Admission criteria and management of critical care patients in a pandemic context: position of the Ethics Commission of the French Intensive Care Society, update of April 2021

Lesieur, Olivier; Quenot, Jean‐Pierre; Cohen-Solal, Zoé; David, Raphaëlle; Blanquat, L. de Saint; Elbaz, Meyer; Roux, Bénédicte Gaillard Le; Goulenok, Cyril; Lavoué, Sylvain; Lemiale, Virginie; Mercier, Emmanuelle; Mezher, Chaouki; Benoît, Michel; Penven, Gwendolyn; Poujol, Anne Laure; Quentin, Bertrand; Queré, Régis; Linden, Thierry Van Der; Rigaud, J.

doi:10.1186/s13613-021-00855-z

Cited by 13 publications

(11 citation statements)

References 3 publications

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“…There is strong ethical component to the discussions about admission decisions to ICU, which is coherent with the recently published recommendations from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine [ 22 , 49 ], and the more recent French guidelines for admission and management of critical care patients in a pandemic context [ 16 ]. In light of these recommendations, in going beyond their usual sphere of activity to take on the role of consultant [ 29 , 43 ] and by aiding the definition of suitable levels of therapeutic engagement for patients in the wards before a need for ICU care arises, ICU physicians have become a central actor in the organisation of the healthcare trajectory and healthcare goals [ 15 , 35 ].…”

Section: Discussionmentioning

confidence: 61%

Anticipating need for intensive care in the healthcare trajectory of patients with chronic disease: A qualitative study among specialists

Taha

Jacquier²,

Meunier-Beillard³

et al. 2022

PLoS ONE

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Introduction We investigated the reflections and perceptions of non-ICU physicians about anticipating the need for ICU admission in case of acute decompensation in patients with chronic disease. Methods We performed a qualitative multicentre study using semi-structured interviews among non-ICU specialist physicians. The interview guide, developed in advance, focused on 3 questions: (1) What is your perception of ICU care? (2) How do you think advance directives can be integrated into the patient’s healthcare goals? and (3) How can the possibility of a need for ICU admission be integrated into the patient’s healthcare goals? Interviews were recorded, transcribed and analysed by thematic analysis. Interviews were performed until theoretical saturation was reached. Results In total, 16 physicians (8 women, 8 men) were interviewed. The main themes related to intensive care being viewed as a distinct specialty, dispensing very technical care, and with major human and ethical challenges, especially regarding end-of-life issues. The participants also mentioned the difficulty in anticipating an acute decompensation, and the choices that might have to be made in such situations. The timing of discussions about potential decompensation of the patient, the medical culture and the presence of advance directives are issues that arise when attempting to anticipate the question of ICU admission in the patient’s healthcare goals or wishes. Conclusion This study describes the perceptions that physicians treating patients with chronic disease have of intensive care, notably that it is a distinct and technical specialty that presents challenging medical and ethical situations. Our study also opens perspectives for actions that could promote a pluridisciplinary approach to anticipating acute decompensation and ICU requirements in patients with chronic disease.

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Section: Discussionmentioning

confidence: 61%

Anticipating need for intensive care in the healthcare trajectory of patients with chronic disease: A qualitative study among specialists

Taha

Jacquier²,

Meunier-Beillard³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…In the field of health, all groups of health professionals working in the hospital setting have been confronted with philosophical dilemmas about what is “good” or “right” and how best to optimise care for the greatest number while guaranteeing a dignified end-of-life, where necessary. In particular, regarding access to intensive care units (ICUs), health inequalities or inequities raised some veritable ethical dilemmas at the peak of the epidemic [ 1 ]. In view of the penury of ICU beds, the French Intensive Care Society issued guidelines to help physicians make decisions about how to manage severely ill patients and how to decide on admission (or not) to the ICU [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, regarding access to intensive care units (ICUs), health inequalities or inequities raised some veritable ethical dilemmas at the peak of the epidemic [ 1 ]. In view of the penury of ICU beds, the French Intensive Care Society issued guidelines to help physicians make decisions about how to manage severely ill patients and how to decide on admission (or not) to the ICU [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Mental Health Support for Hospital Staff during the COVID-19 Pandemic: Characteristics of the Services and Feedback from the Providers

et al. 2022

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French authorities created mental health support services to accompany HCWs during the pandemic. We aimed to obtain feedback from staff providing these mental health support services within French hospitals to identify positive and negative features and avenues for improvement. A mixed-methods study was performed between 1 April and 30 June 2020. We contacted 77 centres to identify those providing mental health support services. We developed a questionnaire containing questions about the staff providing the service (quantitative part), with open questions to enable feedback from service providers (qualitative part). Of the 77 centres, 36 had mental health support services; 77.8% were created specifically for the epidemic. Services were staffed principally by psychologists, mainly used a telephone platform, and had a median opening time of 8 h/day. Thirty-seven professionals provided feedback, most aged 35–49 years. For 86.5%, it was their first time providing such support. Median self-reported comfort level was 8 (interquartiles 3–10), and 95% would do it again. Respondents reported (i) difficulties with work organisation, clinical situations, and lack of recognition and (ii) a desire for training. This study suggests that mental health support needs to be adapted to the needs of HCWs, both in terms of the content of the service and the timing of delivery.

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“…However, non-COVID-19 patients could also have been at high risk of HAI given their health conditions [ 18 ]. In fact, the rationalization of ICU beds because of the pandemic may have determined a change in the pattern of patient admission, limiting it to extremely critical patients who could not be managed in other wards [ 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit

Isonne

Baccolini

Migliara

et al. 2022

JCM

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The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

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Admission criteria and management of critical care patients in a pandemic context: position of the Ethics Commission of the French Intensive Care Society, update of April 2021

Cited by 13 publications

References 3 publications

Anticipating need for intensive care in the healthcare trajectory of patients with chronic disease: A qualitative study among specialists

Anticipating need for intensive care in the healthcare trajectory of patients with chronic disease: A qualitative study among specialists

Mental Health Support for Hospital Staff during the COVID-19 Pandemic: Characteristics of the Services and Feedback from the Providers

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit

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