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Rylander C, Sternley J, Petzold M, Oras J. Unit-to-unit transfer due to shortage of intensive care beds in Sweden 2015-2019 was associated with a lower risk of death but a longer intensive care stay compared to no transfer: a registry study. J Intensive Care 2024; 12:10. [PMID: 38409081 PMCID: PMC10898117 DOI: 10.1186/s40560-024-00722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Intensive care unit-to-unit transfer due to temporary shortage of beds is increasing in Sweden. Transportation induces practical hazards, and the change of health care provider may prolong the length of stay in intensive care. We previously showed that the risk of death at 90 days did not differ between patients transferred due to a shortage of beds and non-transferred patients with a similar burden of illness in a tertiary intensive care unit. The aim of this study was to widen the analysis to a nation-wide cohort of critically ill patients transferred to another intensive care unit in Sweden due to shortage of intensive care beds. METHODS Retrospective comparison between capacity transferred and non-transferred patients, based on data from the Swedish Intensive Care Registry during a 5-year period before the COVID-19 pandemic. Patients with insufficient data entries or a recurring capacity transfer within 90 days were excluded. To assess the association between capacity transfer and death as well as intensive care stay within 90 days after ICU admission, logistic regression models with step-wise adjustment for SAPS3 score, primary ICD-10 ICU diagnosis and the number of days in the intensive care unit before transfer were applied. RESULTS From 161,140 eligible intensive care admissions, 2912 capacity transfers were compared to 135,641 discharges or deaths in the intensive care unit. Ninety days after ICU admission, 28% of transferred and 21% of non-transferred patients were deceased. In the fully adjusted model, capacity transfer was associated with a lower risk of death within 90 days than no transfer; OR (95% CI) 0.71 (0.65-0.69) and the number of days spent in intensive care was longer: 12.4 [95% CI 12.2-12.5] vs 3.3 [3.3-3.3]. CONCLUSIONS Intensive care unit-to-unit transfer due to shortage of bed capacity as compared to no transfer during a 5-year period preceding the COVID-19 pandemic in Sweden was associated with lower risk of death within 90 days but with longer stay in intensive care.
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Affiliation(s)
- Christian Rylander
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, 715 85, Uppsala, Sweden.
| | - Jesper Sternley
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, 715 85, Uppsala, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care Medicine, Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Thomson WR, Puthucheary ZA, Wan YI. Critical care and pandemic preparedness and response. Br J Anaesth 2023; 131:847-860. [PMID: 37689541 PMCID: PMC10636520 DOI: 10.1016/j.bja.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 07/23/2023] [Indexed: 09/11/2023] Open
Abstract
Critical care was established partially in response to a polio epidemic in the 1950s. In the intervening 70 yr, several epidemics and pandemics have placed critical care and allied services under extreme pressure. Pandemics cause wholesale changes to accepted standards of practice, require reallocation and retargeting of resources and goals of care. In addition to clinical acumen, mounting an effective critical care response to a pandemic requires local, national, and international coordination in a diverse array of fields from research collaboration and governance to organisation of critical care networks and applied biomedical ethics in the eventuality of triage situations. This review provides an introduction to an array of topics that pertain to different states of pandemic acuity: interpandemic preparedness, alert, surge activity, recovery and relapse through the literature and experience of recent pandemics including COVID-19, H1N1, Ebola, and SARS.
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Affiliation(s)
- William R Thomson
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
| | - Zudin A Puthucheary
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Yize I Wan
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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3
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Stark AJ, Chohan S. The association of intensive care capacity transfers with survival in COVID-19 patients from a Scottish district general hospital: A retrospective cohort study. J Intensive Care Soc 2023; 24:277-282. [PMID: 37744069 PMCID: PMC9548487 DOI: 10.1177/17511437221111638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: During the second wave of COVID-19 cases within Scotland, local evidence suggested that a large number of interhospital transfers occurred due to both physical capacity and staff shortages. Although there are inherent risks with transferring critically ill patients between hospitals, there are signals in the literature that mortality is not affected in COVID-19 patients when transferred between intensive care units. With a lack of evidence in the Scottish population, and as the greatest source of capacity transfers in our critical care network at that time, we sought to determine whether these transfers impacted on survival to hospital discharge.Methods: We conducted a retrospective cohort study of all patients admitted to our unit between the 1st October 2020 and the 31st March 2021 with a primary diagnosis of COVID-19 pneumonia. Patients were grouped according to whether they underwent an interhospital capacity transfer or not, either for unit shortage of beds or unit shortage of staff. The primary outcome measure was survival to ultimate hospital discharge, and secondary outcomes included total ventilator days and total intensive care unit length of stay. Baseline characteristic data were also collected for all patients. Survival data were entered into a backward stepwise logistic regression analysis that included transfer status, and coefficients transformed into odds ratios and 95% confidence intervals.Results: A total of 108 patients were included. Of these, 30 were transferred to another intensive care unit due to capacity issues at the base hospital. From the baseline characteristic data, age was significantly higher in those transferred out, while other characteristics were similar. Unadjusted mortality rates were 30.8% for those not transferred, and 40% for those transferred out. However, when entered into a logistic regression analysis to attempt to control for confounders in the baseline characteristics, being transferred had an odds ratio of 1.14 (95% confidence interval 0.43-3.1) for survival to hospital discharge. Total ventilator days and total ICU length of stay were both higher in the transferred patients.Conclusion: This unique study of COVID-19 patients transferred from a Scottish district general hospital did not show an association between transfer status and survival to hospital discharge. However, the study was likely underpowered to detect small differences. As the situation continues to evolve, a prospective regional multi-centre study may help to provide more robust findings.
