ICU coping with RSV – for now
They’re caring for some of the sickest babies in the country, but Wellington Regional Hospital’s intensive care unit leaders say they’re ‘‘coping’’ with the demands of respiratory syncytial virus (RSV).
Last week, the unit treated seven babies for the highly contagious virus – the highest number of infant patients ICU had ever had at one time. With 735 cases reported nationwide in the past week, the outbreak has grown to 2543 cases, dwarfing case numbers from the past six years.
Peering through the glass of the unit’s dimly lit isolation rooms offered a confronting insight into this crisis.
Parents appeared powerless as their infants struggled to breathe, their tiny, vulnerable faces obstructed by baby-sized oxygen masks. A host of illuminated machines monitoring vital signs were among their constant companions, alongside the hardworking medical staff.
Because RSV is a virus, antibiotics and steroids are only useful when patients develop secondary bacterial infections.
‘‘There are no medicines or specific treatments for RSV,’’ ICU specialist Dr Kate Tietjens explained.
‘‘The main treatment is for time to take its course, and luckily, almost all of these babies can make a full recovery and go on to have no complications whatsoever.
‘‘What we’re doing mainly is giving them oxygen therapy, and sometimes when they become very unwell, we need to take over and give them IV fluids, or feed them through a nasal-gastric tube,’’ Tietjens said.
Trying to keep a baby calm and settled was one of the most important aspects of their care, because of the distress created by having an oxygen mask on.
‘‘Because they’re working so hard on their breathing, the more upset they get,’’ Tietjens said.
How fast and how hard a baby was working to breathe were the main factors in determining whether a patient would be treated in the children’s ward or transferred to ICU. A small proportion of infant ICU patients would need to be placed on a ventilator, and in those cases a breathing tube and sedation would also be required.
While Tietjens described the unit as being ‘‘the tip of the iceberg’’, young RSV patients had swamped other areas of the hospital too.
More than 100 children of various ages and levels of sickness have been admitted to wards in recent months. And that doesn’t account for those children who had been treated in the emergency department.
Despite an exponential increase in RSV cases nationwide, concerns have been raised that the peak of this year’s outbreak was yet to come.
But ICU charge nurse manager Stephen James said preparations for an RSV spike of this magnitude had been in the pipeline for some time, and if the situation worsened, further contingency plans could also be enacted. This included freeing up beds in the high dependency unit.
‘‘In times [when] we’re not having outbreaks like this, we’re sending our nurses to areas like neonatal and to our paediatric colleagues, or to Starship hospital to get hands-on with babies and get used to it, because it’s not nearly only medicine, but babies [here] need a lot of settling, interaction and care.
‘‘From a nursing perspective, quite a bit of planning has gone into keeping our skill level up and keeping a wide range of nurses capable of looking after babies as it’s only a small part of what we do here,’’ James said.