Number Of Intensive Care Unit Beds Research Articles

Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study.

The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (-9.6%, corresponding to -8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (-14.9%), gastrointestinal (-13.9%) and cardiovascular (-9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.

Association between regional critical care capacity and the incidence of invasive mechanical ventilation for coronavirus disease 2019: a population-based cohort study

BackgroundCoronavirus disease 2019 (COVID-19) has exposed critical care supply shortages worldwide. This study aimed to investigate the association between regional critical care capacity and the incidence of invasive mechanical ventilation following novel COVID-19 during the pandemic in Japan, a country with a limited intensive care unit (ICU) bed capacity of a median of 5.1 ICU beds per 100,000 individuals.MethodsThis population-based cohort study used data from the CRoss Icu Searchable Information System database and publicly available databases provided by the Japanese government and Japanese Society of Intensive Care Medicine. We identified patients recently diagnosed with COVID-19, those who received invasive mechanical ventilation, and those who received extracorporeal membrane oxygenation (ECMO) between February 2020 and March 2023. We analyzed the association between regional critical care capacity (ICU beds, high-dependency care unit (HDU) beds, resource-rich ICU beds, and intensivists) and the incidence of invasive mechanical ventilation, ECMO, and risk-adjusted mortality across 47 Japanese prefectures.ResultsAmong the approximately 127 million individuals residing in Japan, 33,189,809 were recently diagnosed with COVID-19, with 12,203 and 1,426 COVID-19 patients on invasive mechanical ventilation and ECMO, respectively, during the study period. Prefecture-level linear regression analysis revealed that the addition of ICU beds, resource-rich ICU beds, and intensivists per 100,000 individuals increased the incidence of IMV by 5.37 (95% confidence interval, 1.99–8.76), 7.27 (1.61–12.9), and 13.12 (3.48–22.76), respectively. However, the number of HDU beds per 100,000 individuals was not statistically significantly associated with the incidence of invasive mechanical ventilation. None of the four indicators of regional critical care capacity was statistically significantly associated with the incidence of ECMO and risk-adjusted mortality.ConclusionsThe results of prefecture-level analyses demonstrate that increased numbers of ICU beds, resource-rich ICU beds, and intensivists are associated with the incidence of invasive mechanical ventilation among patients recently diagnosed with COVID-19 during the pandemic. These findings have important implications for healthcare policymakers, aiding in efficiently allocating critical care resources during crises, particularly in regions with limited ICU bed capacities.Registry and the registration no. of the study/trial The approval date of the registry was August 20, 2020, and the registration no. of the study was lUMIN000041450.

Racial & ethnic disparities in geographic access to critical care in the United States: A geographic information systems analysis.

It is important to identify gaps in access and reduce health outcome disparities, understanding access to intensive care unit (ICU) beds, especially by race and ethnicity, is crucial. Our objective was to evaluate the race and ethnicity-specific 60-minute drive time accessibility of ICU beds in the United States (US). We conducted a cross-sectional study using road network analysis to determine the number of ICU beds within a 60-minute drive time, and calculated adult intensive care bed ratios per 100,000 adults. We evaluated the US population at the Census block group level and stratified our analysis by race and ethnicity and by urbanicity. We classified block groups into four access levels: no access (0 adult intensive care beds/100,000 adults), below average access (>0-19.5), average access (19.6-32.0), and above average access (>32.0). We calculated the proportion of adults in each racial and ethnic group within the four access levels. All 50 US states and the District of Columbia. Adults ≥15 years old. Adult intensive care beds/100,000 adults and percentage of adults national and state) within four access levels by race and ethnicity. High variability existed in access to ICU beds by state, and substantial disparities by race and ethnicity. 1.8% (n = 5,038,797) of Americans had no access to an ICU bed, and 26.8% (n = 73,095,752) had below average access, within a 60-minute drive time. Racial and ethnic analysis showed high rates of disparities (no access/below average access): American Indians/Alaskan Native 12.6%/28.5%, Asian 0.7%/23.1%, Black or African American 0.6%/16.5%, Hispanic or Latino 1.4%/23.0%, Native Hawaiian and other Pacific Islander 5.2%/35.0%, and White 2.1%/29.0%. A higher percentage of rural block groups had no (5.2%) or below average access (41.2%), compared to urban block groups (0.2% no access, 26.8% below average access). ICU bed availability varied substantially by geography, race and ethnicity, and by urbanicity, creating significant disparities in critical care access. The variability in ICU bed access may indicate inequalities in healthcare access overall by limiting resources for the management of critically ill patients.

