Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis

Carmona, Maria José Carvalho; Quintão, Vinícius Caldeira; Melo, Brigite Feiner de; André, Rodrigo Guerson; Kayano, Rafael Priante; Perondi, Beatriz; Miethke-Morais, Anna; Rocha, Marcelo Cristiano; Malbouisson, Luíz Marcelo Sá; Auler-Júnior, José Otavio Costa

doi:10.6061/clinics/2020/e2023

Cited by 12 publications

(17 citation statements)

References 4 publications

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“…HCFMUSP was located in the national epicenter of the pandemic in the first months of 2020, 9 and the 900 beds of its Central Institute, including 300 ICU beds, 206 of which were newly installed in response to the pandemic, were entirely dedicated to COVID-19 patients referred for admission from the state's public healthcare network; HCFMUSP has delivered tertiary hospital care to more than 4,000 severe COVID-19 patients. 10 , 11 , 12 Due to the large number of hospitalized patients, the fast response to the disaster, the academic characteristics of the institution and its importance to the healthcare system, the results of the studies conducted at HCFMUSP are of great interest to national health policy makers. The centralization of care in a single institute provided a unique opportunity for a precise and homogeneous economic evaluation of these admissions.…”

Section: Introductionmentioning

confidence: 99%

COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors

Miethke-Morais

Cassenote

Piva

et al. 2021

The Brazilian Journal of Infectious Diseases

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Introduction Although patients’ clinical conditions have been shown to be associated with coronavirus disease (COVID-19) severity and outcome, their impact on hospital costs are not known. This economic evaluation of COVID-19 admissions aimed to assess direct and fixed hospital costs and describe their particularities in different clinical and demographic conditions and outcomes in the largest public hospital in Latin America, located in São Paulo, Brazil, where a whole institute was exclusively dedicated to COVID-19 patients in response to the pandemic. Methods This is a partial economic evaluation performed from the hospital´s perspective and is a prospective, observational cohort study to assess hospitalization costs of suspected and confirmed COVID-19 patients admitted between March 30 and June 30, 2020, to Hospital das Clínicas of the University of São Paulo Medical School (HCFMUSP) and followed until discharge, death, or external transfer. Micro- and macro-costing methodologies were used to describe and analyze the total cost associated with each patient's underlying medical conditions, itinerary and outcomes as well as the cost components of different hospital sectors. Results The average cost of the 3,254 admissions (51.7% of which involved intensive care unit stays) was US$12,637.42. The overhead cost was its main component. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic (US$15,257.95) diseases were associated with higher costs. Age strata >69 years, reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, use of mechanical ventilation or dialysis, surgery and outcomes remained associated with higher costs. Conclusion Knowledge of COVID-19 hospital costs can aid in the development of a comprehensive approach for decision-making and planning for future risk management.

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Section: Introductionmentioning

confidence: 99%

COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors

Miethke-Morais

Cassenote

Piva

et al. 2021

The Brazilian Journal of Infectious Diseases

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“…13 The significant decrease in the production of mycophenolate mofetil and PEG is due to the following circumstances: the need to transform the operating room into an ICU bed to meet the patient care demand resulted in the cancellation of transplants at the HCFMUSP Central Institute, resulting in a reduction in use and prescription of immunosuppressants such as mycophenolate mofetil. 18 The decrease in PEG production is due to replacement by other laxative substances.…”

Section: Discussionmentioning

confidence: 99%

Perfil farmacoterapêutico de medicamentos manipulados para tratamento de coronavírus em pacientes internados em hospital público