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Affiliation(s)
- Adam J Stark
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Monklands, Airdrie, UK
| | - Sanjiv Chohan
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Monklands, Airdrie, UK
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4
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Yoshifuji A, Nakahara S, Oyama E, Kobayashi R, Shimizu M, Sakamoto A, Yamane E, Nishida M, Shima T, Sugawara Y, Kikuchi T, Nakazawa A, Ryuzaki M, Sekine K. Managing Interhospital Referrals During a COVID-19 Patient Surge in Japan: Creating Available Beds by Exchanging Patients. Health Secur 2023. [PMID: 37093031 DOI: 10.1089/hs.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
A COVID-19 patient surge in Japan from July to September 2021 caused a mismatch between patient severity and bed types because hospital beds were fully occupied and patient referrals between hospitals stagnated. Japan's predominantly private healthcare system lacks effective mechanisms to coordinate healthcare providers to address the mismatch. To address the surge, in August 2021, Tokyo Saiseikai Central Hospital started a scheme to exchange patients with other hospitals to mitigate the mismatch. In this article, we outline a retrospective observational study using medical records from a tertiary care medical center that treated severe COVID-19 cases. We describe daily patient admissions to our hospital's COVID-19 beds from July to September 2021, and compared the moving average of daily admissions before and after the exchange scheme was introduced. Bed occupancy reached nearly 100% in late July when the patient surge began and continued to exceed 100% in August when the surge peaked. However, the average daily admission did not decrease in August compared with July: the median daily admission (25th to 75th percentile) during each period was 2 (1 to 2.5) in late July and 3 (2 to 4) in August. The number of patients referred in from secondary care hospitals and the number of patients referred out was balanced in August. During the patient surge, the exchange scheme enabled the hospital to maintain and even increase the number of new admissions despite the bed shortage. Coordinating patient referrals in both directions simultaneously, rather than the usual 1-way transfer, can mitigate such mismatches.
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Affiliation(s)
- Ayumi Yoshifuji
- Ayumi Yoshifuji, MD, PhD is Staff, Division of Nephrology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shinji Nakahara
- Shinji Nakahara, MD, MS, PhD, is a Professor, Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Emi Oyama
- Emi Oyama is Staff, Division of Nephrology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Risa Kobayashi
- Risa Kobayashi, RN, is Staff, Department of Nursing, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Mao Shimizu
- Mao Shimizu, RN, is Staff, Department of Nursing, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Akemi Sakamoto
- Akemi Sakamoto, RN, is Staff, Division of Infection Control, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Eri Yamane
- Eri Yamane, RN, is Staff, Division of Infection Control, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Masamichi Nishida
- Masamichi Nishida, MD, PhD, is Director, Department of Emergency Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tamotsu Shima
- Tamotsu Shima, MD, is Chief Physician, Department of Emergency, Toranomon Hospital, Tokyo, Japan
| | - Yoko Sugawara
- Yoko Sugawara, MD, is Staff, Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Takahide Kikuchi
- Takahide Kikuchi, MD, is Director, Division of Hematology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Atsushi Nakazawa
- Atsushi Nakazawa, MD, PhD, is Director, Division of Gastroenterology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Munekazu Ryuzaki
- Munekazu Ryuzaki, MD, PhD, is Director, Division of Nephrology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Kazuhiko Sekine
- Kazuhiko Sekine, MD, PhD, is Director, Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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Hermann B, Benghanem S, Jouan Y, Lafarge A, Beurton A. The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists. Ann Intensive Care 2023; 13:28. [PMID: 37039936 PMCID: PMC10088619 DOI: 10.1186/s13613-023-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023] Open
Abstract
Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better.
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Affiliation(s)
- Bertrand Hermann
- Service de Médecine Intensive - Réanimation, Hôpital Européen Georges Pompidou (HEGP), Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
| | - Sarah Benghanem
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Cochin, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive - Réanimation, CHRU Tours, Tours, France
- Service de Réanimation Chirurgicale Cardiovasculaire & Chirurgie Cardiaque, CHRU Tours, Tours, France
- INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine de Tours, Tours, France
| | - Antoine Lafarge
- Faculté de Médecine, Université Paris Cité, Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Saint Louis, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Nord - Université Paris Cité (AP-HP Nord - Université Paris Cité), Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive - Réanimation, Hôpital Tenon, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université (GHU AP-HP Sorbonne Université), Paris, France.
