From ICU doctor to ICU patient

Abstract

At the beginning of April 2020, I have been admitted to the emergency department with pneumonia. Everything started as a light dry cough and a certain degree of fatigue that, initially, did not bother me too much. After few days, the symptoms became unbearable. As I was already aware, I had already started the therapy with hydroxychloroquine and azithromycin, honestly, without a great improvement. Upon admission, my pneumonia was interstitial, bilateral, maybe more in the left lung. My arterial saturation in room air was 91%, and, interestingly, I was not dyspneic. At the blood gas analysis, I had a PaO2 61 mmHg, PaCO2 29 mmHg, pH 7.47. Thankfully, with the oxygen mask my PaO2 improved to 91 mmHg. This did not help for long: the day after we decided for continuous positive airway pressure (CPAP) with 10 cmH2O of positive end-expiratory pressure (PEEP). Nevertheless, I was still not feeling well, despite the PaO2 further went up. Together with the staff, we decided to opt for the prone position after one day of CPAP. At the beginning, I was lying prone for 5 h in the morning, 3 h in the evening and 4 h at night. One hour after the change in prone position I was feeling immediately much better, my PaO2 was going up to 270 mmHg! For the next three days, we alternated supine and prone position, to the point that I was able to manage myself rather well: I was simply asking the nurses if I could lay belly down, I was completely able to turn and change positions by myself. Slowly, but steadily I kept improving, and the pronation was starting to be less and less needed and the PEEP was lowered to 7 cmH2O. Gradually, we abandoned CPAP after 9 days. During the last 4 days, I kept CPAP only in the night with 2 h of prone position. Slowly, we were able to lower also the FiO2 to finally breathe room air, again. I did one last computed tomography scan and I was discharged home. I had a good recovery by physiotherapy because, initially, I was not completely fine and I had scarce tolerance to the physical activity. Breathing still feels awkward: something happened down there, I can feel my lungs. After more than one month from the symptoms onset I came back home, happy. It was a really, tough experience. As an intensivist and a patient, during my hospital stay, I kept thinking about every notion and experience I learned at the bedside, on the books and from mentors: they really saved my life. Now, I’m back, to be useful again, at the front line. Hassan Kandil, an Italian intensivist.