Characteristics and Outcomes of COVID-19 Patients Admitted to Intensive Care Units in a Large Health System in Western Pennsylvania

AbstractBackground and objectiveIn March 2020 the SARS-CoV-2 outbreak has been declared as global pandemic. Most countries have implemented numerous “social distancing” measures in order to limit its transmission and control the outbreak. This study aims to describe the impact of these control measures on the spread of the disease for Italy and Germany, forecast the epidemic trend of COVID-19 in both countries and estimate the medical capacity requirements in terms of hospital beds and intensive care units (ICUs) for optimal clinical treatment of severe and critical COVID-19 patients, for the Germany health system.MethodsWe used an exponential decline function to model the trajectory of the daily growth rate of infections in Italy and Germany. A linear regression of the logarithmic growth rate functions of different stages allowed to describe the impact of the “social distancing” measures leading to a faster decline of the growth rate in both countries. We used the linear model to predict the number of diagnosed and fatal COVID-19 cases from April 10th until May 31st. For Germany we estimated the required daily number of hospital beds and intensive care units (ICU) using clinical observations on the average lengths of a hospital stay for the severe and critical COVID-19 patients.ResultsAnalyzing the data from Germany and Italy allowed us to identify changes in the trajectory of the growth rate of infection most likely resulted from the various “social distancing” measures implemented. In Italy a stronger decline in the growth rate was observed around the week of March 17th, whereas for Germany the stronger decline occurred approximately a week later (the week of March 23rd). Under the assumption that the impact of the measures will last, the total size of the outbreak can be estimated to 155,000 cases in Germany (range 140,000-180,000) and to 185,000 cases in Italy (range 175,000-200,000). For Germany the total number of deaths until May 31st is calculated to 3,850 (range 3,500-4,450). Based on the projected number of new COVID-19 cases we expect that the hospital capacity requirements for severe and critical cases in Germany will decline from the 2nd week of April onwards from 13,500 to ∼2500 hospital beds (range 1500-4300) and from 2500 to ∼500 ICU beds in early May (range 300-800).ConclusionsThe modeling effort presented here provides a valuable framework to capture the impact of the “social distancing” measures on the COVID-19 epidemic in European countries and to forecast the future trend of daily COVID-19 cases. It provides a tool for medical authorities in Germany and other countries to help inform the required hospital capacity of the health care system. Germany appears to be in the middle of the (first) COVID-19 outbreak wave and the German health system is well prepared to handle it with the available capacities.

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Assessment of Burnout in Critical Care Physicians Across 23 Intensive Care Units in a Large Health System: A Survey Based Study

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4294 ◽

2019 ◽

Author(s):

G.Z. Zaidi ◽

A. Tsegaye ◽

S. Ahn ◽

M. Narasimhan

Keyword(s):

Critical Care ◽

Intensive Care ◽

Health System ◽

Intensive Care Units ◽

System A

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Trends of vasopressor use in intensive care units in Colombia

Colombian Journal of Anesthesiology ◽

10.5554/22562087.e996 ◽

2021 ◽

Author(s):

Andrés Gaviria-Mendoza ◽

Jorge Enrique Machado-Alba ◽

Juan Felipe Benítez-Mejía ◽

Santiago Correa-Ruiz ◽

Juan Sebastián Restrepo-López ◽

...

Keyword(s):

Intensive Care ◽

Health System ◽

Intensive Care Units ◽

Hospitalized Patients ◽

Population Database ◽

Observational Trial ◽

The Mean ◽

Vasopressor Use

Introduction: Vasopressors are essential in the management of various types of shock. Objective: To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods: Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results: 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions: Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.

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Covid-19 and Other Viruses in Brazil: Can the New Pandemic Influence Epidemiological Records?

10.20944/preprints202005.0138.v1 ◽

2020 ◽

Author(s):

Haniel Fernandes

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Health System ◽

Intensive Care Units ◽

Contaminated Data ◽

Epidemiological Surveys ◽

And Control

Amid the covid-19 pandemic, other diseases, including viruses, are still acting to the detriment of their seasonality and risk factors for contagion. For this reason, it is interesting to know the degree of impact of other viruses, mainly respiratory, in which they have similar symptoms, in diagnoses for contamination by the new coronavirus based on epidemiological surveys, via epidemiological weeks, in Brazil. To what extent there may be a hypothesis of confusion of contaminated data, harming the health system, with regard to the need for intensive care units and control of viruses, and negatively or positively implying in the control or uncontrolling of viruses in general.

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The Palliative Care and Covid-19 Pandemic

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.2861 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 618-622

Author(s):

Mercy B. Joseph ◽

Savita Pohekar ◽

Arati Raut ◽

Manoj Patil

Keyword(s):

Palliative Care ◽

Intensive Care ◽

Health System ◽

Intensive Care Units ◽

Acute Care ◽

Life Quality ◽

Healthcare Systems ◽

Healthcare Personnel ◽

Care Planning ◽

Human Being

During this phase of the COVID-19 pandemic, healthcare systems and healthcare personnel are overwhelmed and are already prepared to treat an influx of patients affected. The corona virus poses an uncertain period of intense acute care crisis where hundreds of thousands of people theoretically could get infected, some fatally, and ten thousands could die. This article addresses the normal palliative care issues — Life quality, comprehensive care planning, Patient discernment preferences, treatment of pain and symptoms, and encouragement for caregivers over prolonged trajectories — seem small and weak in contrast. The use of the particular Palliative care skills and abilities needs to be part of the programme. To agree that death is imminent for any human being should be right for the health system. Extending the dying process in days, weeks, or months against the person’s wish is pointless; it will only prolong the physical and emotional agonies. Individual must be at peace at the end of the life and give as much dignity and comfort as possible, but intensive care units cannot give them the comfort or dignity they deserve. It basically means that all COVID- treating nurses will have expertise in the basics of palliative care, as well as access to opioids for symptoms management like breathlessness.

