Patient care in rapid-expansion intensive care units during the COVID-19 pandemic crisis

Abstract

Background The coronavirus-2019 (COVID-19) pandemic highlighted the unfortunate reality that many hospitals have insufficient intensive care unit (ICU) capacity to meet massive, unanticipated increases in demand. To drastically increase ICU capacity, NewYork-Presbyterian/Weill Cornell Medical Center modified its existing operating rooms and post-anaesthesia care units during the initial expansion phase to accommodate the surge of critically ill patients. Methods This retrospective chart review examined patient care in non-standard Expansion ICUs as compared to standard ICUs. We compared clinical data between the two settings to determine whether the expeditious development and deployment of critical care resources during an evolving medical crisis could provide appropriate care. Results Sixty-six patients were admitted to Expansion ICUs from March 1st to April 30th, 2020 and 343 were admitted to standard ICUs. Most patients were male (70%), White (30%), 45–64 years old (35%), non-smokers (73%), had hypertension (58%), and were hospitalized for a median of 40 days. For patients that died, there was no difference in treatment management, but the Expansion cohort had a higher median ICU length of stay (q = 0.037) and ventilatory length (q = 0.015). The cohorts had similar rates of discharge to home, but the Expansion ICU cohort had higher rates of discharge to a rehabilitation facility and overall lower mortality. Conclusions We found no significantly worse outcomes for the Expansion ICU cohort compared to the standard ICU cohort at our institution during the COVID-19 pandemic, which demonstrates the feasibility of providing safe and effective care for patients in an Expansion ICU.

Impact of COVID-19 Pandemic Lockdown on the Prognosis, Morbidity, and Mortality of Patients Undergoing Elective and Emergency Abdominal Surgery: A Retrospective Cohort Study in a Tertiary Center, Saudi Arabia

“…An area of health care that requires serious policy alterations is the surgical care services, one of the most significant health care units. Intensive care ability needs to be increased, needs the conversion of recovery rooms and even waiting rooms into intensive care beds [ 6 ]. In such cases, hospital resources, such as personal protective equipment (PPE), ventilators, and transfusion supplies, should be reserved for COVID-19 patients [ 6 , 7 ].…”

Biological effects of COVID-19 on lung cancer: Can we drive our decisions

“…The most important feature to consider in an injured lung is the inhomogeneity of ventilation, which increases tissue damage, resulting in severe worsening of pulmonary gas exchange, thus promoting respiratory insufficiency in patients with ARDS ( 40 ). This vicious circle increases the stress on tissues, intensifying lung damage.…”

Physician Posttraumatic Stress Disorder During COVID-19

“…In many regions, the volume of cases, hospitalizations, and fatalities exceeded the capacity that health care systems typically handle. To manage this surge in demand, hospitals extended staff working hours, reduced vacation time, and expanded their intensive care unit capacity . Furthermore, physicians were at high risk for infection themselves.…”

“…To manage this surge in demand, hospitals extended staff working hours, reduced vacation time, and expanded their intensive care unit capacity. 7 , 8 Furthermore, physicians were at high risk for infection themselves. Consequently, many of the postulated risk factors for PTSD among physicians were amplified, consistent with previous community-wide traumatic events that led to significant increases in PTSD among physicians.…”