Interview with Dr. med. Rolf Lamberts, Chief Physician Section Intensive and Emergency Medicine
With human expertise and state-of-the-art technology for patients in use
Monitors, cables, hoses and caregivers in full protective fit: At the thought of intensive care, many people get an oppressive feeling. Does intensive care directly mean that the patient is in a life-threatening condition?
“Especially in elderly patients, there is a great deal of concern about the need for care in the intensive care unit. Relatives are also often unsettled when a family member needs intensive care. Staying in an intensive care unit does not necessarily mean that there is a threatening condition or that the patienten is inevitably placed under long-term anesthesia (often referred to as an artificial coma). In large hospitals, a distinction is often made between a monitoring unit and an intensive care unit. In smaller houses of basic and standard care, there is usually only one ward where patients with relevant pre-existing conditions are monitored equally after major surgeries but also acutely severely ill persons.
Patients are treated as intensively as necessary. The human component is very important to us. The dreaded medical devices are a reliable support for our team, so that every vital sign is constantly monitored and every medication is as safe and precise as possible. Monitors, hoses and cables are therefore important helpers in the recovery process, which you do not have to be afraid of.
Nevertheless, we are aware that these measures are often perceived as strange. This is why we try to move patients back to a normal environment as early as possible.”
Why do modern technology and digitization play a major role, especially in intensive care units?
“Technology helps us to capture bodily functions that we cannot permanently measure with our 5 senses. This also leaves us with more humanity, because: every step, which takes place automatically or digitally, gives doctors and nurses time. This time is better invested in some places of care for the patient than in others.
As an example: Our house has the rare advantage of owning a digital patient data management system, even one of the most modern on the market. This ensures that every treatment step on the patient, every medication administered, every change in attitude on medical devices is documented in detail. In addition, it draws a picture of the patient's state of health at regular intervals by constantly measuring blood pressure, oxygen saturation, heartbeat and much more. This avoids human error sources and thus increases the safety of the patient, because an incorrect dosage of a drug or a faulty or incomplete note of treatment steps immediately triggers a warning in the computer.
The data collected in this way can also be used to analyse and improve therapies. This has already helped us a lot in the pandemic when it comes to resuscitating Covid patients.”
Patients who require intensive care regularly suffer from life-threatening injuries or illnesses. In such cases, patients often can no longer express their own will. Many people are afraid of it. What do you advise as a precaution in the event of inability to consent?
‘In advance, the following shall apply: The will of the patient is always and in every treatment priority. For this, of course, the will of the patient must be known. Precaution is important here. My colleagues and I recommend that a patient order or a preventive power of attorney or a care order be drawn up at an early stage. By the way, you can easily write these at home. Notarial assistance is not needed.
The extensive possibilities of modern medicine are as versatile as the individual values. It therefore makes sense that patients should, as a precaution for the possible occurrence of inability to consent, record which treatment they wish to receive or refuse, in which situation – or explain it to people who are just familiar with it.’
Precautionary power of attorney or patient order? What do you recommend?
‘One does not exclude the other. In order to be prepared for as many different situations as possible, patients should combine both ways, because: Patient orders contain information on which medical measures the patient provides for certain constellations. Naturally, it is difficult to regulate all possible circumstances in advance. A person of trust who decides as a substitute shall ensure the best possible patient will as an addendum.’
Are there any long-term consequences of intensive care?
“The aim of intensive care treatment is to achieve the best possible outcome for the patient’s recovery process. However, this does not mean that patients are completely fit and healthy again after treatment in the intensive care unit. Depending on how severe the disease or injury was and how extensively and long bodily functions had to be mechanically supported, the consequences are still noticeable for a long time to come.
To give a recent example: Corona patients who have been invasively ventilated for many hours must be painstakingly weaned from organ support. The lungs are weakened and must first learn to work independently again.
After a stay in an intensive care unit, follow-up care is therefore regularly required.’
In the case of invasive ventilation, the patient is not conscious. Do visits by relatives still make sense?
“The aim of modern sedation concepts is not to keep the patient under deep anesthesia, but to relieve anxiety and pain. Most patients are therefore only slightly sedated and perceive their environment quite well. The presence of familiar people supports the recovery process. This also applies in the event that the patient is not conscious. There are many studies that have proven medically measurable successes such as a soothed heartbeat or falling blood pressure. Even more deeply sedated, patients are likely to subconsciously even be able to perceive touches and voices.”
