Surge and Mortality in ICUs in New York City’s Public Healthcare System

Toth, Alexander T.; Tatem, Kathleen; Hosseinipour, Nicole; Wong, Taylor; Newton-Dame, Remle; Cohen, Gabriel; George, Annie; Sessa, T; Postelnicu, Radu; Uppal, Amit; Davis, Nichola; Mukherjee, Vikramjit

doi:10.1097/ccm.0000000000004972

Cited by 22 publications

(43 citation statements)

References 23 publications

(28 reference statements)

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“…Time of admission was associated with higher likelihood for death until early April 2020 when the number of hospitalizations reached its peak in NYC Health and Hospitals, and in New York overall [29], leading to significant pressure on the health care system [30]. Subsequently, progression in time was strongly associated with decreasing likelihood for death over the rest of the study period with 75% lower odds for death in last patient quartile compared to the first one.…”

Section: Inflammatory Cells and Markers And In-hospital Mortalitymentioning

confidence: 99%

Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City

Palaiodimos

Ali

Teo

et al. 2022

JCM

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Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals’ ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m2. Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.

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Section: Inflammatory Cells and Markers And In-hospital Mortalitymentioning

confidence: 99%

Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City

Palaiodimos

Ali

Teo

et al. 2022

JCM

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“…The experience during COVID‐19 outbreaks in the United States and Europe during 2020 has been that outcomes for patients requiring intensive care are significantly poorer if ICUs need to adopt “surge” approaches, which entail compromised staffing arrangements and providing care in unfamiliar environments 2‐6 …”

mentioning

confidence: 99%

Increasing ICU capacity to accommodate higher demand during the COVID‐19 pandemic

Litton

Huckson²,

Chavan³

et al. 2021

Medical Journal of Australia

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Objectives To describe the short term ability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID‐19 pandemic. Design Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data. Setting All 194 public and private Australian ICUs. Main outcome measures Numbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU‐relevant equipment and staff. Results All 194 ICUs responded to the survey. The total number of currently open staffed ICU beds was 2183. This was 195 fewer (8.2%) than in 2020; the decline was greater for rural/regional (18%) and private ICUs (18%). The reported maximal ICU bed capacity (5623) included 813 additional physical ICU bed spaces and 2627 in surge areas outside ICUs. The number of available ventilators (7196) exceeded the maximum number of ICU beds. The reported number of available additional nursing staff would facilitate the immediate opening of 383 additional physical ICU beds (47%), but not the additional bed spaces outside ICUs. Conclusions The number of currently available staffed ICU beds is lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff numbers while maintaining pre‐pandemic models of care.

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“…Hospital capacity strain, which often results from high community spread, has been shown to negatively impact mortality. ICU overflow has been associated with a 6% ICU mortality increase in Belgium [ 3 ], while in the United States mortality decreased from high/very high surge to low/medium surge among patients 18 to 44 years old and among those 45 to 64 years old [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality over time among COVID-19 patients hospitalized during the first surge of the pandemic: A large cohort study

et al. 2022

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Background Capacity strain negatively impacts patient outcome, and the effects of patient surge are a continuous threat during the COVID-19 pandemic. Evaluating changes in mortality over time enables evidence-based resource planning, thus improving patient outcome. Our aim was to describe baseline risk factors associated with mortality among COVID-19 hospitalized patients and to compare mortality rates over time. Methods We conducted a retrospective cohort study in the largest referral hospital for COVID-19 patients in Sao Paulo, Brazil. We investigated risk factors associated with mortality during hospitalization. Independent variables included age group, sex, the Charlson Comorbidity Index, admission period according to the stage of the first wave of the epidemic (early, peak, and late), and intubation. Results We included 2949 consecutive COVID-19 patients. 1895 of them were admitted to the ICU, and 1473 required mechanical ventilation. Median length of stay in the ICU was 10 (IQR 5–17) days. Overall mortality rate was 35%, and the adjusted odds ratios for mortality increased with age, male sex, higher Charlson Comorbidity index, need for mechanical ventilation, and being admitted to the hospital during the wave peak of the epidemic. Being admitted to the hospital during the wave peak was associated with a 33% higher risk of mortality. Conclusions In-hospital mortality was independently affected by the epidemic period. The recognition of modifiable operational variables associated with patient outcome highlights the importance of a preparedness plan and institutional protocols that include evidence-based practices and allocation of resources.

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Surge and Mortality in ICUs in New York City’s Public Healthcare System

Cited by 22 publications

References 23 publications

Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City

Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City

Increasing ICU capacity to accommodate higher demand during the COVID‐19 pandemic

Mortality over time among COVID-19 patients hospitalized during the first surge of the pandemic: A large cohort study

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