What it’s like to care for someone in ICU with the flu: one doctor’s story
Thursday 28 May 2020
Dr Adam Visser is the Director of Critical Care at Toowoomba Hospital. In his job, he manages the Intensive Care Unit (ICU), where the sickest patients in the hospital are cared for.
We spoke to Dr Visser about what it’s like to look after people who are in ICU because they have influenza. We’ve all heard of the flu and most people have even had influenza at some point in their lives. But not everyone knows that the flu can make you so sick you end up in a ward like Dr Visser’s, or that the flu can even kill you. Dr Visser explained what it’s like to look after someone who is so sick from the flu that they are at risk of dying.
How influenza patients end up in the ICU
Throughout the year, the ICU is a busy place. While the number of patients on the ward is smaller than other general wards, they require care 24 hours a day from a number of different staff members.
“At any one time,” says Dr Visser, “we could have about five or six critically ill patients on ventilators. We’re not admitting people to the ICU because their cough is bad or they’ve got a high fever. It’s organ failure, an inability to breathe, things like that, that see people admitted to our ward.”
Patients on ventilators require a machine to help them breathe, because their bodies are no longer able to breathe by themselves. Once flu season hits, usually from June to September in Queensland and typically peaking in August, Dr Visser sees more of these patients arrive at the ICU.
“We certainly will get a fair bit busier during winter, when we’ll have more respiratory patients with different respiratory viruses. Some of that is influenza. The difference with influenza is people who do end up in Intensive Care tend to be there for longer. It usually takes them a week, sometimes two or even longer, to get better. That’s a long time to be in hospital, let alone in ICU.”
So, why are patients with the flu even ending up in ICU? Dr Visser says that while most people who catch the flu will just spend a week or two at home feeling pretty sick, some people can get severely unwell.
“There are two broad categories of complications we see from influenza,” Dr Visser explains. “One is that the respiratory virus part of it becomes more severe. They might develop pneumonia, and that can often happen if they have an underlying respiratory disease, whether that’s asthma, emphysema, having previous lung damage or from being a smoker.”
These patients will require help breathing, as their lungs struggle to take in the oxygen that keeps their body alive. But Dr Visser says it’s not just breathing problems that affect people who are seriously unwell with the flu. Other, even more deadly conditions, like sepsis, can quickly take over the body.
“We see patients who develop secondary complications from influenza, like a bacterial infection, which can lead to the development of sepsis,” he says. “They can become overwhelmingly sick with multi-organ failure. These patients can develop failure of any organ, so we see the heart can be affected, they could have kidney failure, liver failure, or profound problems with blood pressure.”
Sepsis is a condition that happens when the body’s response to an infection starts to damage healthy organs and tissue. It can be caused by any kind of infection in the body, but one of the most common causes is a bacterial infection in the lungs, which can develop when a person has the flu.
When the young and healthy are struck down by the flu
We all know that it’s dangerous for the elderly to get any kind of illness and we are often more careful around grandparents and elders to not spread germs. But Dr Visser wants Queenslanders to know that the patients he sees in the ICU aren’t just the old or already unwell. Every year, he treats young, healthy people whose bodies have been devastated by the effects of influenza.
“Those are the ones that stick in your head,” Dr Visser says. “It’s the 30-year-old mothers, or the pregnant people, or the people like myself who would normally be completely healthy, normal people going about their business one day, who are struck down by it.”
While it’s more likely for the elderly or people who are already unwell to get very sick from influenza, it’s possible that anyone can develop severe complications from the flu.
“In Toowoomba, which is a relatively small unit, we see one or two of those patients every year. It would be unusual to go a year without seeing someone in the prime of their life become critically unwell or even die from influenza,” says Dr Visser.
Watching a loved one in ICU
Getting the call that your loved one is in ICU can be a devastating experience. Dr Visser says that while staff reassure families that they are working around the clock to save the life of the patient, families know that admission to ICU means that their loved one is extremely unwell and at risk of dying.
“I think anyone who’s got a relative in Intensive Care finds it distressing,” says Dr Visser. “They’re obviously there because they’ve got a risk of dying, and even if we say to them there’s a 90% chance they’ll get better, that’s still a fairly high risk of dying.”
When it comes to an influenza patient, Dr Visser says that the situation can be even more shocking.
“A proportion of the patients we see with influenza have got no risk factors for becoming severely unwell. It must be absolutely shocking for their families to see them become so unwell so quickly, with a disease that everyone’s heard about. I can imagine it’s horrible for them.”
Waiting for the patient to turn a corner
Dr Visser explains that when his staff are treating someone sick with a virus like influenza, there isn’t always a lot they can do to treat the actual virus, because we don’t have many medications that attack viruses.
“For most viral infections, there’s little specific treatment we can offer,” he says. “Our job is to keep the patient alive and wait for them to start getting better on their own.”
Dr Visser and his team help support the patient’s body to function, while they wait for the effects of the virus to ease.
“We support them in their breathing with a ventilator, and we give them dialysis if their kidneys fail,” Dr Visser explains. “We keep their blood pressure up with adrenaline style drugs. And we wait for the immune system response to dampen down and for things to start improving.”
It’s a tough job, one that requires specialist staff who can be resilient in the face of very difficult situations.
“You do see horrible things happen to normal people all the time,” says Dr Visser. “You do end up becoming resilient when you work in Intensive Care – it’s a resilient place full of resilient people.”
How you can prevent yourself and your loved ones from getting the flu
While he’d take great care of you, Dr Visser doesn’t want to see you in his ICU, especially not with influenza. And there’s an easy way to lower your risk of getting sick from influenza, or even catching the virus at all: a flu shot.
Every year, a new influenza vaccine is released targeting the strains of the flu most likely to affect Australia that winter. Everyone should get a new flu shot every year to protect themselves from the flu. Some people are eligible for a free flu shot, including:
- all children from 6 months to less than 5 years of age
- pregnant women (at any stage of pregnancy)
- all Aboriginal and Torres Strait Islander people aged 6 months and older
- all individuals aged 6 months and older with medical conditions which increase their risk of severe influenza and its complications
- individuals 65 years and older.
You can find more information about getting this year’s influenza vaccine from the Queensland Government website.
“It’s very unlikely that you will be the person that ends up on a ventilator in my ICU,” says Dr Visser. “But even if it just stops you from getting sick and ending up in bed for three days or having to take a week off work, to me, that seems like a bit of a bargain. It can also stop you from spreading the flu to your friends and family, who might get really sick.”
This year, it’s more important than ever to get vaccinated against influenza, because the current coronavirus (COVID-19) pandemic is impacting both our health and our ICUs.
“ICU demand is at its peak in the flu season,” says Dr Visser. “If we get a moderately bad flu season as well as a surge in COVID-19 cases, then that will have a lot of implications for Intensive Care Units and resources.”
Getting vaccinated against influenza won’t stop you from getting COVID-19, but it could mean that you won’t catch both viruses one after the other or at the same time, which could make it more likely that you become severely unwell. It also lowers the chance that you’ll become so sick you need to go to ICU in a year where ICU beds and staff are critical in our response to the pandemic.
“To me it’s a no brainer that you get the vaccine,” says Dr Visser. “That’s a fairly easy decision, especially this year.”
Thank you to Dr Adam Visser and the team at Darling Downs Hospital and Health Service for providing your time and expertise for this article.