Teotonio¹,

Chaves²,

França³

et al. 2021

Rev Bras Farm Hosp Serv Saude

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Objetivo: Caracterizar sociodemograficamente e definir perfil de internação dos pacientes, bem como determinar, contabilizar, identificar dosagens e custos gerados com medicamentos manipulados para atender prescrições de internados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) devido ao SARS-CoV-2, entre abril e julho de 2020. Métodos: Estudo seccional retrospectivo da utilização de medicamentos manipulados por pacientes internados por coronavírus no Instituto Central HCFMUSP no período de abril a julho de 2020. Excluiu-se do estudo medicamentos manipulados personalizados ou produzidos pelo setor de semi-industriais da Unidade de Farmacotécnica do HCFMUSP. As variáveis foram apresentadas como média e desvio-padrão ou proporção. Aplicada análise estatística univariada, ANOVA de uma via usando Tukey como teste post-hoc para comprar a produção de manipulados no período de estudo e o mesmo período de 2019. Resultados: Demonstraram o total de 39 medicamentos manipulados padronizados que foram prescritos para o total de 1557 pacientes com confirmação de coronavírus. Do total de medicamentos manipulados prescritos, 11 medicamentos apresentaram aumento significativo de produção em 2020: furosemida (48,8 ± 17,1 p <0,004); amiodarona (50,0 ± 17,4 p <0,005); anlodipino (70,3 ± 14,4 p <0,003); hidralazina (82,8 ± 22,3 p <0,038); diazepam (95,8 ± 53,4 p <0,037); saliva artificial (146,0 ± 50,6 p <0,004); propantelina gel (155,0 ± 33,9 p <0,042); metadona (174,5 ± 45,2 p <0,002); hidroclorotiazida (204,5 ± 46,4 p <0,001); omeprazol (537,5 ± 194,8 p <0,031) e quetiapina (597,0 ± 116,3 p <0,000). Os medicamentos omeprazol e quetiapina foram os produtos mais prescrito para os pacientes internados. O custo total estimado para atender às prescrições no período do estudo foi de US$ 20.854,01. Conclusões: Os medicamentos manipulados proporcionaram aos pacientes em ventilação mecânica a adequada farmacoterapia e facilitaram o processo de desmame da sedação. A instituição obteve redução no custo devido ao produto manipulado apresentar melhor custo-benefício quando comparado às formas injetáveis dos medicamentos.

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“…Dentro de las experiencias internacionales, a la fecha de publicación, no se encontraron resultados de unidades reconvertidas con presencia de VM con máquinas de anestesia. Son varios los artículos que hacen referencia a los desafíos de trasladar la UCI a otras dependencias; respecto a espacio, staff, equipamiento, manejo de infecciones y bioseguridad [1], [8], [10], [15], [16], desafíos que también tuvieron que ser resueltos en nuestro centro.…”

Section: Discussionunclassified

Descripción y seguimiento de pacientes COVID-19 en ventilación mecánica en unidades convertidas dirigidas por anestesiólogos: Clínica Alemana de Santiago

Chuang¹,

V.²,

N.³

et al. 2021

Rev. chil. anest.

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Introduction: The high demand for critical care beds and the need for mechanical ventilation generated by the pandemia of COVID-19 led the Ministry of Health of Chile to authorize both the conversion of beds and the use of anesthesia machines to mechanically ventilate COVID-19 patients. At Clínica Alemana de Santiago (CAS), these converted units were managed by non-intensivist anesthesiologists with technical support from the Intensive Care Unit (ICU). The objective of this study was to compare the survival rate of patients managed at converted and traditional ICU units. The secondary objective was to analyze the factors that may affect morbidity and mortality of these patients. Method: This prospective observational study included mechanically ventilated COVID-19 patients in both traditional and converted units. Patients were followed for 90 days starting at intubation day. Survival rate was determined at 30 and 90 days. A survival analysis was then performed. Results: 41 and 42 patients were admitted to CAS trough converted and traditional ICU units, respectively, between May 24 and June 30, 2020. There was not significant difference in survival rate between converted and traditional ICU units. Age (HR 1.1 per year) and SOFA (HR 1.4 per point) were associated with survival. Conclusions: At CAS, the survival of COVID-19 patients who required mechanical ventilation in converted units was not different as in those patients treated in traditional ICU units. Both age and SOFA were variables that can inform about prognosis of these patients.

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Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis

Abstract: In the article Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis Replace ''Maria José Carvalho Carmona 0

Cited by 12 publications

References 4 publications

COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors

COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors

Perfil farmacoterapêutico de medicamentos manipulados para tratamento de coronavírus em pacientes internados em hospital público

Descripción y seguimiento de pacientes COVID-19 en ventilación mecánica en unidades convertidas dirigidas por anestesiólogos: Clínica Alemana de Santiago

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