Intensive Care Unit Team Research Articles

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.

Artificial Intelligence in the Intensive Care Unit.

The diffusion of electronic health records collecting large amount of clinical, monitoring, and laboratory data produced by intensive care units (ICUs) is the natural terrain for the application of artificial intelligence (AI). AI has a broad definition, encompassing computer vision, natural language processing, and machine learning, with the latter being more commonly employed in the ICUs. Machine learning may be divided in supervised learning models (i.e., support vector machine [SVM] and random forest), unsupervised models (i.e., neural networks [NN]), and reinforcement learning. Supervised models require labeled data that is data mapped by human judgment against predefined categories. Unsupervised models, on the contrary, can be used to obtain reliable predictions even without labeled data. Machine learning models have been used in ICU to predict pathologies such as acute kidney injury, detect symptoms, including delirium, and propose therapeutic actions (vasopressors and fluids in sepsis). In the future, AI will be increasingly used in ICU, due to the increasing quality and quantity of available data. Accordingly, the ICU team will benefit from models with high accuracy that will be used for both research purposes and clinical practice. These models will be also the foundation of future decision support system (DSS), which will help the ICU team to visualize and analyze huge amounts of information. We plea for the creation of a standardization of a core group of data between different electronic health record systems, using a common dictionary for data labeling, which could greatly simplify sharing and merging of data from different centers.

Predictors of Delayed Recognition of Critical Illness in Emergency Department Patients and Its Effect on Morbidity and Mortality

Timely recognition of critical illness is associated with improved outcomes, but is dependent on accurate triage, which is affected by system factors such as workload and staffing. We sought to first study the effect of delayed recognition on patient outcomes after controlling for system factors and then to identify potential predictors of delayed recognition. We conducted a retrospective cohort study of Emergency Department (ED) patients admitted to the Intensive Care Unit (ICU) directly from the ED or within 48 hours of ED departure. Cohort characteristics were obtained through electronic and standardized chart abstraction. Operational metrics to estimate ED workload and volume using census data were matched to patients' ED stays. Delayed recognition of critical illness was defined as an absence of an ICU consult in the ED or declination of ICU admission by the ICU team. We employed entropy-balanced multivariate models to examine the association between delayed recognition and development of persistent organ dysfunction and/or death by hospitalization day 28 (POD+D), and multivariable regression modeling to identify factors associated with delayed recognition. Increased POD+D was seen for those with delayed recognition (OR 1.82, 95% CI 1.13-2.92). When the delayed recognition was by the ICU team, the patient was 2.61 times more likely to experience POD+D compared to those for whom an ICU consult was requested and were accepted for admission. Lower initial severity of illness score (OR 0.26, 95% CI 0.12-0.53) was predictive of delayed recognition. The odds for delayed recognition decreased when ED workload is higher (OR 0.45, 95% CI 0.23-0.89) compared to times with lower ED workload. Increased POD+D is associated with delayed recognition. Patient and system factors such as severity of illness and ED workload influence the odds of delayed recognition of critical illness and need further exploration.

NICU Collaboration During the COVID-19 Worldwide Pandemic: A Memory of Gratitude.

NICU Collaboration During the COVID-19 Worldwide Pandemic: A Memory of Gratitude.

Consequences of suboptimal communication for patients with limited English proficiency in the intensive care unit and suggestions for a way forward: A qualitative study of healthcare team perceptions.

To understand the healthcare team's perceptions of the negative consequences of suboptimal communication and their recommendations to improve communication with patients and families who have Limited English Proficiency (LEP) in the Intensive Care Unit (ICU). We performed a qualitative study using semi-structured interviews of physicians, nurses, and interpreters from 3 ICUs at Mayo Clinic Rochester, between November 2017 and April 2018. We identified 5 consequences of suboptimal communication: 1) Suboptimal assessment and treatment of patient symptoms, 2) Unmet patient and family expectations, 3) Decreased patient autonomy, 4) Unmet end of life wishes and 5) Clinician Distress. Recommendations to improve communication include: 1) Education and training for patients,families, clinicians and interpreters, 4) Greater integration of interpreters into the ICU team 5) Standardized timeline for goals of care conversations with patients and families with LEP. Patients with LEP are at risk of experiencing suboptimal communication with the healthcare team in the ICU. There are several educational and quality improvement strategies that ICUs and institutions can take to mitigate these issues.

