key: cord-1050506-y9kntz3u
authors: Collange, Olivier; Sammour, Yasmine; Soulié, Rodolphe; Castelain, Vincent; Mertes, Paul Michel
title: ICU re-organisation to face the first COVID-19 epidemic wave in a tertiary hospital
date: 2020-10-01
journal: Anaesth Crit Care Pain Med
DOI: 10.1016/j.accpm.2020.09.005
sha: 7b98c9bb10b999201827545fb6b6a943668a95e7
doc_id: 1050506
cord_uid: y9kntz3u

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Olivier COLLANGE 1,2 * olivier.collange@chru-strasbourg.fr, Yasmine SAMMOUR 3 The complex reorganisation process can be summarised in 4 main actions.

Firstly, non-emergency activities were restricted and then stopped. This made it possible to reduce the use of ICU beds for non-urgent care and, above all, reposition medical and nursing staff from the operating theatres to the ICUs. In fact, 7 ICU beds that were closed due to a lack of nursing staff were quickly re-opened.

Secondly, we created 108 new ICU beds by equipping continuous care units with ventilators.

Thirdly, we evacuated 59 patients to other ICUs, in France or other countries.

Fourthly, all ICUs were reorganised, in particular by using the human resources (doctors, Together, these measures helped us keep ahead of the epidemic. This lead was extremely short during the last week of March. At that time, we only had 2 or 3 unoccupied resuscitation beds in the whole facility. This short advance allowed us to avoid the dramatic situation of not being able to provide critical care because of a lack of space in our ICUs. The decrease in non-COVID-19 patients admitted to the ICU also contributed to maintaining a lead over the epidemic. From March 24 to April 15, fewer than 20 ICU beds were occupied by non-COVID-19 patients, a decrease of almost 80% from the usual occupancy rate. Part of this decrease directly reflects the decline in non-emergency activities, particularly surgical activities that usually require ICU hospitalisation (e.g. cardiac surgery). In addition, it is possible that some frail patients who could have benefited from intensive care may not have sought emergency care during this period for fear of being hospitalised in a "COVID-19 hospital". The human cost of these non-hospitalisations has not yet been assessed.

We observed a 20% mortality rate for all ICU COVID-19 patients. This number should be interpreted with caution as 1) we managed the most serious patients and, in particular, those on ECMO (39 patients) in our hospital and 2) patients evacuated to other ICUs were less severely J o u r n a l P r e -p r o o f ill (mortality rate 14%). Nevertheless, this number is similar to that published in Italy where there was a 26% mortality rate (although 54% of the patients were still in the ICU at the time of publication of this article) 1 , in the USA where the ICU mortality rate was 35.4% 2 and in the UK where mortality varied from 29.3% to 41.4%, depending on the use of dexamethasone 3 .

The reorganisation of our hospital has enabled us to stay one step ahead of the epidemic.

Nevertheless, this reorganisation has had other consequences, the significance of which has not yet been fully appreciated. Patients' families had only very restricted access to their loved ones and, in particular, we were unable to accompany the families of deceased patients as we usually do. This example shows that the response to the epidemic led to working conditions that were sometimes degraded compared to the high-quality standards with which we usually expect to work.

The authors have no conflict of interest to disclose related to this topic.

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region

Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report

We thank Professor Francis Schneider, Professor Eric Noll and Professor Julien Pottecher for their work and useful discussions.