It took a pandemic to recognise the role of an intensivist

Interview/ Dr Rahul Pandit, director, critical care, Fortis Hospital, Mulund, Mumbai


Q/ Do you think that Covid-19 brought critical care to the forefront like never before?

A/ Certainly. Most of the action happened in this field of medicine during the pandemic. For a start, people recognised that intensive care units and, more importantly, ventilators save lives. The common perception that a patient on ventilator is unlikely to survive has changed completely. Now every aspect of intensive care is regarded as important, not to forget that it is the person behind the machine that matters. Hence the young specialty of intensive care specialist, commonly referred to as intensivist, is now highly sought after. It took a pandemic to bring about this change that was long overdue.

Q/ What is the role of an intensivist in patient management?

A/ An intensivist has been the backbone of patient management in the ICU, often spending hours at the patient’s bedside, observing the clinical signs and every change in physiology as visible on the monitor, ventilator and different gadgets, and then correlating them and treating appropriately based on these variables....

To give perspective, clinicians are confronted with more than 200 variables when caring for the critically ill, yet most are unable to judge the degree of relatedness between more than two or three variables. Thus a new specialty was born, called critical or intensive care specialist, who would be trained to recognise these variables, correlate them, be skilled in bedside procedures and have exceptional communication skills to be able to convey this to colleagues and patients’ families.

Q/ How has modern technology helped in the growth of critical care management?

A/ Critical care is one of those fields of medicine where technology and medicine share a symbiotic relationship. To support organs, often the help of modern machines like ventilators, cardiac monitors or a simple feeding pump is necessary. The interpretation of data and utility of these machines is mainly done by doctors, nurses and other ICU staff. This is where the major advancements are now taking place. It is often important how data is presented. A graphical presentation helps in better integration of data, helping in speedy and accurate clinical decision-making.

Q/ What is the role of artificial intelligence in an ICU set-up?

A/ The use of artificial intelligence has helped us develop algorithms that can predict the possibility of a life-threatening event early and prompt us to take corrective action. For example, smart packs installed in ventilators help clinicians in deciding when to wean the patient from the ventilator. The technology is becoming smaller and smarter. The picture of a patient attached with various wires to a monitor is soon going to be a thing of the past.

Q/ Tell us about the birth of e-ICU or tele ICU.

A/ This technology has enabled the ICU to walk out of the confines of four walls. This access to data is a safety net and works in the patient’s favour, because now more eyes are looking at a patient on site as well as remotely. This helps not only in timely interventions, but also in avoiding medical errors and in aiding early recovery. This safety net can be extended to patients in wards, where typically this type of continuous monitoring was never done, and even at home.