A multisite study of multidisciplinary ICU team member beliefs toward early mobility

BackgroundEarly mobility is underutilized in critical care. ObjectiveDescribe multidisciplinary intensive care unit (ICU) providers beliefs about the conduct of early mobility during critical illness. MethodsA 7-item elicitation survey was administered to a multidisciplinary sample of ICU team members. We conducted independent thematic analysis of n = 95 surveys. ResultsAnalysis resulted in three themes: immediate risk vs. long-term reward conflict, nurse is the initiator and coordinator of early mobilization, and situational factors. Staffing was the primary facilitator and barrier to early mobility. Enablers included protection from complications of hospitalization, reduced hospital length of stay, and improved patient morale. Barriers strongly revolved around team member risk aversion (e.g., falls, hemodynamic instability, line dislodgment). Nurses were equally identified as positive and negative referents for early mobility. ConclusionsStrong positive and negative attitudinal beliefs were elicited. Early mobility is a protective behavior that requires sufficient numbers of trained staff and equipment.

The Silence Behind the Mask: My Journey as a Deaf Pediatric Resident Amid a Pandemic.

A patient had just arrived from the emergency department with respiratory failure, and I felt the high tensions given the potential for coronavirus disease of 2019 (COVID-19). Feelings aside, the intensive care unit (ICU) team assembled, buzzing around me with personal protective equipment on full display—yellow gowns, gloves, surgical masks, and N95s. The code cart and ventilator were eerily on standby. Our patient was flawlessly cared for by the skilled ICU team, but there was just one problem.

Frontline Redeployment of Psychiatry Residents During the COVID-19 Pandemic.

This article discusses the frontline redeployment of psychiatry residents during the COVID-19 pandemic in New York City Early in its transmission in the United States, COVID-19 had a disproportionate impact on New York City, pushing local hospitals nearly to their limits In the intensive care unit at New York-Presbyterian/Columbia University Irving Medical Center, the capacity of 99 beds was exceeded by nearly 300% in April 2020 This surge required expansion and restructuring of existing inpatient medical services, as well as "redeployment" of attending and trainee physicians from various specialties, including psychiatry In this paper, the authors describe the process of the redeployment of psychiatry residents at a major urban academic medical center to the front lines of the COVID-19 pandemic (PsycInfo Database Record (c) 2021 APA, all rights reserved)

22 -Year Results of an Intensive Care Unit Infection Control Program in Ribeirao Preto, Brazil

Background: Healthcare-associated infection (HAI) control programs have improved patient care all over the world. Our program was implemented in 1997 in a general intensive care unit (ICU) based upon surveillance of HAI with regular infection rates feedback to the ICU team and implementation of best practices such as hand hygiene (HH) and oral care for ventilated patients, optimal care, and early removal of invasive devices. Objective: To report our decreasing HAI rates in the past 22 years. Methods: Hospital Sao Francisco 20-bed ICU admits 120–140 surgical and clinical patients monthly, with 90% occupancy. The HAI infection control team implemented HAI surveillance and developed several protocols for HAI prevention. In the past 5 years, ICU personnel initiated the collection of several indicators using random direct observations of HH compliance, central venous catheter correct care, and appropriated oral care, among others. HAI definitions followed Brazilian Health Ministry HAI definitions and were expressed as infections per 1,000 patient days (total HAI rate) and device-related infections per 1,000 device days. Catheter-associated urinary tract infection (CAUTI), central-line–associated blood stream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates are reported here. The study period spanned January 1997 to August 2019. Measurement of antibiotic utilization (ie, meropenem, vancomycin, and piperacillin-tazobactam) was calculated by dividing the of antibiotic consumed vials by the daily defined dose and patient days. Results: The total HAI, CAUTI, CLABSI, and VAP rates dropped 70%, 85%, 84%, and 87%, respectively, from 1997 to 2019 (Table 1). From 2009 to 2019, we detected decreases in hospital use of meropenem from 52 to 38, in vancomycin from 50 to 40, and in piperacillin-tazobactam from 144 to 88. Conclusions: HAI control programs can be effective in ICUs, with impressive results, but it requires time and considerable effort. Data on compliance with basic infection control measures should accompany HAI data and should be shared with the ICU team because ICU team participation is essential to keeping the program alive. Broad-spectrum antibiotics use also decreased, with potential benefits to the hospital flora.Funding: NoneDisclosures: None