- Service de Médecine Intensive - Réanimation, Hôpital Pitié Salpêtrière, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
- UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
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Cini C, Neto AS, Burrell A, Udy A. Inter-hospital transfer and clinical outcomes for people with COVID-19 admitted to intensive care units in Australia: an observational cohort study. Med J Aust 2023. [PMID: 37037671 DOI: 10.5694/mja2.51917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To examine the association between inter-hospital transfer and in-hospital mortality among people with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in Australia. DESIGN Retrospective cohort study; analysis of data collected for the Short Period Incidence Study of Severe Acute Respiratory Illness (SPRINT-SARI) Australia study. SETTING, PARTICIPANTS People with COVID-19 admitted to 63 ICUs, 1 January 2020 - 1 April 2022. MAIN OUTCOME MEASURES Primary outcome: in-hospital mortality; secondary outcomes: ICU and hospital lengths of stay and frequency of selected complications. RESULTS Of 5207 people with records in the SPRINT-SARI Australia database at 1 April 2022, 328 (6.3%) had been transferred between hospitals, 305 (93%) during the third pandemic wave. Compared with patients not transferred, their median age was lower (53 years; interquartile range [IQR], 45-61 years v 60 years; IQR, 46-70 years), their median body mass index higher (32.5 [IQR, 27.2-39.0] kg/m2 v 30.1 [IQR, 25.7-35.7] kg/m2 ), and fewer had received a COVID-19 vaccine (22% v 44.9%); their median APACHE II scores were similar (14.0; IQR, 12.0-18.0 v 14.0; IQR, 10.0-19.0). Bacterial pneumonia (64.7% v 29.0%) and bacteraemia (27% v 8%) were more frequent in transferred patients, as was the need for more intensive ICU interventions, including invasive mechanical ventilation (71.2% v 38.1%) and extra-corporeal membrane oxygenation (26% v 1.7%). Crude ICU (19% v 14.9%) and in-hospital mortality (19% v 18.4%) were similar for patients who were or were not transferred; median lengths of ICU (20.0 [IQR, 11.2-40.3] days v 4.6 [IQR, 2.1-10.1] days) and hospital stay (29.7 [IQR, 18.1-49.6] days v 12.3 [IQR, 7.3-21.0] days) were longer for transferred patients. In the multivariable regression analysis, in-hospital mortality risk was lower for transferred patients (risk difference [RD], -5.0 percentage points; 95% confidence interval [CI] -10 to -0.03 percentage points), but not in the propensity score-adjusted analysis (RD, -3.4 [95% CI, -8.9 to 2.1] percentage points). CONCLUSIONS Among people with COVID-19 admitted to ICUs, patients transferred from another hospital required more intense interventions and remained in hospital longer, but were not at greater risk of dying in hospital than the patients who were not transferred.
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Affiliation(s)
| | - Ary S Neto
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- Austin Hospital, Melbourne, VIC
| | - Aidan Burrell
- Alfred Health, Melbourne, VIC
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
| | - Andrew Udy
- Alfred Health, Melbourne, VIC
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
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Abstract
OBJECTIVES Here, we report the management of a catastrophic COVID-19 Delta variant surge, which overloaded ICU capacity, using crisis standards of care (CSC) based on a multiapproach protocol. DESIGN Retrospective observational study. SETTING University Hospital of Guadeloupe. PATIENTS This study retrospectively included all patients who were hospitalized for COVID-19 pneumonia between August 11, 2021, and September 10, 2021, and were eligible for ICU admission. INTERVENTION Based on age, comorbidities, and disease severity, patients were assigned to three groups: Green (ICU admission as soon as possible), Orange (ICU admission after the admission of all patients in the Green group), and Red (no ICU admission). MEASUREMENTS AND MAIN RESULTS Among the 328 patients eligible for ICU admission, 100 (30%) were assigned to the Green group, 116 (35%) to the Orange group, and 112 (34%) to the Red group. No patient in the Green group died while waiting for an ICU bed, whereas 14 patients (12%) in the Orange group died while waiting for an ICU bed. The 90-day mortality rates were 24%, 37%, and 78% in the Green, Orange, and Red groups, respectively. A total of 130 patients were transferred to the ICU, including 79 from the Green group, 51 from the Orange group, and none from the Red group. Multivariate analysis revealed that among patients admitted to the ICU, death was independently associated with a longer time between ICU referral and ICU admission, the Sequential Organ Failure Assessment score, and the number of comorbidities, but not with triage group. CONCLUSIONS CSC based on a multiapproach protocol allowed admission of all patients with a good prognosis. Higher mortality was associated with late admission, rather than triage group.
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Zappella N, Dirani C, Lortat Jacob B, Tanaka S, Kantor E, El Kalai A, Rkik Y, Gouel Cheron A, Tran Dinh A, Montravers P. Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre. BMC Anesthesiol 2022; 22:310. [PMID: 36192702 PMCID: PMC9527134 DOI: 10.1186/s12871-022-01845-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background During the COVID-19 first wave in France, the capacity of intensive care unit (ICU) beds almost doubled, mainly because of the opening of temporary ICUs with staff and equipment from anaesthesia. Objectives We aim to investigate if the initial management in temporary ICU is associated with a change in ICU mortality and short-term prognosis. Design Retrospective single-centre cohort study. Setting Surgical ICU of the Bichat Claude Bernard University Hospital during the COVID-19 “first wave” (from 18 March to 10 April 2020). Patients All consecutive patients older than 18 years of age with laboratory-confirmed SARS-CoV-2 infection and/or typical radiological patterns were included during their first stay in the ICU for COVID-19. Intervention Patients were admitted to a temporary ICU if no room was available in the classical ICU and if they needed invasive mechanical ventilation but no renal replacement therapy or Extracorporeal Membrane Oxygenation (ECMO) in the short term. The temporary ICUs were managed by mixed teams (from the ICU and anaesthesiology departments) following a common protocol and staff meetings. Main outcome measure ICU mortality Results Among the 59 patients admitted, 37 (62.7%) patients had initial management in the temporary ICU. They had the same characteristics on admission and the same medical management as patients admitted to the classical ICU. ICU mortality was similar in the 2 groups (32.4% in temporary ICUs versus 40.9% in classical ICUs; p=0.58). SAPS-II and ECMO use were associated with mortality in multivariate analysis but not admission to the temporary ICU. Conclusion In an overload context of the ICU of a geographical area, our temporary ICU model allowed access to intensive care for all patients requiring it without endangering them.
