If you have a relative on the COVID-19 Critical Care Unit, you might have a lot of questions about their care. We've answered some of your questions here.
Why does someone with COVID-19 need critical care?
Patients usually go to the COVID-19 Critical Care Unit because the virus has caused life-threatening breathing difficulty or very low oxygen levels. In Critical Care, we can give additional support to help patients with COVID-19. This may include any or all of the following:
- Closer monitoring by our machines and staff
- Special oxygen masks and hoses
- Machines to help breathing (ventilators) attached via a breathing tube
- Strong medicines and painkillers to keep patients asleep
- Powerful drugs to support the heart/blood pressure
- Machines and medicines to support kidneys/liver/blood/bowels
The illness can also affect other parts of the body and all patients experience the illness differently. Not everybody needs the same care.
Care is delivered by an expert team of nurses, doctors, physiotherapists, dietitians, pharmacists, advanced critical care practitioners, and speech and language therapists.
Should we be worried?
Patients who come to the Critical Care Unit are the sickest in the hospital. The purpose of critical care is to give these critically ill patients the best chance of recovery. We will deliver treatments that we believe a patient will benefit from.
However, despite everyone’s best efforts, unfortunately some patients do not recover from COVID-19. See also the section below titled "the death of a loved one".
Are there treatments specific to COVID-19?
On the Critical Care Unit patients may receive medicines or treatments to help them recover from COVID-19. This may include the following:
- Dexamethasone, which is a steroid to reduce inflammation in the lungs
- Proning: a treatment where a patient is moved to lie on their front for several hours
- Other special medications that may make the illness less severe. COVID-19 is a new illness and new medicines are being developed. When they are available and if they are suitable, they will be given to your relative
Can we visit our relative on the COVID-19 Critical Care Unit during the pandemic?
We appreciate that during an illness relatives and friends want to see each other. However, all hospital visiting has been suspended during the pandemic, with a few exemptions. This is to protect patients, staff and the community.
If you should be self-isolating you must not visit our hospitals in any circumstances. Guidance on when to self-isolate is available on the NHS website.
Can we visit if our relative is dying on the COVID-19 Critical Care Unit?
If a patient is dying and in the last 24 to 48 hours of their life, then two close family members or other people important to the patient may be invited to visit. The visit will cause exposure to COVID-19 and therefore is a risk to the health of relatives, especially those who are older or have health problems. Please discuss this with the Critical Care Team.
As visitors will be exposed to COVID-19 they must self-isolate for 10 days following a visit.
Critical Care Unit staff will communicate with visitors before and during the visit to ensure they are kept as safe as possible and follow the visiting safety protocols in line with Public Health England guidance.
Why have we been asked about research?
We are still trying to find more ways to treat COVID-19. The only way to discover if treatments work is to ask patients to take part in research studies, or to ask relatives on a patient's behalf.
You may be consulted about taking part in a study that involves your loved one receiving a new type of treatment. If you agree, our research team will contact you or the patient with information about a particular study.
All of the treatments that are given have already been checked for safety. All of the studies are part of approved national and international research trials. Patients do not have to be part of a research study, and their treatment will not change if the patient (or their relatives) does not want to take part.
There's some other important information you need to know about your relative's treatment.
Communicating with the Critical Care Team
We understand how distressing this time is for patients, and their relatives and friends. We will do our best to look after everyone’s needs, but our focus will be on the needs of the patient.
The Critical Care Team will usually try to contact a family when a patient is admitted to the Critical Care Unit. We will set up a communication password. Usually, it is best to communicate via a single family member, but we know this is not always possible.
Ongoing routine communication
Most of our patients are too unwell or are unable to communicate themselves. We have a family liaison team made up of healthcare professionals who will telephone a designated relative most days to provide them with an update about their relative.
Please do not call the COVID-19 Critical Care Unit, as the team is extremely busy looking after your relative, and communication is difficult due to the facemasks worn by staff.
If there is a complication, deterioration, significant test result or the need for a major change to treatment, the Critical Care Team will contact the designated next of kin. This may happen at any time of the day or night, so please make sure you can be contacted at all times, e.g. by keeping your mobile phone charged and switched on.
Communication during recovery
If your relative recovers, they may be able to take part in video or telephone calls.
During the pandemic this has usually only been possible when the patient is well enough to operate the devices themselves as staff are so busy, and the calls can only happen when the privacy of adjacent patients can be maintained.
Your relative may be transferred to another hospital
During the coronavirus pandemic there have been many patients needing treatments that can only be given in a critical care unit. Sometimes there are more patients than there is space on a critical care unit.
To allow everybody access to critical care when they need it, it has been necessary to move patients to other critical care units. This often occurs within the same hospital or trust. However, it has been necessary to move patients across a region, or further away, to allow those patients to continue to receive critical care. Patients are moved to other critical care units where there is more space and staff so their standard of care can be maintained.
If it is necessary to transfer your relative to another hospital, the Critical Care Team will talk to you about what is going to happen. This transfer is done by an expert team of senior doctors, nurses and other healthcare professionals.
Other patients may have been transferred to allow your relative onto this critical care unit.
The death of a loved one
The purpose of critical care is to treat seriously ill patients who have a reasonable chance of recovery. Sometimes it becomes clear that, despite our best efforts, our treatments aren't working and a patient unfortunately won't survive.
In these situations, the Critical Care Team may need to discuss with relatives whether our treatments are only delaying an inevitable death.
When this occurs, the focus of care may change to the comfort of a patient, rather than a cure for them.