The resilient intensive care unit

Abstract

Background The COVID-19 pandemic tested the capacity of intensive care units (ICU) to respond to a crisis and demonstrated their fragility. Unsurprisingly, higher than usual mortality rates, lengths of stay (LOS), and ICU-acquired complications occurred during the pandemic. However, worse outcomes were not universal nor constant across ICUs and significant variation in outcomes was reported, demonstrating that some ICUs could adequately manage the surge of COVID-19. Methods In the present editorial, we discuss the concept of a resilient Intensive Care Unit, including which metrics can be used to address the capacity to respond, sustain results and incorporate new practices that lead to improvement. Results We believe that a resiliency analysis adds a component of preparedness to the usual ICU performance evaluation and outcomes metrics to be used during the crisis and in regular times. Conclusions The COVID-19 pandemic demonstrated the need for a resilient health system. Although this concept has been discussed for health systems, it was not tested in intensive care. Future studies should evaluate this concept to improve ICU organization for standard and pandemic times.

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

“…The current pandemic has exposed limitations of critical care disaster management at large tertiary care centers in first-world nations ( 3 ). Comparing critical care outcomes between illnesses occurring in usual care settings and pandemics or other disasters may fail to account for these factors ( 4 ).…”

The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists

“…Moreover, the response of healthcare systems to the COVID-19 pandemic was hampered by a lack of public policy coordination both at national and international levels, deficient cooperation between governments and industry [ 5 , 141 ] and the lack of international solidarity. It is now our responsibility to capitalize on this acknowledgment so as to remind the policy makers and civil society how important it is to build resilient and effective critical care that will need to outlast the current pandemic [ 142 ]. The public financial concessions achieved so far will not be enough.…”

Factors related to COVID‐19 mortality among three Swedish intensive care units—A retrospective study

“…However, the unit with the lowest mortality rate showed a numerically higher number of ICU nurses and physicians per ICU bed (prepandemic), perhaps contributing to different resilience levels between the units that may not be directly reflected in nursing workload. 14 In non-COVID settings, appropriate nurse and physician staffing levels have been shown to reduce the mortality rate. [15][16][17][18][19] Although there is scarce international evidence regarding the relationship of staffing with COVID-19-related mortality, it points to the same direction.…”