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Affiliation(s)
- Nathalie Zappella
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France.
| | - Chadi Dirani
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France
| | - Brice Lortat Jacob
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France
| | - Sébastien Tanaka
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France.,Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Saint-Denis, de La Réunion, France
| | - Elie Kantor
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France
| | - Adnan El Kalai
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France
| | - Yassine Rkik
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France
| | - Aurélie Gouel Cheron
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France.,Paris University, Paris, France.,Antibody in Therapy and Pathology, Pasteur Institute, UMR 1222 INSERM, Paris, France.,Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Alexy Tran Dinh
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France.,Paris University, Paris, France
| | - Philippe Montravers
- Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat - Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France.,Paris University, Paris, France.,INSERM UMR 1152, Paris, France
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9
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Slagt C, Spoelder EJ, Tacken MCT, Frijlink M, Servaas S, Leijte G, van Eijk LT, van Geffen GJ. Safety during interhospital helicopter transfer of ventilated COVID-19 patients. No clinical relevant changes in vital signs including non-invasive cardiac output. Respir Res 2022; 23:256. [PMID: 36123727 PMCID: PMC9484339 DOI: 10.1186/s12931-022-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were transferred not only between hospitals by ambulance but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the physiological impact of helicopter transport on critically ill patients and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated patients with severe COVID-19, with special focus on take-off, midflight, and landing. Methods All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch ‘Lifeliner 5’ HEMS team and who were fully monitored, including noninvasive cardiac output, were included in this study. Three 10-min timeframes (take-off, midflight and landing) were defined for analysis. Continuous data on the vital parameters heart rate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO2 and noninvasive cardiac output using electrical cardiometry were collected and stored at 1-min intervals. Data were analyzed for differences over time within the timeframes using one-way analysis of variance. Significant differences were checked for clinical relevance. Results Ninety-eight patients were included in the analysis. During take-off, an increase was noticed in cardiac output (from 6.7 to 8.2 L min−1; P < 0.0001), which was determined by a decrease in systemic vascular resistance (from 1071 to 739 dyne·s·cm−5, P < 0.0001) accompanied by an increase in stroke volume (from 88.8 to 113.7 mL, P < 0.0001). Other parameters were unchanged during take-off and mid-flight. During landing, cardiac output and stroke volume slightly decreased (from 8.0 to 6.8 L min−1, P < 0.0001 and from 110.1 to 84.4 mL, P < 0.0001, respectively), and total systemic vascular resistance increased (P < 0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians. Conclusions Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02177-5.
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Affiliation(s)
- Cornelis Slagt
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands. .,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Eduard Johannes Spoelder
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marijn Cornelia Theresia Tacken
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maartje Frijlink
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sjoerd Servaas
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guus Leijte
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lucas Theodorus van Eijk
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Geert Jan van Geffen
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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10
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Wortel SA, Bakhshi‐Raiez F, Termorshuizen F, de Lange DW, Dongelmans DA, Keizer NFD, Barnas MGW, Bindels AJGH, Boer DP, Bosman RJ, Brunnekreef GB, de Bruin MT, de Graaff M, de Jong RM, de Meijer AR, de Ruijter W, de Waal R, Dijkhuizen A, Dormans TPJ, Draisma A, Drogt I, Eikemans BJW, Elbers PWG, Epker JL, Erkamp ML, Festen‐Spanjer B, Frenzel T, Gommers D, Gritters NC, Hené IZ, Hoeksema M, Holtkamp JWM, Hoogendoorn ME, Houwink API, Jacobs CJMG, Janssen ITA, Kieft H, Koetsier MP, Koning TJJ, Kusadasi N, Lens JA, Lutisan JG, Mehagnoul‐Schipper DJ, Moolenaar D, Nooteboom F, Pruijsten RV, Ramnarain D, Reidinga AC, Rengers E, Rijkeboer AA, Rozendaal FW, Schnabel RM, Silderhuis VM, Spijkstra JJ, Spronk P, te Velde LF, Urlings‐Strop LC, van den Berg AE, van den Berg R, van der Voort PHJ, van Driel EM, van Gulik L, van Iersel FM, van Lieshout M, van Slobbe‐Bijlsma ER, van Tellingen M, Vandeputte J, Verbiest DP, Versluis DJ, Verweij E, Mos MV, Wesselink RMJ. Comparison of patient characteristics and long‐term mortality between transferred and non‐transferred COVID‐19 patients in Dutch Intensive Care Units; A national cohort study. Acta Anaesthesiol Scand 2022; 66:1107-1115. [PMID: 36031794 PMCID: PMC9539143 DOI: 10.1111/aas.14129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
Background COVID‐19 patients were often transferred to other intensive care units (ICUs) to prevent that ICUs would reach their maximum capacity. However, transferring ICU patients is not free of risk. We aim to compare the characteristics and outcomes of transferred versus non‐transferred COVID‐19 ICU patients in the Netherlands. Methods We included adult COVID‐19 patients admitted to Dutch ICUs between March 1, 2020 and July 1, 2021. We compared the patient characteristics and outcomes of non‐transferred and transferred patients and used a Directed Acyclic Graph to identify potential confounders in the relationship between transfer and mortality. We used these confounders in a Cox regression model with left truncation at the day of transfer to analyze the effect of transfers on mortality during the 180 days after ICU admission. Results We included 10,209 patients: 7395 non‐transferred and 2814 (27.6%) transferred patients. In both groups, the median age was 64 years. Transferred patients were mostly ventilated at ICU admission (83.7% vs. 56.2%) and included a larger proportion of low‐risk patients (70.3% vs. 66.5% with mortality risk <30%). After adjusting for age, APACHE IV mortality probability, BMI, mechanical ventilation, and vasoactive medication use, the hazard of mortality during the first 180 days was similar for transferred patients compared to non‐transferred patients (HR [95% CI] = 0.99 [0.91–1.08]). Conclusions Transferred COVID‐19 patients are more often mechanically ventilated and are less severely ill compared to non‐transferred patients. Furthermore, transferring critically ill COVID‐19 patients in the Netherlands is not associated with mortality during the first 180 days after ICU admission.
