Moving From Robotic to Personalized COVID-19 Care.

Abstract

HomeCirculation: Heart FailureVol. 13, No. 7Moving From Robotic to Personalized COVID-19 Care Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBMoving From Robotic to Personalized COVID-19 Care Thierry H. Le Jemtel Thierry H. Le JemtelThierry H. Le Jemtel Correspondence to: Thierry H. Le Jemtel, MD, Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, SL-48, New Orleans, LA 70112. Email E-mail Address: [email protected] https://orcid.org/0000-0003-3315-6880 Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA. Search for more papers by this author Originally published25 Jun 2020https://doi.org/10.1161/CIRCHEARTFAILURE.120.007303Circulation: Heart Failure. 2020;13:e007303Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 25, 2020: Ahead of Print In retrospect, I may have contracted coronavirus disease 2019 (COVID-19) when directing a diaphoretic patient in respiratory distress toward the emergency room. Without symptoms for a few days, I continued rounding until profuse diarrhea and waves of deep exhaustion made it clear that I was on a downhill course. A few days later, I developed respiratory symptoms and was eventually confirmed as COVID-19 positive. Having heard that COVID-19 providers and patients may not directly communicate but commonly exchange medical information through an interactive personal application device, I recklessly drove North where I hoped a former colleague would communicate effectively with the intensive care unit team on my behalf.Deteriorating rapidly, I learnt that being 77 years old and without relatives and clearly stated advanced directives intubation was ill advised as it would increase the risk of contamination to the Critical Care Team. It did not seem to matter that before getting sick, I exercised 3 to 4 times per week, was free of any cardiac pulmonary or renal disease and working full time as a senior clinician.1With further deterioration and in response to my pleas, I was finally intubated and put in prone position for 5 days. My condition improved, and I was discharged from the hospital 3 weeks ago.The intent of this article is not to start a polemic with physicians who work through algorithms and communicate through their interactive personal application devices. The diagnosis of COVID-19 puts patients in a special hospital track: No visitors and scarce interaction with nurses and rotating attending physicians who monitor the patient through laboratory results. The only physician who sat down and spoke to me was offering enrollment in a randomized therapeutic trial. I fully understand that the lack of personal protective equipment was the major factor behind my limited interaction with nurses and physicians. However, protective equipment was used for instance for the delivery of meals I could not eat and temperature check every 4 hours when all other vital signs and clinical status were stable on telemetry.I am not advocating that critical care physicians risk their life to treat patients with COVID-19. I am pleading that, when time allows, estimated likelihood of success and not age or lack of advanced directives should be the key factor when deciding on mechanical ventilation. A noncritical care physician may help estimate the likelihood of success. When consulted soon after admission, this physician may have the time to collect all pertinent information and contact relatives. Furthermore, this consultant may be the best positioned to supervise continuity of care when patients leave the intensive care unit and to strengthen the physician-patient relationship that is an essential part of therapeutic success.Sources of FundingNone.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to: Thierry H. Le Jemtel, MD, Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, SL-48, New Orleans, LA 70112. Email [email protected]edu