Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

Jeitziner, Marie‐Madlen; Moser, André; Wendel‐Garcia, Pedro David; Exl, Matthias Thomas; Keiser, Stefanie; Schuepbach, Reto A.; Pietsch, Urs; Cereghetti, Sara; Boroli, Filippo; Marrel, Julien; Sigg, Anne-Aylin; Ksouri, Hatem; Schøtt, Peter; Dullenkopf, Alexander; Fleisch, Isabelle; Heise, Antje; Laurent, Jean-Christophe; Jakob, Stephan M.; Hilty, Matthias P.; Que, Yok-Ai

doi:10.4414/smw.2022.w30183

Cited by 5 publications

(10 citation statements)

References 36 publications

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“…It is also worth noting that some studies found no difference in mortality among patients with COVID-19 during surge months or based on resource availability ( 171 ). However, it is possible that hospitals worldwide experienced a surge of patients with COVID-19 during different time frames based on spread of the culprit virus, and this variation in timing was a confounding factor in applied analyses.…”

Section: Discussionmentioning

confidence: 99%

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Chandel

Leazer

Alcover

et al. 2023

Critical Care Explorations

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OBJECTIVES:To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.DATA SOURCES: A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.STUDY SELECTION: Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.DATA EXTRACTION: Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.

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Section: Discussionmentioning

confidence: 99%

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Chandel

Leazer

Alcover

et al. 2023

Critical Care Explorations

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“…In our study, we employed the occupancy ratio on the day of ICU admission as an indicator of the ICU's strain level. Nevertheless, a more exact delineation of "strain" would be advantageous, given the current disparity in definitions across studies (27,(33)(34)(35)(36)(37)(38). Disparities in definition may, to some extent, account for variations in the observed effect sizes regarding strain's impact on mortality.…”

Section: Discussionmentioning

confidence: 99%

Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study*

Brinkman,

de Keizer,

de Lange

et al. 2023

Critical Care Medicine

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Objectives: Strain on ICUs during the COVID-19 pandemic required stringent triage at the ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, patient selection, and worse outcome of non-COVID-19 patients, especially during the pandemic peaks when the strain on ICUs was extreme. We analyzed this potential impact on the non-COVID-19 patients. Design: A national cohort study. Setting: Data of 71 Dutch ICUs Participants: A total of 120,393 patients in the pandemic non-COVID-19 cohort (from March 1, 2020 to February 28, 2022) and 164,737 patients in the prepandemic cohort (from January 1, 2018 to December 31, 2019). Interventions: None. Measurements and Main Results: Volume, patient characteristics, and mortality were compared between the pandemic non-COVID-19 cohort and the prepandemic cohort, focusing on the pandemic period and its peaks, with attention to strata of specific admission types, diagnoses, and severity. The number of admitted non-COVID-19 patients during the pandemic period and its peaks were, respectively, 26.9% and 34.2% lower compared with the prepandemic cohort. The pandemic non-COVID-19 cohort consisted of fewer medical patients (48.1% vs. 50.7%), fewer patients with comorbidities (36.5% vs. 40.6%), and more patients on mechanical ventilation (45.3% vs. 42.4%) and vasoactive medication (44.7% vs. 38.4%) compared with the prepandemic cohort. Case-mix adjusted mortality during the pandemic period and its peaks was higher compared with the prepandemic period, odds ratios were, respectively, 1.08 (95% CI, 1.05–1.11) and 1.10 (95% CI, 1.07–1.13). Conclusions: In non-COVID-19 patients the strain on healthcare has driven lower patient volume, selection of fewer comorbid patients who required more intensive support, and a modest increase in the case-mix adjusted mortality.

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“…Surge was associated with higher mortality in 32 of 39 studies (82%), including 26 of 31 COVID-19 studies (84%), 4 of 6 non-COVID-19 studies (67%), and 2 of 2 studies that included patients with and without COVID-19. Notably, seven studies (18%) (one using composite metric, three using occupancy, and the remaining three using indirect caseload metrics) reported no impact on mortality with caseload surge (eTable 5, http://links.lww.com/CCM/H520) (6,17,18,37,38,47,35). Only one (25%) of four studies using indirect caseload metrics reported worse survival with surge (42).…”

Section: Surge-mortality Relationship Across Caseload-based Studiesmentioning

confidence: 99%

“…), care settings (emergency departments, hospitals, ICUs), and global regions with differing baseline healthcare infrastructure using a variety of traditional and novel exposures and surge metrics. Results have been inconsistent, some demonstrated surge-associated harm (3)(4)(5), while others showed no effect (6,7), and a few even demonstrated better outcomes (8,9) at surging hospitals. Furthermore, no studies have systematically summarized the evidence addressing this question.…”

mentioning

confidence: 99%

Measures and Impact of Caseload Surge During the COVID-19 Pandemic: A Systematic Review*

Neupane,

De Jonge,

Angelo

et al. 2024

Critical Care Medicine

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Objectives: COVID-19 pandemic surges strained hospitals globally. We performed a systematic review to examine measures of pandemic caseload surge and its impact on mortality of hospitalized patients. Data Sources: PubMed, Embase, and Web of Science. Study Selection: English-language studies published between December 1, 2019, and November 22, 2023, which reported the association between pandemic “surge”-related measures and mortality in hospitalized patients. Data Extraction: Three authors independently screened studies, extracted data, and assessed individual study risk of bias. We assessed measures of surge qualitatively across included studies. Given multidomain heterogeneity, we semiquantitatively aggregated surge–mortality associations. Data Synthesis: Of 17,831 citations, we included 39 studies, 17 of which specifically described surge effects in ICU settings. The majority of studies were from high-income countries (n = 35 studies) and included patients with COVID-19 (n = 31). There were 37 different surge metrics which were mapped into four broad themes, incorporating caseloads either directly as unadjusted counts (n = 11), nested in occupancy (n = 14), including additional factors (e.g., resource needs, speed of occupancy; n = 10), or using indirect proxies (e.g., altered staffing ratios, alternative care settings; n = 4). Notwithstanding metric heterogeneity, 32 of 39 studies (82%) reported detrimental adjusted odds/hazard ratio for caseload surge–mortality outcomes, reporting point estimates of up to four-fold increased risk of mortality. This signal persisted among study subgroups categorized by publication year, patient types, clinical settings, and country income status. Conclusions: Pandemic caseload surge was associated with lower survival across most studies regardless of jurisdiction, timing, and population. Markedly variable surge strain measures precluded meta-analysis and findings have uncertain generalizability to lower-middle-income countries (LMICs). These findings underscore the need for establishing a consensus surge metric that is sensitive to capturing harms in everyday fluctuations and future pandemics and is scalable to LMICs.

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Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

Cited by 5 publications

References 36 publications

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study*

Measures and Impact of Caseload Surge During the COVID-19 Pandemic: A Systematic Review*

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