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Affiliation(s)
- Safira A. Wortel
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9 Amsterdam Netherlands
- Amsterdam Public Health, Quality of care Amsterdam Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics Amsterdam Netherlands
| | - Ferishta Bakhshi‐Raiez
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9 Amsterdam Netherlands
- Amsterdam Public Health, Quality of care Amsterdam Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics Amsterdam Netherlands
| | - Fabian Termorshuizen
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9 Amsterdam Netherlands
- Amsterdam Public Health, Quality of care Amsterdam Netherlands
| | - Dylan W. de Lange
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics Amsterdam Netherlands
- Department of Intensive Care Medicine University Medical Centre Utrecht Netherlands
| | - Dave A. Dongelmans
- Amsterdam Public Health, Quality of care Amsterdam Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics Amsterdam Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Intensive Care Medicine Netherlands
| | - Nicolette F. de Keizer
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9 Amsterdam Netherlands
- Amsterdam Public Health, Quality of care Amsterdam Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics Amsterdam Netherlands
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11
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Painvin B, Ehrmann S, Thille AW, Tadié JM. Intensive care unit-to-unit capacity transfers are associated with increased mortality: no hasty conclusions in the event of a crisis. Ann Intensive Care 2022; 12:60. [PMID: 35779148 PMCID: PMC9250566 DOI: 10.1186/s13613-022-01031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Benoit Painvin
- Service des Maladies Infectieuses et de Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes, France.
| | - Stephan Ehrmann
- Service de Médecine Intensive Et Réanimation, CRICS- Triggersep Research Network, Centre Hospitalier Régional Universitaire de Tours, CIC INSERM 1415Hôpital Bretonneau 2, boulevard Tonnellé, 27044, Tours, France.,Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Arnaud W Thille
- Service de Médecine Intensive Et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 90577 86000, Poitiers, France
| | - Jean-Marc Tadié
- Service des Maladies Infectieuses et de Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes, France. .,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France.
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12
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Grier S, Browne R. Developments in adult critical care transfer in England: a positive legacy of the COVID-19 pandemic. Anaesthesia 2022; 77:858-860. [PMID: 35510956 PMCID: PMC9347502 DOI: 10.1111/anae.15752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- S Grier
- Retrieve Adult Critical Care Transfer Service, Bristol, UK
| | - R Browne
- Adult Critical Care Co-ordination and Transfer Service, Birmingham, UK
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13
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del Carmen Arcentales Herrera J, Santa Cruz Belela-Anacleto A, Pedreira ML, Kusahara DM. Influence of transport conditions on infusion pumps performance and triggering alarms: A simulation-based research. Int Emerg Nurs 2022; 62:101144. [DOI: 10.1016/j.ienj.2022.101144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 10/29/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022]
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14
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Sarzynski SH, Mancera A, Mann C, Dai M, Sun J, Warner S, Kadri SS. Frequency and Risk of Emergency Medical Service Interhospital Transportation of Patients With Acute Lower Respiratory Tract Illness During the COVID-19 Pandemic in the US. JAMA 2022; 327:874-877. [PMID: 35089309 PMCID: PMC8889457 DOI: 10.1001/jama.2022.0812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study compares the frequency of hospital-to-hospital transportation events and associated life-threatening deterioration during transport among patients with acute lower respiratory tract illness during vs before the COVID-19 pandemic.
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Affiliation(s)
- Sadia H. Sarzynski
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Alex Mancera
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Clay Mann
- University of Utah School of Medicine, National Emergency Medical Services Information System Technical Assistance Center, Salt Lake City
| | - Mengtao Dai
- University of Utah School of Medicine, National Emergency Medical Services Information System Technical Assistance Center, Salt Lake City
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sarah Warner
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sameer S. Kadri
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
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15
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Évacuations sanitaires en TGV durant la crise sanitaire COVID-19 : pourquoi ? Pour quoi ? MÉDECINE DE CATASTROPHE - URGENCES COLLECTIVES 2022. [PMCID: PMC8802610 DOI: 10.1016/j.pxur.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Huq F, Manners E, O'Callaghan D, Thakuria L, Weaver C, Waheed U, Stümpfle R, Brett SJ, Patel P, Soni S. Patient outcomes following transfer between intensive care units during the COVID-19 pandemic. Anaesthesia 2022; 77:398-404. [PMID: 35226964 PMCID: PMC9111416 DOI: 10.1111/anae.15680] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/25/2022]
Abstract
Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID-19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID-19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID-19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter-hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra-hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty-five patients underwent inter-hospital transfers compared with 92 intra-hospital transfers. There was no significant change in median compliance 6 h pre-transfer, immediately post-transfer and 24 h post-transfer in patients who underwent either intra-hospital or inter-hospital transfers. For inter-hospital transfers, there was an initial drop in median PaO2 /FI O2 ratio: from median (IQR [range]) 25.1 (17.8-33.7 [12.1-78.0]) kPa 6 h pre-transfer to 19.5 (14.6-28.9 [9.8-52.0]) kPa immediately post-transfer (p < 0.05). However, this had resolved at 24 h post-transfer: 25.4 (16.2-32.9 [9.4-51.9]) kPa. For intra-hospital transfers, there was no significant change in PaO2 /FI O2 ratio. We also found no meaningful difference in pH; PaCO2 ;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID-19 undergoing mechanical ventilation of the lungs may have short-term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID-19 pandemic.
