MUMBAI: Doctors across private intensive care units (ICUs) in Mumbai have noted arise in ‘Do not escalate treatment’ requests from families, particularly when the patient is elderly with severe Covid-related complications. The decision, say doctors, is driven by a range of factors such as uncertainty about the treatment outcome, research showing poor survival among the elderly with comorbidities and even financial constraints.
Intensivists fear that the lack of physical contact with the patient during hospitalisation could also be a key contributor. The son of an 85-year-old woman urged doctors at Bhatia Hospital to not put her on ventilator after she developed bad lungs. “The son said they didn’t want her to suffer any more. While ICUs commonly see such requests, it’s definitely more during Covid times,” said Dr Gunjan Chanchalani, chief intensivist at Bhatia Hospital.
“Roughly, we may be seeing this in nearly 5% ICU admissions.” Some doctors told TOI that it was happening in 15-20% of extremely critical cases. ‘Do not escalate treatment’ simply means the family’s consent to withhold life sustaining therapies. In city hospitals, physicians said the requests range from not putting a central line, starting the patient on invasive or noninvasive ventilation, oxygen support to even carrying out dialysis.
Doctors have mostly observed it in cases when the patient is aged above 75-80, has a chronic ailment prior to Covid infection and the prognosis is notencouraging. Dr Abdul Ansari, director of critical care at Nanavati Hospital in Vile Parle, said that some families are taking the decision to give up “sooner” than in non-Covid times.
“There are families who outright refuse ventilator care. The downside is that some patients are not getting the chance to fight,” he added. Infectious disease expert Dr Tanu Singh of Kokilaben Hospital’s Covidcare team said there could be cost constraints. “The cost of antiviral medicines, such as Tocilizumab (Rs 40,000/vial) and Remdesivir (Rs 5,000/vial), could become prohibitive for families who may be going through job or income loss,” she said. According to Dr Arpita Dwivedy, head of critical care at Hiranandani Hospital, the trend is a mixed one.
“Many families insist that we use everything, while others ask us to go slow.” BMC data shows that the case fatality rate for patients in the age groups of 80-90 and 91-100 is 19%. It declines to 15% for those aged 70-80 and further to 12% for those in the 60-70 age group.