Intensive Respiratory Care

A unit for the intensive management of cases of potential, imminent or actual respiratory failure has existed in the Royal Victoria Hospital since 1962 but for three years prior to this, members of the Department of Anaesthetics were treating such cases in the general wards of the hospital or giving advice on their management elsewhere if requested. The present consultant in charge of the unit held a hoispital research fellowship for two years. The object was to investigate the need for such specialised work in Northern Ireland and suggest how it could be best carried out. Over the seven year period 1959-1966 about 400 patients have been cared for in, or by members of, the unit and this brief report deals with the nature of 350 consecutive cases, with some data on the method and outcolme of treatment. Some aspects of this have been published by Dundee and Gray (1963) and by Gray and Dundee (1965). This is not an exhaustive survey but it is hoped that it will give some indication of the type of patient most likely to benefit from intensive respiratory care. STAFFING In contrast to some other centres, the main care of these patients is in the hands of the anaesthetists, but when they are transferred from other units the advice and help of the staff concerned is valued, particularly in relation to special problems. The unit has full time Consultant Anaesthetist cover on a sessional basis, Dr. R. C. Gray contributing six sessions and Professor J. W. Dundee and Dr. R. S. J. Clarke, two sessions each. The senior anaesthetic tutor provides holiday cover and night and week-end cover is shared by all foiur. There is an anaesthetist in training allocated to the unit on a rota basis; these are of seniority ranging from senior house officers to senior registrars, depending on their needs. The period is normally for one month and a night rota is provided by all the trainees. This means that there is always an anaesthetist in the unit (which has its own bed-sitting room) when a patient is on a respirator and at such other times as necessary. The permanent nursing staff consists of one sister and three staff nurses, continuity being provided by the staff nurses taking turns on night as well as day duty. The junior nursing cover is on the basis of one nurse per patient at all times so that the total number of nurses required varies widely but can be as many as 19 with six patients in the unit. Physiotherapy is also necessary seven days a week and at least once during the evening and night as well as the standard day-time visits.