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Affiliation(s)
- F Huq
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - E Manners
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - D O'Callaghan
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - L Thakuria
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - C Weaver
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - U Waheed
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - R Stümpfle
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.,Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - S J Brett
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - P Patel
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.,Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - S Soni
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.,Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
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17
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Litton E, Huckson S, Chavan S, Bucci T, Holley A, Everest E, Kelly S, McGloughlin S, Millar J, Nguyen N, Nicholls M, Secombe P, Pilcher D. Increasing ICU capacity to accommodate higher demand during the COVID-19 pandemic. Med J Aust 2021; 215:513-517. [PMID: 34642941 PMCID: PMC8661872 DOI: 10.5694/mja2.51318] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To describe the short term ability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID-19 pandemic. DESIGN Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data. SETTING All 194 public and private Australian ICUs. MAIN OUTCOME MEASURES Numbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU-relevant equipment and staff. RESULTS All 194 ICUs responded to the survey. The total number of currently open staffed ICU beds was 2183. This was 195 fewer (8.2%) than in 2020; the decline was greater for rural/regional (18%) and private ICUs (18%). The reported maximal ICU bed capacity (5623) included 813 additional physical ICU bed spaces and 2627 in surge areas outside ICUs. The number of available ventilators (7196) exceeded the maximum number of ICU beds. The reported number of available additional nursing staff would facilitate the immediate opening of 383 additional physical ICU beds (47%), but not the additional bed spaces outside ICUs. CONCLUSIONS The number of currently available staffed ICU beds is lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff numbers while maintaining pre-pandemic models of care.
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Affiliation(s)
- Edward Litton
- Fiona Stanley HospitalPerthWA
- The University of Western AustraliaPerthWA
| | - Sue Huckson
- Centre for Outcome and Resource Evaluation (CORE)Australian and New Zealand Intensive Care Society (ANZICS)MelbourneVIC
| | - Shaila Chavan
- Centre for Outcome and Resource Evaluation (CORE)Australian and New Zealand Intensive Care Society (ANZICS)MelbourneVIC
| | - Tamara Bucci
- Centre for Outcome and Resource Evaluation (CORE)Australian and New Zealand Intensive Care Society (ANZICS)MelbourneVIC
| | | | | | - Sean Kelly
- Central Coast Local Health DistrictCharmhavenNSW
| | | | | | - Nhi Nguyen
- NSW Agency for Clinical InnovationSydneyNSW
- Nepean HospitalPenrithNSW
| | | | | | - David Pilcher
- Centre for Outcome and Resource Evaluation (CORE)Australian and New Zealand Intensive Care Society (ANZICS)MelbourneVIC
- The Alfred HospitalMelbourneVIC
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18
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Berguigua H, Iche L, Roche P, Aubert C, Blondé R, Legrand A, Puech B, Combe C, Vidal C, Caron M, Jaffar-Bandjee MC, Caralp C, Oulehri N, Kerambrun H, Allyn J, Boué Y, Allou N. Emergency air evacuation of patients with acute respiratory failure due to SARS-CoV-2 from Mayotte to Reunion Island. Medicine (Baltimore) 2021; 100:e27881. [PMID: 35049190 PMCID: PMC9191376 DOI: 10.1097/md.0000000000027881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46-65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO2/FiO2 ratio was lower on ICU admission (140 [102-192] mmHg) than on departure (165 [150-200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.
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Affiliation(s)
- Hamza Berguigua
- Department of Emergency, Center Hospitalier Universitaire Felix Guyon, Saint Denis, France
| | - Ludovic Iche
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Philippe Roche
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Cyril Aubert
- Department of Emergency, Center Hospitalier Universitaire Felix Guyon, Saint Denis, France
| | - Renaud Blondé
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Antoine Legrand
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Bérénice Puech
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Chloé Combe
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Charles Vidal
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Margot Caron
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | | | - Christophe Caralp
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Nora Oulehri
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Hugo Kerambrun
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Jérôme Allyn
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
- Département d’Informatique Clinique, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Yvonnick Boué
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Nicolas Allou
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
- Département d’Informatique Clinique, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
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19
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L'Hotellier S. [Resuscitation and care organisation in the face of a pandemic]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2021; 66:32-35. [PMID: 34895570 DOI: 10.1016/j.soin.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Resuscitation units, and the care practices they implement, require specific procedures and technologies, as well as particular and distinct knowledge, skills and human qualities within the care setting. Already facing tensions related to the challenges and vital issues of their mission, these resuscitation units have been destabilised by the influx of patients and the unprecedented complexity of the Covid-19 pandemic, which has forced them to rethink their organisation to a large extent and to envisage the future differently.
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Affiliation(s)
- Sylvie L'Hotellier
- Centre hospitalier universitaire de Strasbourg, 1 place de l'hôpital, BP 426, 67091 Strasbourg cedex, France.
