Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience

Abstract

Background: Response to the outbreak of poliomyelitis in mid-1950 led to recognition and consequent development of critical care. Seventy years later the humankind was struck by COVID-19, another major challenge for critical care medicine which was especially big in Low-Resources-Settings where more than two thirds of the world population live, including the population of the Republic of Srpska (RS). Design and methods: The main aim was to show an overview of all interventions in order to boost hospitals’ capacities to the level which is sufficient to manage high amount of critically ill COVID-19 patients in the RS. A before-after cohort study design was conducted to evaluate the effects of interventions for increase in preparedness and capacity of ICUs for admission and treatment of COVID-19 critically ill patients in nine hospitals in the RS. Results: Following interventions, the biggest and university affiliated hospital in the RS has increased ICU capacities: total number of ICU beds increased by 38% and number of ventilators by 114%. Availability of machines for veno-venous extracorporeal membrane oxygenation (vvECMO) increased by 100%. Number of doctors who were involved in treatment of critically ill patients increased by 47% and nurse/patient’s ratio reached 1:2.5. Similarly, all other hospitals experienced boosting of ICU beds by 189% and ventilators by 373% while number of doctors increased by 108% and nurse/patient’s ratio reached 1:4. Conclusion: All interventions implemented during COVID-19 pandemic outbreak in the RS resulted in increasing capacity for treatment of critically ill patients, but the education of health care professionals was identified as the most important conducted intervention.

Burnout syndrome among healthcare workers employed in intensive care units: Experiences from three large university hospitals in the Southeast Balkans: Burnout syndrome among healthcare workers of intensive care units in the Southeast Balkans

“…Kada je u pitanju Upitnik za samoprocjenu nivoa stresa, najlošije rezultate (najveći procenat ispitanika sa procjenjenim visokim nivoom stresa) su imali ispitanici iz Novog Sada, što je i statistički značajno u odnosu na druga dva centra. Analizom nivoa emocionalne iscrpljenosti, depersonalizacije i ličnog postignuća, ispitanici iz Novog Sada pokazuju najveće opterećenje po sve tri komponente sindroma sagorjevanja, dok su ispitanici iz Ljubljane imali najbolje pokazatelje, izuzev u kategoriji ličnog postignuća gdje su ispitanici iz Banja Luke imali najbolje ostvarenje u odnosu na druga dva 14,15 Ispitivana je korelacija između sociodemografksih karakteristika (bračni status, pol, dob, dužina radnog staža i stručna sprema) i procjenjenog nivoa stresa, kao i sve tri komponenete sindroma sagorjevanja (emocionalna iscrpljenost, depersonalizacija i lično postignuće), gdje je utvrđeno da je u ukupnom broju ispitanika ženski pol bio u statistički značajnoj negativnoj korelaciji sa ličnim postignućem. Takođe, u nekim drugim studijama je dokazana razlika u osjećaju ličnog postignuća među polovima u jedinicama intenzivne njege.…”

Population Pharmacokinetic Model of Linezolid and Probability of Target Attainment in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation—A Step toward Correct Dosing

“…Millions of people worldwide diagnosed with COVID-19 developed pneumonia from the beginning of 2020 until the end of 2021, and 5% of them developed a critical illness related to acute respiratory distress syndrome (ARDS), with an unacceptably high mortality rate (of at least 45%), especially in low-resource settings [ 1 , 2 ]. COVID-19-associated ARDS (CARDS) is connected with the extended length of both intensive care unit (ICU) and hospital stays, with prolonged mechanical ventilation, and in some cases, with veno-venous extracorporeal membrane oxygenation (vv ECMO) as a last option for advanced life support [ 3 ].…”

Comparative Efficacy of High-Dose Dexamethasone Versus Methylprednisolone in Coronavirus Disease 2019 (COVID-19)-Associated Acute Respiratory Distress Syndrome

“…The diagnosis of ARDS in COVID-19 patients follows the well-established Berlin definition of ARDS [3,4]. This syndrome and the problems related to its treatment are particularly manifested in low-resource settings, where the mortality rate for intubated patients can be as high as 80% [5]. Today, it is known that the dysregulation and excessive response of the immune system (cytokine storm) is one of the key links in the chain of pathophysiological events in patients who develop ARDS associated with COVID-19 [6,7].…”