Healthcare costs 2

With the overuse and abuse of antibiotics & disinfectants in our society at personal level, healthcare facilities and in farming, poultry & animal husbandry, bacteria are getting smarter and devising ways to become drug resistant. There are several bacteria now which are resistant to multiple antibiotics. Infection is a major problem in tertiary care ICUs. Infection may be the primary problem or can happen as an add on to some other disease. Either the disease or the infection can lead to failure of organ systems in the body. When an organ system fails, we have means to support it as and when required. The level of support varies depending on the amount of malfunction.

Simple example is the usage of supplemental oxygen when the respiratory system is affected, and the lungs are not able to maintain the oxygen levels in the blood using atmospheric air. The oxygen supplements are given through simple cannula in the nose or a mask at low flow rate. Depending on the necessity the flow rate is increased. If this is not sufficient, specialized masks are used. Next level is administering oxygen at a pressure more than the atmospheric pressure using machines, which can monitor the pressure levels of air pumped and avoid damage to lungs due to excessive pressure. Up to this level of support, patient is conscious and will be breathing on their own. If masks and increasing the pressure are not sufficient, then a tube is placed directly into the windpipe of the patient and connected to a ventilator. This is called invasive ventilation and all the breathing is done by the ventilator. Patients are generally sedated and paralyzed so that they do not ‘fight’ the ventilator. New generation ventilators are smart, able to identify patient’s breathing effort and can supplement, as necessary. All these are done by the intensive care specialists who have the necessary gadgets and tests to monitor the patient’s condition continuously.

If the oxygen saturation in the blood is not being maintained despite the highest level of invasive ventilatory support, the next available option is called ECMO – extra corporeal membrane oxygenator, artificial lungs in simple terms. If this also fails, in select patients, lung transplantation is an option. Simultaneously the original problem of infection or other systems must also be treated and supported, as necessary. At some point in time, the patient’s lungs and other systems must improve and start working again. Otherwise, all these outside supports are of no use. The main problem is no one can predict accurately whether a particular patient is going to be benefited for sure or not. When the patient is deteriorating despite the support given, it is natural tendency to escalate the treatment.

In view of the COVID affecting the lungs primarily, I gave the example of lung failure. Like this, kidneys, heart, intestines, or liver may fail and need support. Each support system has increasing levels of complexity, cost and risk of collateral damage associated with it. Despite the best will and efforts by experienced doctors, inadvertent injury or complications may arise during the process of treatment. If this happens, it may worsen patient’s condition, needs additional treatment and incurs more cost.

Machines used for these supports are reused but, a major chunk of equipment used these days is discarded after single use to prevent cross infection. All these cost monies. Whether the patient makes a successful recovery or not, money must be spent in the effort to save the patient.