ICUs under pressure as admissions rise

Almost three-quarters of NSW’s available staffed intensive care beds are full with doctors increasingly concerned at the pressure on the system.

Intensive care doctors are increasingly concerned at the pressure on the state hospital system as rising case numbers lead to a significant spike in hospitalis­ations.

Almost three-quarters of NSW’s available staffed intensive care beds are full, with Covid-19 ­patients making up 10 per cent of total ICU admissions.

Intensive care doctors are increasingly concerned at the pressure on the state hospital system as rising case numbers lead to a significant spike in hospitalis­ations. There are currently 69 patients in ICU in NSW with Covid-19, with 25 on ventilators.

The state has 844 staffed ICU beds available, and 608 of them were occupied on Monday.

President of the Australian and New Zealand Intensive Care Society Anthony Holley said doctors and nurses were under significant pressure but the state’s hospitals were a long way from being overloaded.

“The intensive care fraternity is concerned,” Professor Holley said.

“The workload has definitely substantially increased but in terms of numbers of patients in intensive care, we’re still nowhere near overwhelmed and there remains capacity.”

Several hospitals in Sydney’s west and southwest have activated surge plans as the numbers of patients in hospital with Covid-19 increases. Elective surgery is on hold and some wards have been converted into Covid-19 wards to provide more space.

The pressure of Covid-19 cases on the ICU system is intense, with one-on-one care necessary and onerous PPE requirements. The average Covid-19 patient who enters ICU stays much longer than most patients who enter intensive care. The median length of stay for patients who are ventilated is 16 days and one in five dies. Of all ­patients who are hospitalised with Covid-19, about 10 per cent end up in ICU.

Professor Holley said the system would become overwhelmed if the proportion of Covid-19 patients in ICU rose to about 50 per cent. “If we were up around the 50 per cent Covid occupancy rate, that would be a very demanding situation,” he said.

“That is why the intensive care community would strongly encourage the strictest compliance with the chief health officer’s directives and for people to seriously consider vaccination. is situation is serious and it’s imperative people comply with health orders.”

As ICU units come under pressure, some surgeons in western Sydney are finding themselves unable to book patients in for ­urgent cancer surgery because of limited ICU capacity.

The head of Westmead Hospital’s acute surgical unit, Vincent Lam, circulated a message to fellow surgeons on August 5 warning that the hospital’s ICU unit would be “completely overwhelmed” if case numbers continued to rise.

At the time, the hospital had 50 ­patients admitted with Covid-19, and that number has now risen. “The projection is there will be 110 cases in the next two to three weeks and ICU will be completely overwhelmed,” Professor Lam wrote.

“We were told three theatres will be cancelled from Monday and the planning is up to five very soon. Staffing will be the main issue and how we could staff the various surgical wards plus Covid wards in the next few weeks. Clearly, there isn’t a clear plan from high up.”

Professor Lam said the hospital was struggling with staffing shortages as weary medics quit amid the growing pressures of Covid-19, with surgical operations short-staffed as nurses were redeployed to Covid wards, vaccination centres or testing stations.

However, when contacted to discuss the message, Professor Lam denied Westmead’s ICU was close to being overwhelmed. Westmead Hospital also said there was still capacity within the intensive care unit. “As far as I know, there is no capacity issue in ICU,” Professor Lam said.

“We have been doing the cases that need to be done.”

A spokesperson for the Western Sydney Local Health District said: “Westmead Hospital intensive care unit currently has no ­capacity issues.”

The number of Covid patients in hospital increased markedly on Tuesday and now stands at 447, up from 391 the day before.

NSW has the capacity to stretch to 2000 physical ICU beds but it would be almost impossible to adequately staff that number.

Professor Holley said the capacity in the system this year is significantly enhanced compared with last year, but intensive care units were often running close to capacity even without Covid-19 patients.