose.”

“Do what you can,” the nurse said to the daughter-in-law.

The parent later left the patient’s room, his eyes cloudy and shaken.

“It’s really hard to see her like that,” she said. “She lets herself go.

In another room, Gouin gently pleaded with a 55-year-old market stall operator who complained that his oxygen mask made him claustrophobic.

“You have to play the game,” insisted the doctor. “My goal is not to get to the point where we have to put you to sleep.”

The patient agreed. “I don’t want to be intubated, to be in a coma, not to know when you’re going to wake up,” he says.

Intubations can be traumatic for everyone involved. A patient who sobbed while asleep remained sedated in the ICU almost two weeks later.

“You could tell he was terrified,” Bombard recalls. “It was horrible.”


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