scholarly journals Early indicators of intensive care unit bed requirement during the COVID-19 epidemic: A retrospective study in Ile-de-France region, France

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241406 ◽  
Author(s):  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Hospital Admissions ◽  
Rt Pcr ◽  
Icu Patients ◽  
Health Authorities ◽  
Ed Visits ◽  
Gp Visits ◽  
Second Wave

The aim of our retrospective study was to evaluate the earliest COVID19-related signal to anticipate requirements of intensive care unit (ICU) beds. Although the number of ICU beds is crucial during the COVID-19 epidemic, there is no recognized early indicator to anticipate it. In the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient, depending on the number of days the indicator has been shifted. Primary endpoint was the number of ICU patients. EMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated (R2 ranging between 0.79 to 0.99, all P<0.001) with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement. A qualitative analysis of the onset of the second wave period of the epidemic (August 1 to September 15, 2020) in the same region provided similar results. The daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19, or decide additional social measures.

Emergency calls are early indicators of ICU bed requirement during the COVID-19 epidemic A retrospective study in Ile-de-France region, France

2020 ◽  
Author(s):  
Frédéric Adnet ◽  
Marin Boyet ◽  
Jean-Jacques Avrane ◽  
Frédéric Batteux ◽  
Pierre-Yves Boëlle ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Admissions ◽  
Rt Pcr ◽  
Icu Patients ◽  
Health Authorities ◽  
Ed Visits ◽  
Polymerase Chain ◽  
Telephone Calls ◽  
Gp Visits ◽  
Second Wave

Abstract Background The aim of our retrospective study was to evaluate the earliest COVID19-related signal to anticipate requirements of intensive care unit (ICU) beds. Although the number of ICU beds is crucial during the COVID-19 epidemic, there is no recognized early indicator to anticipate it. Methods In the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient, depending on the number of days the indicator has been shifted. Primary endpoint was the number of ICU patients. Results EMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement. Conclusion The daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19 or decide additional social measures.

scholarly journals Emergency calls are early indicators of ICU bed requirement during the COVID-19 epidemic

2020 ◽  
Author(s):  
◽  
Bruno Riou
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Icu Patients ◽  
Ambulance Dispatch ◽  
Polymerase Chain ◽  
Gp Visits ◽  
Second Wave

AbstractBackgroundAlthough the number of intensive care unit (ICU) beds is crucial during the COVID-19 epidemic caring for the most critically ill infected patients, there is no recognized early indicator to anticipate ICU bed requirements.MethodsIn the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of COVID-19 ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient (R), depending on the number of days the indicator has been shifted. A delay ≥7 days was considered as an early alert, and a delay ≥14 days a very early alert.FindingsEMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement.InterpretationThe daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis in the Ile-de-France region, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19 or decide additional social measures.FundingOnly institutional funding was provided.Research in contextEvidence before the studyWe searched PubMed and preprint archives for articles published up to May 17, 2020, that contained information about the anticipation of intensive care unit (ICU) bed requirement during the COVID-19 outbreak using the terms “coronavirus”, “2009-nCOV”, “COVID-19”, SARS-CoV2”, “prediction” “resource” and “intensive care”. We also reviewed relevant references in retrieved articles and the publicly available publication list of the COVID-19 living systematic review.22 This list contains studies on covid-19 published on PubMed and Embase through Ovid, bioRxiv, and medRxiv, and is continuously updated. Although many studies estimated the number of patients who would have severe COVID-19 requiring ICU, very few contained assessment for early signals (from internet or social media), and we retrieved no study whose data came from suspected or infected patients.Added values of this studyDuring the COVID-19 epidemic, emergency medical system (EMS) calls, percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, ambulance dispatch, emergency department (ED) and general practitioner (GP) visits of COVID-19 patients were strongly associated with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipated COVID-19 ICU bed requirement.Implication of all available evidenceEMS calls and ambulance dispatch, percent of positive RT-PCR, and ED and GP visits could be valuable tools as daily alert signals to set up plan to face the burden of ICU bed requirement during the initial wave of the COVID-19 epidemic, and may possibly also help anticipating a second wave. These results are important since mortality has been reported being correlated to health care resources.