Friend or Foe: Perceptions of Infectious Disease Specialists as Stewards and Social Determinants of Antimicrobial Prescribing

Background: Inappropriate prescribing behavior can be associated with higher rates of antibiotic resistance, calling for detailed studies on how physicians make prescribing decisions. We conducted a mixed-methods study to investigate physician antibiotic prescribing behavior in a 141-bed pediatric hospital. Methods: We applied a mixed-methods research design. The quantitative phase was conducted over a 6-month period to identify cases of inappropriate prescribing. The qualitative phase comprised 22 qualitative interviews with clinical teaching units (CTU) and pediatric intensive care unit (PICU) team members (physicians and pharmacists). Two coders analyzed the data deductively using the theoretical domain framework (TDF), as well as the social determinants of antimicrobial prescribing (SDAP). Results: In 52.9% of the 36 identified cases in the CTU and 31.4% of the 37 cases in the PICU, an infectious diseases (ID) consultation occurred. Compliance rates with ID recommendations were 79% and 91% in the CTU and PICU, respectively. The CTU and PICU expressed appreciation for ID involvement when ID supported their de-escalation choices in complex cases and in cases in which less commonly known antibiotics were used. However, the ID service involvement was perceived as detrimental to antimicrobial prescribing decisions for CTU and PICU across 3 of the 4 SDAP domains (Fig. 1, qualitative research quotes). Relationship between clinicians: CTU physicians and pharmacists perceived ID involvement as negatively impacting the relationship of the team. Antimicrobial decisions were automatically defaulted to ID, whereas pharmacy involvement was disregarded and the decisions were delayed. Risk, fear, and emotion: These were experienced across all respondents’ groups that identified ID specialists’ egos and personalities as contrary to open collaborative discussion on antimicrobial decisions. (Mis)perception of the problem: ID physicians were identified as more conservative in their antimicrobial choices, leading to prolonged duration of treatment, broader choices, and longer hospitalizations. The CTU and pharmacy respondents felt that ID recommendations were inconsistent among physicians and deviated from guidelines with little justification. Conclusions: Although CTU and PICU teams tend to comply with ID prescribing recommendations and ID involvement with complicated cases, pharmacists, CTU physicians, and PICU physicians perceived ID consultations to negatively affect collaborative efforts for stewardship. These findings offer novel insights into how an ID service can improve its role to positively affect appropriate prescribing. CTU and PICU respondents called for a supportive and trusting relationship with the ID service as a major driver for behavioral change and enhanced stewardship.Funding: NoneDisclosures: None

Analysis and Temporal Evolution of Extubation Parameters for Patients Undergoing Single-Stage Circumferential Cervical Spine Surgery.