Investigation on the current situation of the development of intensive care units in Inner Mongolia Autonomous Region in 2022

Investigation on the current situation of the development of intensive care units in Inner Mongolia Autonomous Region in 2022

Evaluation of Emergency Service Admissions for Planning the Number of Intensive Care Beds in Hospitals

A significant portion of intensive care unit (ICU) admissions occur through the emergency department (ED). Since there are insufficient ICU beds, critically ill patients may have to be monitored and treated in ED for an extended period. In this study, we aimed to show the importance of the emergency department intensive care unit (EDICU) and that ED applications should be taken into account in determining the number of intensive care unit (ICU) beds in hospitals by analyzing the patients hospitalized in intensive care units from the ED. In this retrospective descriptive study, patients over 18 who applied to the ED of a tertiary hospital between July 1, 2018, and July 1, 2019, and were deemed suitable for ICU admission were included. In descriptive statistics, percentages were used in categorical data, and mean, and standard deviation were used in numerical data. Chi-square test was applied for categorical variables. Since the distribution within the groups was normal in the analysis of continuous variables, one-way analysis of variance (ANOVA) was used when more than two groups were compared. The student's t-test was used when two groups were compared. Of the 2783 patients who applied to the ED and were suitable for admission to the ICU, 1341 (48.2%) were admitted to the second-level ICU, and 1442 (51.8%) were admitted to the third-level ICU. 1140 (40.96%) patients were hospitalized in the EDICU and toxicology ICU within the ED. These units played an important role in facilitating the ED operation and reducing crowding. Patients admitted to the ICU were divided into three groups based on their length of stay. Of the patients, 2312 (%83.1) were hospitalized in the first 6 hours, 337 (%12.1) in 6-12 hours, and 205 (7.36%) in more than 12 hours. It was observed that the mortality rate increased significantly when hospitalization in the ICU was delayed (P=0.014). ED admissions should be considered when determining the number of ICU beds and step levels of hospitals. In addition, the presence of EDICU in tertiary care hospitals relieves the density of the emergency department and indirectly reduces the mortality rate.

Value of information analysis for pandemic response: intensive care unit preparedness at the onset of COVID-19

BackgroundDuring the early stages of the COVID-19 pandemic, there was considerable uncertainty surrounding epidemiological and clinical aspects of SARS-CoV-2. Governments around the world, starting from varying levels of pandemic preparedness, needed to make decisions about how to respond to SARS-CoV-2 with only limited information about transmission rates, disease severity and the likely effectiveness of public health interventions. In the face of such uncertainties, formal approaches to quantifying the value of information can help decision makers to prioritise research efforts.MethodsIn this study we use Value of Information (VoI) analysis to quantify the likely benefit associated with reducing three key uncertainties present in the early stages of the COVID-19 pandemic: the basic reproduction number (R_0), case severity (CS), and the relative infectiousness of children compared to adults (CI). The specific decision problem we consider is the optimal level of investment in intensive care unit (ICU) beds. Our analysis incorporates mathematical models of disease transmission and clinical pathways in order to estimate ICU demand and disease outcomes across a range of scenarios.ResultsWe found that VoI analysis enabled us to estimate the relative benefit of resolving different uncertainties about epidemiological and clinical aspects of SARS-CoV-2. Given the initial beliefs of an expert, obtaining more information about case severity had the highest parameter value of information, followed by the basic reproduction number R_0. Resolving uncertainty about the relative infectiousness of children did not affect the decision about the number of ICU beds to be purchased for any COVID-19 outbreak scenarios defined by these three parameters.ConclusionFor the scenarios where the value of information was high enough to justify monitoring, if CS and R_0 are known, management actions will not change when we learn about child infectiousness. VoI is an important tool for understanding the importance of each disease factor during outbreak preparedness and can help to prioritise the allocation of resources for relevant information.

