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To take even one patient in the ICU off a ventilator after nearly two weeks takes a team of heroes, and on April 7, the team at Geisinger Community Medical Center extubated three.

April 7 was a day to remember at Geisinger Community Medical Center’s ICU as three COVID-19 positive patients were deemed healthy enough to be taken off ventilators. Danielle Krimmel, RN, who was caring for one of the patients, wasn’t sure she’d see it happen. “My patient had come back from a trip to Ireland with symptoms,” she explains. “She tested positive and ended up in Intensive Care. She’d been on a ventilator since March 26. That’s a very long time. These patients are in more respiratory failure than any I’ve seen in my whole career.”

A view from the ICU

When patients are put on ventilators, the machines do all the breathing for them while their lungs heal. Which means they’re often medically paralyzed and sedated to let the machine do its work. “My patient was very unstable at one point. It was heartbreaking to see,” says Ms. Krimmel. “Her husband would call in every day so we could give him updates.”

Ms. Krimmel says she feels bad that, because of the visitation rules, no families can come to the ICU. “We had one person pass away for reasons that had nothing to do with COVID-19,” she explains. “They said goodbye through FaceTime using an iPad. We were glad the family could be there — at least virtually.”

Ms. Krimmel’s patient used an iPad to FaceTime her husband the day she was taken off her ventilator. “At 10 a.m. her voice was hoarse, but she managed to say ‘hi’. By 6 p.m. she was speaking clearly to her husband,” Ms. Krimmel says. “She was also able to eat and drink with no issues. She went to the step-down unit the next day.”

Using proning to make breathing easier

Melissa Demanovich, RN, and Rachel Kevra, RN, also had patients taken off ventilators that day. Ms. Kevra’s patient also came in at the end of March. “Patients aren’t usually on ventilators for two weeks,” she says. “They’re usually more mobile.”

To make breathing as easy as possible, Ms. Kevra’s patient was flipped to lie flat on her chest on two separate occasions. This procedure, called proning, takes four staff members — all of whom need to be masked and hyper-aware of endotracheal tubes and lead stickers. “It’s a very stressful situation for everyone involved,” Ms. Kevra explains.

The patient was weaned off her sedation and ventilator slowly. “Once she was off, it took about a half an hour to know she was safe. She was scared — really scared — but she made it,” Ms. Kevra says. By 10 a.m., Ms. Kevra’s patient was in the clear. “By dinnertime she was eating, texting and talking to her family. A few days earlier, she’d been completely paralyzed.”

Ms. Kevra says she doubts her patient realizes how sick she was. “She was the first patient extubated. It was an amazing thing to see,” she says.

It takes a team of heroes

Both nurses agree that they are seeing an incredible sense of camaraderie among everyone caring for the patients affected by the COVID-19 pandemic. “Chad Cope is our manager. If I go to him with an issue, I know he will listen and find a solution,” says Ms. Kevra.

To take even one patient in the ICU off a ventilator after nearly two weeks takes a team of heroes, and on April 7, 2020, the team at Geisinger Community Medical Center extubated three. Hats off to attending physician, Nikul Patel, DO, these three dedicated nurses and everyone else who made it happen.

ICU Nurses
When three ICU nurses took their patients off ventilators on the same day, it was a sign of hope for all patients. Well done, Rachel, Danielle and Melissa.

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