ObjectiveAirway obstruction after postoperative extubation is a dreaded but uncommon complication in patients undergoing circumferential cervical spine surgery (CCSS). The cuff leak test (CLT) has been utilized to assess air leak around the endotracheal tube which may reflect airway swelling. In this prospective observational study, we analyze the temporal evolution of CLT and perioperative factors that may influence it. MethodsTwenty patients undergoing single-stage CCSS were managed according to our extubation protocol. Patients were maintained intubated overnight following surgery. They were extubated if a CLT > 200 mL and both intensive care unit (ICU) and Neurosurgery teams agreed that it was safe. Patients extubated in the first postoperative day (8 of 20) comprised the early group, and the remaining patients (12 of 20) the delayed group. Patient and operative data were analyzed as a single group and comparing both groups. ResultsThe main indication for surgery was cervical deformity. Median number of levels fused was 5 anteriorly (range, 1–6) and 6 (range, 1–13) posteriorly. Patients were kept intubated for an average of 73.6 hours (range, 26–222 hours) and stayed in the ICU for 119.1 hours (range, 36–360 hours). There were 4 failed extubations and 3 patients (15%) required a tracheostomy. Patient profiles between both groups were very similar across most patient variables but differed significantly regarding infraglottic luminal area (p < 0.05). Patients with larger preoperative cuff leak values tended to have a shorter intubation period (p=0.053). ConclusionThis study objectively demonstrates the difficulties in airway management following CCSS and provides useful insight for preoperative planning and counseling. Local anatomic factors influence airway outcome more than operative factors. The study format does not allow for testing of interventions but we suggest that patients with favorable anatomy (larger infraglottic luminal area) may benefit from a less strict airway management protocol.

Clinical pharmacy interventions in intensive care unit patients.

The drug therapy of critically ill patients requires intensive evaluation and management due to their severity of illness. These patients often require complex medication regimens. This study analysed the pharmaceutical care provided by clinical pharmacists (CPs) in a single medical centre in Taiwan. In addition, we explored the drug-related problems (DRPs) experienced by patients in intensive care units (ICUs) to determine how to improve the quality and safety of drug therapy. This retrospective study was conducted from February 2019 to January 2020. The CPs implemented Taiwan's National Health Insurance (NHI) Scheme for Improving Hospital Drug Safety and Quality programme to improve the safety and quality of drug therapy. The CPs included in the study had at least 2years' clinical experience and had participated in an ICU team for at least 6 consecutive months. They provided individualized drug treatment evaluation and intervention. Content of care was documented in the Clinical Pharmacy Service Record. A total of 4374 pharmacy care records were evaluated by 12 CPs. The major category of ICU pharmaceutical care was medication reconciliation (n=2938; 67.2%). Most of the medication interventions were for errors in dosing or dosing frequency (n=218; 55.8%). Patients with renal dysfunction required more pharmaceutical interventions than did patients with normal renal function (odds ratio=1.63; 95% confidence interval 1.31-2.01). The main interventions were related to antimicrobial agents (n=386; 81.3%). During the study period, 99.2% of interventions were accepted and 90.8% were changed within 24hours. Increased pharmaceutical interventions for patients with renal dysfunction compared with patients with normal renal function were observed. Most cases of inappropriate frequency of dosing or dosing of antimicrobial agents required intervention.

COVID-19: Mobilizing Quickly for a Rapid Response.

COVID-19: Mobilizing Quickly for a Rapid Response.

A Model for a Standardized and Sustainable Pediatric Anesthesia-Intensive Care Unit Hand-Off Process.

Background and Objectives: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives were to (1) standardize the hand-off process in children’s ICUs, and (2) evaluate the provider satisfaction, efficiency and sustainability of the improved hand-off process. Methods: Following multidisciplinary discussions, the hand-off process was standardized for transfers of care between anesthesia-ICU teams. A pre-implementation and two post-implementation (6 months, >2 years) staff satisfaction surveys and audits were conducted to evaluate the success, quality and sustainability of the hand-off process. Results: There was no difference in the time spent during the sign out process following standardization—median 5 min for pre-implementation versus 5 and 6 min for post-implementation at six months and >2 years, respectively. There was a significant decrease in the number of missed items (airway/ventilation, venous access, medications, and laboratory values pertinent events) post-implementation compared to pre-implementation (p ≤ 0.001). In the >2 years follow-up survey, 49.2% of providers felt that the hand-off could be improved versus 78.4% in pre-implementation and 54.2% in the six-month survey (p < 0.001). Conclusion: A standardized interactive hand-off improves the efficiency and staff satisfaction, with a decreased rate of missed information at the cost of no additional time.