Διαχείριση της Κρίσης CoViD-19 στις ΜΕΘ, πριν τη Χρήση Εμβολίων

At the end of 2019, the Chinese health authorities detected a new strain of coronavirus (SARS-CoV-2 ). This new strain seemed to cause a number of cases with serious complications and deaths. As the virus spread, health systems around the world were unprepared for the pandemic that followed. Here we study the coping strategies, in the form of govern- ment guidelines and/or scientific associations’ recommendations, for prioritizing patients due to the increased flow of patients in Intensive Care Units (ICUs), before the production and use of the vaccines, during the first year of the pandemic. Moreover, we study the ethical dilemmas of this period. A bibliographic review was conducted in the databases Pubmed, Researchgate, and GoogleScholar, in English, Italian, French, and Greek language using the keywords “COVID -19”, “ethics”/“etica”/“ethique”/“ηθική”,“bioethics”/“bioetica”/“bioethique”/“βιοηθική”,“ICU”/“UTI”/“USI”/ “ΜΕΘ”. The time limit for inclusion in the survey was the end of 2020. We found that for crisis management effectiveness, those in volved, both directly and indirectly, were asked to consider options such as (a) the prioritization in ICU's admission of patients with the best prognosis, (b) the increase in the number of ICU beds, (c) the transfer of patients in need to ICUs in remote areas, where had available beds, and (d) the cessa- tion of life support. Each option, whether chosen to be implemented alone or in combination with other, raises basic eth- ical dilemmas for health professionals working in the ICU. In conclusion, the adoption of boundary solutions in the provision of health care, where the common denominator is respect for human life, tests or contradicts the moral standards and personal ethics of those responsible for making the decision.

Measuring Acuity and Pediatric Critical Care Nursing Workload by Using ICU CAMEO III.

The Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes (ICU CAMEO III) acuity tool measures patient acuity in terms of the complexity of nursing cognitive workload. To validate the ICU CAMEO III acuity tool in US children's hospitals. Using a convenience sample, 9 sites enrolled children admitted to pediatric intensive care units (ICUs). Descriptive statistics were used to summarize patient, nursing, and unit characteristics. Concurrent validity was evaluated by correlating the ICU CAMEO III with the Therapeutic Intervention Scoring System-Children (TISS-C) and the Pediatric Risk of Mortality III (PRISM III). Patients (N = 840) were enrolled from 15 units (7 cardiac and 8 mixed pediatric ICUs). The mean number of ICU beds was 23 (range, 12-34). Among the patients, 512 (61%) were diagnosed with cardiac and 328 (39%) with noncardiac conditions; 463 patients (55.1%) were admitted for medical reasons, and 377 patients (44.9%) were surgical. The ICU CAMEO III median score was 99 (range, 59-163). The ICU CAMEO complexity classification was determined for all 840 patients: 60 (7.1%) with level I complexity; 183 (21.8%) with level II; 201 (23.9%), level III; 267 (31.8%), level IV; and 129 (15.4%), level V. Strong correlation was found between ICU CAMEO III and both TISS-C (ρ = .822, P < .001) and PRISM III (ρ = .607, P < .001) scores, and between the CAMEO complexity classifications and the PRISM III categories (ρ = .575, P = .001). The ICU CAMEO III acuity tool and CAMEO complexity classifications are valid measures of patient acuity and nursing cognitive workload compared with PRISM III and TISS-C in academic children's hospitals.

COVID-19 Pandemisinde, Ağır Hastaların Yoğun Bakımda Kalma Sürelerinin Ülkeler Arasındaki Farklılıkları: Retrospektif Tanımlayıcı Araştırma

Objective: Health systems of countries face various challenges during epidemics and pandemics. Countries differ in hospital admission of coronavirus disease-2019 (COVID-19) patients and the treatment procedures followed. The aim of this study is to reveal the relation between the number of critical COVID-19 patients (CP) and the mortality rate [death number (DN)] as well as the country differences in patients' length of stay in intensive-care unit (ICU). Material and Methods: The research is a retrospective type, analyzed with a time series model. The 7 countries with the highest number of ICU beds (Türkiye, USA, UK, France, Spain, Italy and Germany) were included in the study. The 6-month period (1 August 2020-31 January 2021) has been analyzed. Koyck model has been used to measure the lagged impact of CP on DN. Results: The country with the highest positive correlation rate between the number of CP and DN is Spain. Almost all of the COVID-19 deaths in Türkiye are among severe COVID-19 patients who stayed in ICU. Results display that there is a strong relation between CP and DN in Türkiye, Spain and Italy. The death rate per million people, Türkiye has the lowest DN. It has also been seen that the period needed for the changes in the number of CP to have a dramatic effect on DN is the shortest in the UK and longest in Türkiye. Conclusion: Although CoV infects a small part of billions of people, there will be many critically ill patients in need of ICU, so countries must already take precautions against possible future waves of the pandemic and prepare their health systems in advance.