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Unidades de terapia intensiva no Brasil e a fila única de leitos na pandemia de COVID-19

Enfermagem em Foco ◽

10.21675/2357-707x.2020.v11.n2.esp.4152 ◽

2020 ◽

Vol 11 (2.ESP) ◽

Author(s):

Maria Clara Marques Fagundes ◽

Neyson Pinheiro Freire ◽

Maria Helena Machado ◽

Francisco Rosemiro Guimarães Ximenes Neto

Keyword(s):

Intensive Care ◽

Health System ◽

Intensive Care Units ◽

Rio De Janeiro ◽

Sao Paulo ◽

São Paulo ◽

Mato Grosso ◽

Distrito Federal ◽

Terapia Intensiva ◽

Per Capita

Objetivo: Discutir a proposta de Fila Única nas Unidades de Terapia Intensiva (UTI) durante a pandemia de COVID-19. Método: Pesquisa quantitativa, descritiva, desenvolvida durante os meses de abril a junho de 2020, com buscas de dados em sites oficiais e relatórios institucionais. Resultados: No Brasil, apenas 5,3% dos municípios possuem leitos de UTI. Os estados da região Norte apresentam os menores indicadores de leitos/100 mil habitantes. O Sistema Único de Saúde detém 54,0% dos leitos do país. Nos estados do Rio de Janeiro, Mato Grosso, São Paulo e no Distrito Federal os leitos não SUS predominam. A região Sudeste possui o maior cluster (50,2%) de leitos. Dos 8.980 leitos de UTI COVID-19, 53,8% estão sob a gestão municipal e 46,2% estadual; 37,9% estão na região Sudeste e 29,5% na Nordeste. Conclusões: O colapso do sistema de saúde, projetado por especialistas frente ao avanço da COVID-19, já chegou a alguns estados. A desigualdade no número de leitos per capita entre as redes públicas e privadas dificulta a racionalização dos recursos, sendo observadas também disparidades regionais. A criação de uma “fila única” nas UTI é uma medida necessária para promover um acesso mais equitativo e racionalizar decisões.Descritores: Sistema Único de Saúde; Unidades de Terapia Intensiva; Pandemias; Infecções por Coronavírus; Acesso aos Serviços de Saúde.INTENSIVE CARE UNITS IN BRAZIL AND THE SINGLE QUEUE OF BEDS IN THE COVID-19 PANDEMICObjective: To discuss the proposal for a Single Queue in Intensive Care Units (ICU) during COVID-19 pandemic in Brazil. Method: Quantitative, descriptive research, carried out from April to June 2020, with data searches on official websites and institutional reports. Results: In Brazil, only 5.3% of municipalities have ICU beds. The states of North region have lowest bed indicators/100 thousand inhabitants. Health Unic System holds 54.0% of the country's beds. In states of Rio de Janeiro, Mato Grosso, São Paulo and Federal District, non-HUS beds predominate. The Southeast region has largest cluster (50.2%) of beds. Of 8,980 ICU beds COVID-19, 53.8% are under municipal management and 46.2% state; 37.9% are in Southeast and 29.5% in Northeast. Conclusions: The collapse of health system, designed by specialists in face of advancement of COVID-19, has already reached some states. The inequality in number of beds per capita between public and private networks makes it difficult to rationalize resources, and regional disparities are also observed. The creation of a “single row” in ICU is a necessary measure to promote more equitable access and to rationalize decisions.Descriptors: Unified Health System; Intensive Care Units; Pandemics; Coronavirus Infections; Health Services Accessibility.UNIDADES DE CUIDADO INTENSIVO EN BRASIL Y LA SOLA COLA DE CAMAS EN LA PANDEMIA COVID-19Objetivo: Discutir la propuesta de una Cola Única en Unidades de Cuidados Intensivos (UCI) durante la pandemia de COVID-19 en Brasil. Método: Investigación cuantitativa, descriptiva, realizada de abril a junio de 2020, con búsquedas de datos en sitios web oficiales e informes institucionales. Resultados: En Brasil, solo 5,3% de los municipios tienen camas en UCI. Los estados de la región Norte tienen los indicadores de camas más bajos/100 mil habitantes. Sistema Único de Salud posee el 54.0% de las camas del país. En los estados de Río de Janeiro, Mato Grosso, São Paulo y Distrito Federal, predominan las camas que no son del SUS. La región Sudeste tiene el grupo más grande (50,2%) de camas. De las 8,980 camas de UCI COVID-19, 53.8% están bajo administración municipal y 46.2% estatales; 37.9% están en Sudeste y 29.5% en Noreste. Conclusiones: El colapso del sistema de salud, diseñado por especialistas ante el avance de COVID-19, ya ha llegado a algunos estados. La desigualdad en número de camas per cápita entre las redes públicas y privadas dificulta la racionalización de los recursos, y también se observan disparidades regionales. La creación de una "fila única" en las UCI es una medida necesaria para promover un acceso más equitativo y racionalizar las decisiones.Descriptores: Sistema Único de Salud; Unidades de Cuidados Intensivos; Pandemias; Infecciones por Coronavirus; Accesibilidad a los Servicios de Salud.

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