Surgical Support for Severe COVID-19 Patients: A Retrospective Cohort Study in a French High-Density COVID-19 Cluster.

Background. The COVID-19 epidemic has resulted in a massive surge in the need for intensive care unit (ICU) care. To avoid being overwhelmed, hospitals had to adapt and support the ICU teams in structured ICU care including involving surgical teams. This work aims at describing the collaborative efforts between the ICU care team and the Surgical Task Force (STF) during a surge of ICU activity in a University Hospital in a French high-density COVID-19 cluster. Study Design. This retrospective single center study analyzed the STF workflow and the ICU population. The study included 55 patients hospitalized in our ICU, ICU-converted step-down units, and post-anesthesia care units. The primary measure was the global daily STF activity. The secondary measure was the daily activity for each of the 5 tasks accomplished by the STF. Results. The STF attempted 415 phone calls for 55 patients’ families, 237 mobilizations of patients requiring prone positions, follow-up of 20 patients requiring medevac, and contribution to ethical discussion for 2 patients. The mean (SD) daily number of successful phones calls, ethical discussions, mobilizations of patients requiring prone positions and medevac follow-up were 18 (7), .1 (.4), 10 (7), and 2 (3), respectively. No actions for discharge summaries writing were required. The maximum number of daily mobilizations for patients requiring prone positions was 25. The maximum number of daily attempted phone calls and successful phone calls were 37 and 26, respectively. Conclusion. Surgeons’ technical and nontechnical skills represented an effective support for ICU teams during the COVID-19 pandemic.

Financial impact of including dentists in UCIs for reducing cases of Nosocomial Pneumonia

It is a study of Financial Impact Analysis, where the financial consequences arising from the possibility of inclusion of the dentist in the Intensive Care Units (ICU), within the reality of the Unified Health System (SUS), were evaluated in Brazil. It was based on a quick review of the literature and economic evaluation with reference to the year 2018. Information on costs and hospitalizations were collected from the official databases of the Ministry of Health, the Federal Council of Medicine and the Union of Dentists of the State of São Paulo. Only the direct medical costs related to the hospitalizations were calculated. Scenarios were simulated for a time horizon of 1 year (2018) and a sensitivity analysis was made for a more optimistic scenario (values 20% lower) and another less optimistic (values 20% higher). On average, the presence of a dentist in the ICU reduces the development of pneumonia cases by 56% and 8.18 days, which represents a savings of 34.92% in hospitalization costs in the evaluated scenario. In Brazil, when hiring dentists in all ICUs, each avoided case would contribute to savings of R$ 7,949.45 (1US$ = R$ 4,02 in 30/10/2019), ranging from R$ 6,359.56 to R$ 9,539.35 in the optimistic and pessimistic scenarios, respectively, where each case avoided is higher than the dentist's monthly salary. It would be necessary to spend R$ 142,060,140.00 on hiring the dentist to cover the ICUs, making the final savings more than 865 million reais. It is concluded that the inclusion of the Dental Surgeon (DS) in ICU teams would have a positive economic impact, with savings in hospitalization costs from the perspective of SUS. The COVID-19 pandemic in Brazil, depending on the State's action in containment strategies, could require 2.17 times more in the bests of scenarios where the action of total suppression would be used. Such a situation requires emergency measures, and the role of the dentist is a strategy that can support the health system.Key messages Dental care in the ICU is an important and cost-effectiveness strategy for the control of microorganisms that act in the evolution of the pneumonia nosocomial.Such a situation requires emergency measures, and the role of the dentist is a strategy that can support the health system.