An overview of intensive care unit services in Nigeria.

To have a current overview of the state of critical care services in Nigeria, with a view to having information about the basic infrastructure, personnel, equipment, and processes in place to complement the acute peri-operative and medical emergencies in Nigeria. This was a cross-sectional survey of public and private intensive care units (ICUs) in Nigeria at the instance of the Intensive and Critical Care Society of Nigeria. Structured questionnaires were sent and collated over a 4-month period. Information on the institutions, ICU equipment and personnel were collected and analyzed using SPSS version 21(Chicago, Illinois). Data are presented in numbers, percentages, medians, and interquartile ranges (IQR) as appropriate. A total of 30 ICUs spread within all the six geo-political zones in Nigeria took part in this survey. Majority (63.3%) of them were located in teaching hospitals. The median number of ICU beds and equipment in hospitals surveyed were beds, 5(4-6), ventilators, 3 (1-4); multiparameter monitor, 4 (3-5.25) and arterial blood gas machine, 0(0-1). The anaesthetists led in running 90% of the units. This survey showed a low ICU bed capacity and deficits in basic and advanced haemodynamic monitoring equipment. There is also shortage of trained ICU Physicians.

Using the Evidence for Palliative Care to Improve Outcomes for Patients With Heart Failure.

Using the Evidence for Palliative Care to Improve Outcomes for Patients With Heart Failure.

Increasing ICU capacity to accommodate higher demand during the COVID‐19 pandemic

ObjectivesTo 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.DesignSurvey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data.SettingAll 194 public and private Australian ICUs.Main outcome measuresNumbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU‐relevant equipment and staff.ResultsAll 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.ConclusionsThe 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.

Assessment of Critical Care Surge Capacity During the COVID-19 Pandemic in Japan.

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion. Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

Can we learn from others? The Swedish intensive care unit database for COVID-19 cases.

Can we learn from others? The Swedish intensive care unit database for COVID-19 cases.

Identifying and managing patient–ventilator asynchrony: An international survey

ObjectiveTo describe the main factors associated with proper recognition and management of patient–ventilator asynchrony (PVA). DesignAn analytical cross-sectional study was carried out. SettingAn international study conducted in 20 countries through an online survey. ParticipantsPhysicians, respiratory therapists, nurses and physiotherapists currently working in the Intensive Care Unit (ICU). Main variables of interestUnivariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) and the ability of HCPs to correctly identify and manage 6 PVA. ResultsA total of 431 healthcare professionals answered a validated survey. The main factors associated to proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95%CI 1.14–4.52; p=0.019), courses with more than 100h completed (OR 2.28; 95%CI 1.29–4.03; p=0.005), and the number of ICU beds (OR 1.037; 95%CI 1.01–1.06; p=0.005). The main factor influencing the management of PVA was the correct recognition of 6 PVAs (OR 118.98; 95%CI 35.25–401.58; p<0.001). ConclusionIdentifying and managing PVA using ventilator waveform analysis is influenced by many factors, including specific training programs in MV, the number of ICU beds, and the number of recognized PVAs.

Spatial accessibility assessment of COVID-19 patients to healthcare facilities: A case study of Florida

During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the “equal access” assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.