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20
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Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation. Crit Care Explor 2021; 3:e0559. [PMID: 34729490 PMCID: PMC8553251 DOI: 10.1097/cce.0000000000000559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Supplemental Digital Content is available in the text. Studying interhospital transfer of critically ill patients with coronavirus disease 2019 pneumonia in the spring 2020 surge may help inform future pandemic management.
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21
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Taxbro K, Granath A, Sunnergren O, Seifert S, Jakubczyk MN, Persson M, Hammarskjöld A, Alkemark C, Hammarskjöld F. Low mortality rates among critically ill adults with COVID-19 at three non-academic intensive care units in south Sweden. Acta Anaesthesiol Scand 2021; 65:1457-1465. [PMID: 34386972 PMCID: PMC8441887 DOI: 10.1111/aas.13972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 01/08/2023]
Abstract
Background The COVID‐19 pandemic has put an exceptional strain on intensive care units worldwide. During the first year, the survival of patients with acute hypoxaemic respiratory failure appears to have improved. We aimed to describe the mortality rates, management characteristics and two pandemic waves during the first year at three non‐academic rural intensive care units in Sweden. Methods We retrospectively analysed all cases of COVID‐19 admitted to intensive care units in Region Jönköping County during 1 year. The primary endpoint was 30‐day mortality. Results Between 14th March 2020 and 13th March 2021, 264 patients were admitted to undergo intensive care with confirmed SARS‐CoV‐2 infection. The 30‐day mortality rate after the initial intensive care admission was 12.9%, and this rate remained unchanged during both pandemic waves. However, we found several distinct differences between the two pandemic waves, including an increase in the use of high‐flow nasal oxygen but a decrease in invasive mechanical ventilation use, biochemical markers of inflammation, continuous renal replacement therapy and length of stay in the intensive care unit. Conclusion Our study showed that critically ill patients with COVID‐19 in Sweden have a low 30‐day mortality rate which compares well with results published from academic centres and national cohorts throughout Scandinavia. During the second pandemic wave, the proportion of patients receiving invasive mechanical ventilation and continuous renal replacement therapy was lower than that in the first wave. This could be the result of increased knowledge and improved therapeutic options.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jonkoping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Andreas Granath
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jonkoping Sweden
| | - Ola Sunnergren
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Department of Otorhinolaryngology Region Jönköping County Jonkoping Sweden
| | - Stefanie Seifert
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jonkoping Sweden
| | - Milena N. Jakubczyk
- Department of Anaesthesia and Intensive Care Medicine Eksjö Hospital Eksjö Sweden
| | - Magnus Persson
- Department of Anaesthesia and Intensive Care Medicine Värnamo Hospital Värnamo Sweden
| | - Anneli Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jonkoping Sweden
| | - Catarina Alkemark
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jonkoping Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jonkoping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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22
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Sanchez MA, Vuagnat A, Grimaud O, Leray E, Philippe JM, Lescure FX, Boutonnet M, Coignard H, Hibon AR, Sanchez S, Pottecher J. Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France. Ann Intensive Care 2021; 11:151. [PMID: 34698966 PMCID: PMC8546754 DOI: 10.1186/s13613-021-00933-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to. Method A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality. Results In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6–0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2–0.4, p < 0.0001 for transfer distance > 200 km). Mortality decreased overall over the 3-month study period. Conclusions Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00933-2.
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Affiliation(s)
- Marc-Antoine Sanchez
- Information Systems and Digital Department (DSIN), French Army Health Service, Saint Mandé-Bat 14, 69 avenue de Paris, 94165, Saint-Mandé, France. .,Central Directorate of the Military Health Service (DCSSA), French Army Health Service, Paris, France.
| | - Albert Vuagnat
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES(Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, Rennes, France
| | - Emmanuelle Leray
- Univ Rennes, EHESP, REPERES(Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, Rennes, France
| | - Jean-Marc Philippe
- General Directorate for Health (DGS)-French Health and Social Affairs Ministry, Paris, France
| | - François-Xavier Lescure
- Tropical and Infectious Disease Services, Bichat AP HP, Paris, France.,INSERM 1137, Paris Diderot University, Paris, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Hélène Coignard
- Emergency Medical Service, Lyon University Hospital, Lyon, France
| | | | - Stephane Sanchez
- Department of Public Health and Performance, Troyes Hospital, Champagne Sud Hospital, Troyes, France
| | - Julien Pottecher
- Anaesthesiology, Critical Care and Perioperative Medicine, Strasbourg University Hospital-EA3072, FMTS, Strasbourg, France
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23
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Grimaud O, Bayat S, Renault A, Maury E, Pottecher J, Dolz M, Braun F, Fermanian C, Ricard-Hibon A, Prieto N, Philippe JM, Leray E. TRANSCOV cohort protocol: an epidemiological study assessing the impact of critically ill COVID-19 patients long distance transfers between intensive care units. BMJ Open 2021; 11:e054774. [PMID: 34675022 PMCID: PMC8532140 DOI: 10.1136/bmjopen-2021-054774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION During spring 2020, four regions of France faced a surge of severe COVID-19 patients which threatened to overflow local intensive care units (ICU) capacities. As an emergency response, between 13 March 2020 and 10 April 2020, an estimated 661 patients were transferred from overcrowded ICUs to eight other French regions and four neighbouring countries. The intensity, geographical spread and the diversity of vectors used are unprecedented. The study aims at assessing the impact of these inter-ICU transfers on the short-term and medium-term physical and psychological outcomes in this population of severe COVID-19 patients. METHODS AND ANALYSIS The TRANSCOV cohort is a multicentre observational retrospective study. All transferred patients between ICUs outside the origin region will be invited to take part. For each transfer, up to four control patients will be selected among those admitted in the same ICU during the same period (±4 days of transfer date). Clinical data will be extracted from medical records and will include haemodynamic and respiratory parameters, as well as clinical severity scores before, during and after transfer. Data linkage with medicoadministrative data will enrich the clinical database and allow follow-up up to 1 year after initial admission. ETHICS AND DISSEMINATION The study has been approved by the French Ethics and Scientific Committee on the 16 July 2020 (file no. 2046524). The results will be disseminated via publication of scientific articles and communications in national and international conferences. TRIAL REGISTRATION NUMBER 20 CO 015 CZ.
