Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources

Abstract

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.

Figure 1.

A, Positioning of the BIS sensor on the forehead. B, Swimmer’s position: showing the actual ease with which BIS monitoring can be applied in the prone position. C, Positioning of the BIS sensor postauricular site. BIS indicates bispectral index.

Figure 2.

COVID-19 patient’s isolation room before implementing paperless work. On the computer, there are paper charts, pens, smart cards; all these objects could be accidentally carried outside the isolation area and could spread this infection. EHRs allow clinicians to prescribe and document exclusively on a computer. This has reduced the number of objects that are taken in and out of the isolation rooms. This is a mechanism that could protect health care workers from this infection. This figure is showing a system using smartcards that are needed to access information and enter documents or prescriptions. These cards have been either removed or strictly kept outside the isolation rooms. The limitation with removing those from the bed space is that clinicians cannot see blood results or images at the bedside and they need to leave the room to complete their examination and treatment plan. Clinicians might not be able to document their findings and they have to defer their work. COVID-19 indicates Coronavirus Disease 2019; EHR, electronic health records.

Figure 3.

The figure shows that communication is very difficult with PPEs, and normal phones are not efficient because the head is mostly protected and it is very difficult to hear. Furthermore, using landline systems while wearing PPEs might expose to contamination via the contact of the face with infected phones. PPEs indicates personal protective equipments.

Figure 4.

The pleural ultrasound in a patient with COVID-19 by high-frequency linear probe (5–10 MHz). White triangle = pleural line. White arrow = subpleural consolidation. COVID-19 indicates Coronavirus Disease 2019.

Figure 5.

The lung parenchymal ultrasound in a patient with COVID-19 by the curvilinear probe (2–5 MHz). White triangle = pleural line; A = spared area of horizontal A-lines; B = confluent B lines in a curtain-like pattern. COVID-19 indicates Coronavirus Disease 2019.

Figure 6.

The lung ultrasound performed in a patient with COVID-19 complicated with secondary bacterial pneumonia showing evidence of right lower lobe consolidation = C, the diaphragm = D, and the liver = L. COVID-19 indicates Coronavirus Disease 2019.