Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic

Abstract

IntroductionThe specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs.MethodsWe conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden.ResultsAmong the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated in a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. Three hundred ninety-one critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non-University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas.ConclusionsThe peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non-University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.

Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference

“…The capacity of the centers receiving patients requiring ECMO would soon be exceeded, as was reported during the 2009 H1N1 influenza epidemic [59]. In such a situation it is important that some centers quickly become operational.…”

Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française

“…Les capacités des centres accueillant les patients relevant de l'ECMO pourraient être vite dépas-sées, comme cela a été rapporté lors de l'épidémie de grippe H1N1 de 2009 [59]. Dans une telle situation il est important qu'un certain nombre de centres puissent être rapidement opérationnels.…”

Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française

“…Enfin, il est indispensable de prendre en considération les difficultés majeures que la France devrait affronter en cas de pandémie virale. Les capacités des centres accueillant les patients relevant de l'ECMO pourraient être vite dépassées, comme cela a été rapporté lors de l'épidémie de grippe H1N1 de 2009 [59]. Dans une telle situation, il est important qu'un certain nombre de centres puissent être rapidement opérationnels.…”