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Affiliation(s)
| | - Sahar Bayat
- Univ Rennes, EHESP, CNRS, ARENES - UMR 6051, Rennes, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHU Brest, Brest, France
| | - Eric Maury
- Université Pierre et Marie Curie Faculté de Médecine, Paris, France
| | - Julien Pottecher
- Anesthesiology and Critical Care, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Manuel Dolz
- Direction centrale du service de santé des armées, Paris, France
| | | | | | - Agnès Ricard-Hibon
- Emergency Department SAMU-SMUR 95, CHG Pontoise-Beaumont/Oise Pontoise, Pontoise, France
| | - Nathalie Prieto
- Cellule d'Urgence Médico-Psychologique (CUMP), Centre Régional du Psychotraumatisme (CRP), Hôpital Edouard Herriot, HCL, Lyon, Auvergne-Rhône-Alpes, France
| | - Jean-Marc Philippe
- France Ministère des Solidarités et de la Santé Direction Générale de la Santé, Paris, France
| | - Emmanuelle Leray
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, Rennes, France, Rennes, France
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24
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Lombardi Y, Azoyan L, Szychowiak P, Bellamine A, Lemaitre G, Bernaux M, Daniel C, Leblanc J, Riller Q, Steichen O. External validation of prognostic scores for COVID-19: a multicenter cohort study of patients hospitalized in Greater Paris University Hospitals. Intensive Care Med 2021; 47:1426-1439. [PMID: 34585270 PMCID: PMC8478265 DOI: 10.1007/s00134-021-06524-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/30/2021] [Indexed: 12/21/2022]
Abstract
Purpose The Coronavirus disease 2019 (COVID-19) has led to an unparalleled influx of patients. Prognostic scores could help optimizing healthcare delivery, but most of them have not been comprehensively validated. We aim to externally validate existing prognostic scores for COVID-19. Methods We used “COVID-19 Evidence Alerts” (McMaster University) to retrieve high-quality prognostic scores predicting death or intensive care unit (ICU) transfer from routinely collected data. We studied their accuracy in a retrospective multicenter cohort of adult patients hospitalized for COVID-19 from January 2020 to April 2021 in the Greater Paris University Hospitals. Areas under the receiver operating characteristic curves (AUC) were computed for the prediction of the original outcome, 30-day in-hospital mortality and the composite of 30-day in-hospital mortality or ICU transfer. Results We included 14,343 consecutive patients, 2583 (18%) died and 5067 (35%) died or were transferred to the ICU. We examined 274 studies and found 32 scores meeting the inclusion criteria: 19 had a significantly lower AUC in our cohort than in previously published validation studies for the original outcome; 25 performed better to predict in-hospital mortality than the composite of in-hospital mortality or ICU transfer; 7 had an AUC > 0.75 to predict in-hospital mortality; 2 had an AUC > 0.70 to predict the composite outcome. Conclusion Seven prognostic scores were fairly accurate to predict death in hospitalized COVID-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06524-w.
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Affiliation(s)
- Yannis Lombardi
- Faculty of Medicine, AP-HP, Sorbonne Université, Paris, France
| | - Loris Azoyan
- Faculty of Medicine, AP-HP, Sorbonne Université, Paris, France
| | - Piotr Szychowiak
- Médecine Intensive-Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | | | | | - Mélodie Bernaux
- Strategy and Transformation Department, AP-HP, Paris, France
| | | | - Judith Leblanc
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, UMR-S 1136 , Sorbonne Université, INSERM, Paris, France.,Clinical Research Platform, Saint Antoine Hospital, AP-HP, Paris, France
| | - Quentin Riller
- Faculty of Medicine, AP-HP, Sorbonne Université, Paris, France
| | - Olivier Steichen
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, UMR-S 1136 , Sorbonne Université, INSERM, Paris, France. .,Internal Medicine Department, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France. .,Service de Médecine Interne, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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25
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Lefrant JY, Pirracchio R, Benhamou D, Dureuil B, Pottecher J, Samain E, Joannes-Boyau O, Bouaziz H. ICU bed capacity during COVID-19 pandemic in France: From ephemeral beds to continuous and permanent adaptation. Anaesth Crit Care Pain Med 2021; 40:100873. [PMID: 33910085 PMCID: PMC8069631 DOI: 10.1016/j.accpm.2021.100873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Université de Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California San Francisco, San Francisco, California, United States
| | - Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Université Paris Saclay, Hôpital Bicêtre - 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Bertrand Dureuil
- Department of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre - Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072 Strasbourg, France
| | - Emmanuel Samain
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, EA 3920, Bourgogne Franche-Comte University, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Hervé Bouaziz
- Département d'Anesthésie Réanimation, Hôpital Central - CHRU Nancy, Nancy, France
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