Indian Journal of Critical Care Medicine
Volume 26 | Issue 6 | Year 2022

Ten Practice Changes in COVID-19 Intensive Care Unit of a Tertiary Care Teaching Hospital in India during the Peak of Pandemic: Adapt and Improve

Lipika Soni1, Neha Pangasa2, Dalim K Baidya3, Rajeshwari Subramaniam4

1–4Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India

Corresponding Author: Dalim K Baidya, Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India, e-mail:

How to cite this article: Soni L, Pangasa N, Baidya DK, Subramaniam R. Ten Practice Changes in COVID-19 Intensive Care Unit of a Tertiary Care Teaching Hospital in India during the Peak of Pandemic: Adapt and Improve. Indian J Crit Care Med 2022;26(6):710–711.

Source of support: Nil

Conflict of interest: None


During the peak of the coronavirus disease-2019 (COVID-19) pandemic, 10 practice-changing decisions were adopted which led to an improved standard of clinical care in the face of overwhelming burden to the healthcare setup. Formation of a control unit with the piggyback team, briefing before donning, replacement of personal protective equipment (PPE) with impermeable surgical gowns, a dedicated prone team and the prone bundle of care, weaning-extubation and tracheostomy protocol, online audiovisual family-patient meet, daily rounds by hospital infection control committee member, each one clean one policy, focused onsite training of healthcare support staff and discharge policy with post-discharge follow-up were the 10 important changes adopted.

Keywords: COVID-19, COVID-19 pandemic, Intensive care unit.

The coronavirus disease-2019 (COVID-19) pandemic has evolved as a global health crisis leading to unprecedented rise in intensive care unit admission and death.1 In a 28-bedded COVID-19 ICU of a tertiary care institute, most of the patients were either on noninvasive or invasive mechanical ventilation and in prone position or in high-flow oxygen therapy devices. However, during the peak of pandemic in April–May 2021, we had to quickly enforce few practice-changing decisions to cater to the increased demand and challenge faced by the healthcare setup.

The increased requirement of manpower in the peak of pandemic could be met due to discontinuation of elective surgeries and routine out-patient services and decision by the institute to extend the period of residency. Addition of control and piggyback unit reduced the burden of clinical team, ensured smooth clinical functioning and timely communication with the relatives. Provision of cooling-off period was instrumental in maintaining physical and mental health of HCPs. Implementation of prone team, prone bundle of care, and infection control policies improved patient care. Implementation of extubation and PDT protocol and discharge policy ensured ICU bed availability in the peak of pandemic. Each one clean one policy and daily audio-visual family meet increased patient comfort and discontinuation of coverall PPE improved comfort of the HCPs. With the adoption of the aforesaid practice changes from routine critical care, we believe that we could provide improved standard of care to all patients at the time of crisis.


Lipika Soni

Neha Pangasa

Dalim K Baidya

Rajeshwari Subramaniam


1. World Health Organization. Available from: [Accessed on January 19, 2022].

2. Anand RK, Baidya DK, Maitra S, Ray BR. A proposal for dedicated “prone team” and “prone bundle of care” in COVID-19 ICU. Indian J Crit Care Med 2021;25(3):349–350. DOI: 10.5005/jp-journals-10071-23754.

3. Carsetti A, Damia Paciarini A, Marini B, Pantanetti S, Adrario E, Donati A. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care 2020;24(1):225. DOI: 10.1186/s13054-020-02956-w.

4. Haritha D, Pangasa N, Hirolli D, et al. Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients and initial experience [Accepted for publication in J Anaesthesiol Clin Pharmacol].

5. Baidya DK, Maitra S. Improving quality and satisfaction in care of Covid-19: a patient-centric approach. Natl Med J India 2021;34(1):59–60. DOI: 10.4103/0970-258X.323454.

6. Hirolli D, Panda R, Baidya DK. Air at rest, oxygen at movement! J Anaesthesiol Clin Pharmacol 2022. DOI: 10.4103/joacp.joacp_321_21.

7. Revised discharge policy for COVID-19. Ministry of Health and Family Welfare, Government of India. Available from:

© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.