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Dr. Suresh Ramasubban, Senior Consultant, Critical Care, Apollo Gleneagles Hospitals shared his insights to BE’s Ankita Chakraborty on the nuances of the critical care unit.

A.  Life threatening illnesses and injuries typify admissions into intensive care units. Acute deterioration in the functioning of various organ systems, either alone or, in conjunction with multiple organ failures leads to ICU admissions. The common conditions that result in patients requiring critical care are shock, respiratory failure, coma, trauma etc. Intensive monitoring of organ function to preempt organ failure is another important facet of critical care units that result in patients being treated in ICU’s. Monitoring of hemodynamic parameters, respiratory status are the hallmark of intensive care units. Perioperative care and assisting recovery of sick post-surgical patients is also an important aspect of critical care.

Q. How does the critical care unit of Apollo Hospitals work?

A. Apollo hospitals provide a level III care, i.e., provide comprehensive care and is a tertiary referral centre capable of managing all organ failures including organ transplants. The prerequisites of running a level III critical care unit require staffing by well-trainedIntensivist’s (critical care specialist). Providing care to a critically ill patient with multiple organ failures requires teamwork and Apollo provides care as a team. The patients are admitted under the primary specialist team and are jointly looked after by the critical care team. The critical care team consists of qualified practitioners of Intensive care medicine, nurses and ICU technicians. The physician team consists of consultants who oversee the working of registrars and residents in the ICU and ensure standardized care in a holistic manner to the patient. Nurses and technicians trained in intensive care are the main drivers of quality care at Apollo. Each patient is assigned an intensive care doctor, a nurse and a technician in an appropriate ratio that mirrors the standards of western ICU’s. The intensivist coordinates the care provided by the primary team and the multiple medical specialists who provide inputs to the care of the patient. Providing such a system streamlines care and the patient benefits from a comprehensive outlook.

Q. What is the post-critical care pursuit provided by Apollo to its patients?

A. Post critical care recovery and rehabilitation is the cornerstone of a successful ICU. Apollo provides a coordinated rehabilitation of physical and psychological strength to both patients and caregivers. We have a very strong physical medicine department, which ably assists post ICU rehabilitation. Patients are followed up in the ward and outpatients by the intensivists also to facilitate recovery.

Q. Does infectious disease require critical care?

A. In a developing country like ours where public hygiene is an issue, infectious diseases remain the number one cause of admission to the ICUs. Malaria, dengue, typhoid etc. have been the scourge of many million Indians and remains so till date. Bacterial infections especially of the urinary tract and respiratory tract leading to septic shock are the number one diagnosis for patients admitted to any ICU in India. The burden of infectious diseases in intensive care units is disproportionately high as compared to western ICUs. The other big challenge that ICUs in India face is multi drug resistant gram-negative bacterial infections due to rampant antibiotic use and poor infection control practices. Having a strong infection control program and an antibiotic stewardship programme can help in tackling these issues to a great extent.