110. Don’t let the obvious distract from the occult: a case of cardiac tamponade masquerading as refractory asthma

Introduction: “Not all that wheezes is asthma” is a famous adage in medical literature, that pretty much underscores a valuable tip in the approach of dyspneic patients. Congestive heart failure is a well-known non-pulmonary cause of wheezy chests, but cardiac tamponade is not that much known as a cause. Here, we present a case of cardiac tamponade that laid behind a wheezy chest in an asthmatic patient; mimicking an asthma exacerbation. Case Report: A 69-year-old female presented to the emergency department (ED) in moderate respiratory distress during the early hours of a morning. Her shortness of breath started 2 days back and had been progressively worsening. It was associated with productive cough and nausea. Her past medical history was significant for bronchial asthma and metastatic ovarian cancer. She tried Salbutamol and Atrovent at home, but felt no improvement. Her initial set of vitals were as follows: Temperature 37.3 C, pulse 115/min, blood pressure 113/82 mmHg, respiratory rate 32/min, O2 saturation 95% on room air. She was alert, oriented, but anxious. On lungs auscultation, she was found to have bilateral wheezes, so she was assumed to be suffering from an asthma exacerbation and was managed accordingly. A diagnostic work-up was started simultaneously. The patient’s symptoms failed to respond, so the intensive care unit (ICU) team were consulted to review the case and aid in its management. Following their assessment, they came to the impression that her lungs were congested, so they started her on Bi-level Positive Airway Pressure (BiPAP) ventilation and administered a small dose of furosemide. Approximately one hour later, the patient’s condition deteriorated as she became more tachycardic and tachypneic. A junior resident with outside-the-box thinking reviewed the case and decided to do a bedside ultrasound assessment of the heart. Surprisingly, he found large pericardial effusion with diastolic right ventricular collapse. The BiPAP was stopped, a liter of normal saline plus 500 mL of Albumin 5% were given, and a pericardiocentesis was performed. About half a liter of bloody fluid was removed during the procedure, and the patient’s condition improved dramatically after it. Discussion: Cardiac tamponade is a life-threatening dilemma that can develop in the context of traumatic events or non-traumatic medical conditions. Sometimes, it can be difficult to diagnose due to its non-specific symptoms and signs. Beck’s triad, which is considered the classic presentation of cardiac tamponade, is very uncommon in clinical practice and may not be seen until late stages. In contrast to congestive heart failure (CHF), the association of cardiac tamponade with bronchospasm has been infrequently reported in medical literature. This type of presentation is particularly challenging if the patient’s past medical history is significant for asthma or CHF. Nevertheless, the use of bedside point-of-care ultrasound can significantly improve the chances of recognizing this condition in a timely fashion. Therefore, it is very important for emergency medicine physicians to have the skills of using this tool, and to use it whenever it is needed. Conclusion: Thinking outside-the-box and utilizing the point-of-care ultrasound saved this patient’s life. It is of no doubt that these two can save many other lives too.

Understanding burnout and moral distress to build resilience: a qualitative study of an interprofessional intensive care unit team.

The purpose of this study was to explore personal and organizational factors that contribute to burnout and moral distress in a Canadian academic intensive care unit (ICU) healthcare team. Both of these issues have a significant impact on healthcare providers, their families, and the quality of patient care. These themes will be used to design interventions to build team resilience. This is a qualitative study using focus groups to elicit a better understanding of stakeholder perspectives on burnout and moral distress in the ICU team environment. Thematic analysis of transcripts from focus groups with registered intensive care nurses (RNs), respiratory therapists (RTs), and physicians (MDs) considered causes of burnout and moral distress, its impact, coping strategies, as well as suggestions to build resilience. Six focus groups, each with four to eight participants, were conducted. A total of 35 participants (six MDs, 21 RNs, and eight RTs) represented 43% of the MDs, 18.8% of the RNs, and 20.0% of the RTs. Themes were concordant between the professions and included: 1) organizational issues, 2) exposure to high-intensity situations, and 3) poor team experiences. Participants reported negative impacts on emotional and physical well-being, family dynamics, and patient care. Suggestions to build resilience were categorized into the three main themes: organizational issues, exposure to high intensity situations, and poor team experiences. Intensive care unit team members described their experiences with moral distress and burnout, and suggested ways to build resilience in the workplace. Experiences and suggestions were similar between the interdisciplinary teams.

A California Hospital's Response to COVID-19: From a Ripple to a Tsunami Warning.

The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a "tsunami" warning requiring instantaneous implementation and escalation of disaster plans. An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S's became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.