A national healthcare response to intensive care bed requirements during the COVID-19 outbreak in France

Abstract

Background Whereas 5,415 Intensive Care Unit (ICU) beds were initially available, 7,148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. Results From 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5,054/5,531 (91%) ICU beds. During the outbreak, 4,806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2,283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1,522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9,860, 1,982 and 3,089 ICU, ACU and PACU beds were made available. Before the outbreak, 3,548 physicians (2,224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1,785 residents, 11,023 nurses and 6,763 nursing auxiliaries worked in established ICUs. During the outbreak, 2,524 physicians, 715 residents, 7,722 nurses and 3,043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3,212 new ventilators were added to the 5,997 initially available in ICU. Conclusion During the COVID-19 outbreak, the French Health Care system created 4,806 ICU beds (+ 95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context.

Impact of the SARS-COV-2 Outbreak on Epidemiology and Management of Major Trauma in France: Registry-Based Study. The COVITRAUMA Study

“…In France, the vast majority of designated trauma centers are also the regional referral or tertiary care centers, suggesting a potential competition between patient cohorts for critical care resources. However as demonstrated by Lefrant et al this potential effect was partially compensated by the surge in intensive care beds [16]. Furthermore, the present results document the national lockdown generated a su cient reduction in overall trauma incidence of 43% compared to previous years.…”

“…This may not be the case in a second wave that may require to continue to provide a large spectrum of medical and surgical procedures to maintain the best possible chances for patients not affected by COVID-19 in particular those affected by oncological disease. As stated above, the study by Lefrant et al reports 4,806 newly created ICU beds (+ 95% increase) in France [16]. Without these adjustments, the strain on the trauma care networks could have been far higher and could have altered the level of care provided.…”

Analysis of anaesthesia services to calculate national need and supply of anaesthetics in Switzerland during the COVID-19 pandemic

“…During the first wave of the pandemic in Switzerland, the Swiss Federal Office of Public Health (BAG) prohibited all non-urgent elective surgical cases over a 6 week period in March and April 2020 [ 4 ]. Thereby, resources like staff, mainly specialized nurses and physicians, materials and drugs were shifted from non-COVID-19 to COVID-19 units in order to prevent a bottleneck in these resources–a reaction that happened in most countries [ 5 ]. In the second wave starting end of October 2020 however, no federal restrictions on surgical and anaesthesia activity were passed by law.…”

Maintaining elective surgery capacity while freeing up resuscitation capacity: the challenge of COVID-19 epidemic resumption

“…Availability in the ICU can be increased by postponing elective surgery to limit the need for downstream ICU beds or by temporarily increasing the capacity by using perioperative anaesthesia resources. During the initial French lockdown, all elective operations were postponed, and ICU capacity was temporarily doubled by transforming beds from acute care units or postoperative anaesthetic units 1 . The ongoing postponement of non-essential surgeries worldwide to promote non-surgical care is unprecedented 2 .…”