Association of opioid exposure during intensive care unit stays with post-discharge opioid use: A retrospective study and literature review

2021 ◽  
Vol 17 (6) ◽  
pp. 511-516
Author(s):  
Yoonsun Mo, MS, PharmD, BCPS, BCCCP ◽  
John Zeibeq, MD ◽  
Nabil Mesiha, MD ◽  
Abou Bakar, PharmD ◽  
Maram Sarsour, PharmD ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Hospital Discharge ◽  
Invasive Mechanical Ventilation ◽  
High Dose ◽  
Opioid Use ◽  
Electronic Health Record Data ◽  
Icu Patients ◽  
Mechanically Ventilated

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation. Design: A retrospective, observational study.Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.Participants: This study included mechanically ventilated patients requiring continuous opioid infusion from April 25, 2017 to May 16, 2019. Patients were excluded if they received chronic opioid therapy at home or expired during this hospital admission. Eligible patients were identified using an electronic health record data query.Main outcome measure(s): The proportion of ICU patients who continued to require opioids upon ICU and hospital discharge. Results: A total of 196 ICU patients were included in this study. Of these, 22 patients were transferred to a regular floor while receiving a fentanyl transdermal patch. However, the fentanyl patch treatment was continued only for three patients (2 percent) at hospital discharge.Conclusions: This retrospective study suggested that high-dose use of opioids in mechanically ventilated, opioid-naive ICU patients was not associated with continued opioid use upon hospital discharge.

scholarly journals Potential Intensive Care unit Ventilator Demand/Capacity Mismatch due to Novel Swine-Origin H1N1 in Canada

2009 ◽  
Vol 20 (4) ◽  
pp. e115-e123 ◽  
Author(s):  
Paul Smetanin ◽  
David Stiff ◽  
Anand Kumar ◽  
Paul Kobak ◽  
Ryan Zarychanski ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Prevention ◽  
Health Care System ◽  
Attack Rate ◽  
H1n1 Virus ◽  
Prevention Measures ◽  
Icu Patients ◽  
Second Wave

PURPOSE: To investigate the ability of Canadian intensive care units (ICUs) and ventilators to handle widespread re-emergence of the swine-origin H1N1 virus in the context of an aggressive strategy of vaccination.METHOD: Data collected during the first wave in Winnipeg, Manitoba, were applied to a variety of second wave pandemic models to determine potential ICU and ventilator demand.RESULTS: For attack rates greater than 20% to 25%, significant shortages in ventilators may be expected across Canada regardless of the duration of the pandemic if vaccination is not considered. The shortfall arises largely due to the extended durations that patients must remain on ventilation. From the Winnipeg study, 50% of patients required ventilation for more than two weeks. For larger attack rates of 35%, ventilator demand may exceed capacity for over five weeks, with a peak shortfall of 700 ventilators. Vaccination can significantly reduce the attack rates, and is expected to reduce ventilator demand to manageable levelsCONCLUSION: Canada’s health care system must be prepared for the possibility of a significant influx of ICU patients during the second wave of swine-origin H1N1. Efficient vaccination and other disease prevention measures can reduce the attack rate to manageable levels.

scholarly journals Diuretic strategies in patients with resistance to loop-diuretics in the intensive care unit: A retrospective study from the MIMIC-III database

2021 ◽  
Vol 65 ◽  
pp. 282-291
Author(s):  
Jean-Maxime Côté ◽  
Josée Bouchard ◽  
Patrick T. Murray ◽  
William Beaubien-Souligny
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Loop Diuretics ◽  
Mimic Iii

scholarly journals In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 431
Author(s):  
Chun-Fu Lin ◽  
Yi-Syun Huang ◽  
Ming-Ta Tsai ◽  
Kuan-Han Wu ◽  
Chien-Fu Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Regression Analysis ◽  
Intensive Care ◽  
Medical Cost ◽  
Total Medical Cost ◽  
Hospital Outcomes ◽  
Return Visit ◽  
Icu Admission ◽  
Ed Visits

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

scholarly journals Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tessa L. Steel ◽  
Shewit P. Giovanni ◽  
Sarah C. Katsandres ◽  
Shawn M. Cohen ◽  
Kevin B. Stephenson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Alternative Measure ◽  
Icu Patients ◽  
Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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