P0748 / #2018: CLINICAL EXPERIENCE OF SIX PEDIATRIC INTENSIVISTS IN AN ADULT INTENSIVE CARE UNIT DURING COVID-19 PANDEMIC

Aims & Objectives: Covid-19 was declared a Public Health Emergency on January 30, 2020. This pandemic has overwhelmed healthcare systems around the world and organizational changes have been necessary. The objective of this study is to describe the experiences lived by PICU (Pediatric Intensive care Unit) attending physicians who had to practice in the adult intensive care unit (ICU) during covid-19 pandemic. Methods: Observational, descriptive, transversal and retrospective study. Description of the paediatric consultant experiences between March and May 2020, while attending covid-19 adults in a ICU of a tertiary hospital in Madrid were included. Results: The team consisted of six PICU physicians. Was a full time job position with five additional 24 hours shifts per month. By the end of May, 3007 covid-19 patients were admitted to the hospital and 250 to the adult ICU. The number of ICU beds were increased to 150, compared with 30 pre-covid ICU beds. The high complexity of covid-19 patients, along with the elevated number of cases, fostered collaboration between pediatric and adult intensivists. During the teamwork, paediatricians were able to perform techniques such as orotracheal intubation, vascular access or tracheostomy, and were independent in adult ICU management of ECMO, hemofiltration, or comorbidities such as hypertension, obesity and diabetes. Conclusions: Hospitals have been able to expand their capacity in terms of ICU beds. Shortages of equipment and staff has been a major problem. PICU physicians can be of great value in supporting adult ICUs. However, this may have limitations and implications for clinical practice. Additional studies with objective data are required.

Association of Intensive Care Unit Patient Load and Demand With Mortality Rates in US Department of Veterans Affairs Hospitals During the COVID-19 Pandemic

Although strain on hospital capacity has been associated with increased mortality in nonpandemic settings, studies are needed to examine the association between coronavirus disease 2019 (COVID-19) critical care capacity and mortality. To examine whether COVID-19 mortality was associated with COVID-19 intensive care unit (ICU) strain. This cohort study was conducted among veterans with COVID-19, as confirmed by polymerase chain reaction or antigen testing in the laboratory from March through August 2020, cared for at any Department of Veterans Affairs (VA) hospital with 10 or more patients with COVID-19 in the ICU. The follow-up period was through November 2020. Data were analyzed from March to November 2020. Receiving treatment for COVID-19 in the ICU during a period of increased COVID-19 ICU load, with load defined as mean number of patients with COVID-19 in the ICU during the patient's hospital stay divided by the number of ICU beds at that facility, or increased COVID-19 ICU demand, with demand defined as mean number of patients with COVID-19 in the ICU during the patient's stay divided by the maximum number of patients with COVID-19 in the ICU. All-cause mortality was recorded through 30 days after discharge from the hospital. Among 8516 patients with COVID-19 admitted to 88 VA hospitals, 8014 (94.1%) were men and mean (SD) age was 67.9 (14.2) years. Mortality varied over time, with 218 of 954 patients (22.9%) dying in March, 399 of 1594 patients (25.0%) dying in April, 143 of 920 patients (15.5%) dying in May, 179 of 1314 patients (13.6%) dying in June, 297 of 2373 patients (12.5%) dying in July, and 174 of 1361 (12.8%) patients dying in August (P < .001). Patients with COVID-19 who were treated in the ICU during periods of increased COVID-19 ICU demand had increased risk of mortality compared with patients treated during periods of low COVID-19 ICU demand (ie, demand of ≤25%); the adjusted hazard ratio for all-cause mortality was 0.99 (95% CI, 0.81-1.22; P = .93) for patients treated when COVID-19 ICU demand was more than 25% to 50%, 1.19 (95% CI, 0.95-1.48; P = .13) when COVID-19 ICU demand was more than 50% to 75%, and 1.94 (95% CI, 1.46-2.59; P < .001) when COVID-19 ICU demand was more than 75% to 100%. No association between COVID-19 ICU demand and mortality was observed for patients with COVID-19 not in the ICU. The association between COVID-19 ICU load and mortality was not consistent over time (ie, early vs late in the pandemic). This cohort study found that although facilities augmented ICU capacity during the pandemic, strains on critical care capacity were associated with increased COVID-19 ICU mortality. Tracking COVID-19 ICU demand may be useful to hospital administrators and health officials as they coordinate COVID-19 admissions across hospitals to optimize outcomes for patients with this illness.

The SARS-CoV-2 epidemic, a step towards recognizing the speciality of critical care nursing in France.

The SARS-CoV-2 epidemic, a step towards recognizing the speciality of critical care nursing in France.

Alternative cardiac intensive care unit locations during the COVID-19 pandemic at an academic medical center

Alternative cardiac intensive care unit locations during the COVID-19 pandemic at an academic medical center