A National Healthcare Response to Intensive Care Bed Requirements During the COVID-19 Outbreak in France

Lefrant, Jean‐Yves; Fischer, M.; Potier, Hugo; Degryse, C.; Jaber, Samir; Muller, Laurent; Pottecher, Julien; Charboneau, Hélène; Meaudre, Éric; Lanot, Pierre; Bruckert, Vincent; Plaud, Benoît; Bertrand, Denis; Samain, Emmanuel; Bouaziz, Hervé; Ecoffey, Claude; Capdevila, Xavier

doi:10.2139/ssrn.3692545

Cited by 5 publications

(6 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 76%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Moyer

James

Gakuba

et al. 2021

Preprint

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BackgroundEvidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. MethodsThis retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers participating to the TraumaBase® registry in France during the first wave of the SARS-CoV-2 pandemic in France. ResultsOver a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Patient demographics changed substantially during the pandemic and more specifically during the lockdown period specially with a reduction in both absolute numbers admitted and the proportion of road traffic accidents (348 annually 2017-2019 [55.4 % of trauma admissions] vs 143 [36.8 %] in 2020 p<0.005). Mortality during the pandemic period and the difference between predicted and observed mortality was not different compared to the non-pandemic years. ConclusionsDuring this first wave of COVID-19 in France, management of trauma patients admitted to regional Traumacenters was not significantly altered, despite medical resources being reallocated and reorganized. Mortality as well as prehospital and in hospital care remained stable throughout the period of the first pandemic wave despite a massive increase in demand for acute care beds.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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

Moyer

James

Gakuba

et al. 2021

Preprint

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“…The current COVID-19 pandemic has led to a global outbreak of respiratory distress and, subsequently, to an unprecedented demand for mechanical ventilation and critical care. To prevent ICUs from being overwhelmed, many countries created new temporary ICU beds from the existing non-ICU ones [54].…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Kiekkas

Tzenalis

Gklava

et al. 2022

BioMed Research International

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Delayed admission of patients to the intensive care unit (ICU) is increasing worldwide and can be followed by adverse outcomes when critical care treatment is not provided timely. This systematic review and meta-analysis appraised and synthesized the published literature about the association between delayed ICU admission and mortality of adult patients. Articles published from inception up to August 2021 in English-language, peer-reviewed journals indexed in CINAHL, PubMed, Scopus, Cochrane Library, and Web of Science were searched by using key terms. Delayed ICU admission constituted the intervention, while mortality for any predefined time period was the outcome. Risk for bias was evaluated with the Newcastle-Ottawa Scale and additional criteria. Study findings were synthesized qualitatively, while the odds ratios (ORs) for mortality with 95% confidence intervals (CIs) were combined quantitatively. Thirty-four observational studies met inclusion criteria. Risk for bias was low in most studies. Unadjusted mortality was reported in 33 studies and was significantly higher in the delayed ICU admission group in 23 studies. Adjusted mortality was reported in 18 studies, and delayed ICU admission was independently associated with significantly higher mortality in 13 studies. Overall, pooled OR for mortality in case of delayed ICU admission was 1.61 (95% CI 1.44-1.81). Interstudy heterogeneity was high ( I 2 = 66.96 % ). According to subgroup analysis, OR for mortality was remarkably higher in postoperative patients (OR, 2.44, 95% CI 1.49-4.01). These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non-ICU settings.

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“…Some changes to hospital-based care were implemented by healthcare leaders to minimize the spread of the virus, protect healthcare workers, and preserve personal protective equipment 20 . Hospital units previously used for postoperative care were converted to intensive care–capable units and elective surgical and endoscopic procedures were canceled 21 . Healthcare workers may have followed leaders' example by expediting hospital discharges to preserve hospital beds for impending volumes of patients infected with the virus.…”

Section: Discussionmentioning

confidence: 99%

“…20 Hospital units previously used for postoperative care were converted to intensive care-capable units and elective surgical and endoscopic procedures were canceled. 21 Healthcare workers may have followed leaders' example by expediting hospital discharges to preserve hospital beds for impending volumes of patients infected with the virus. Similarly, patients may have requested expedient discharge to minimize their risk of exposure to the virus.…”

Section: Discussionmentioning

confidence: 99%

Hospital Trends of Acute Pancreatitis During the Coronavirus Disease 2019 Pandemic

et al. 2022

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Objective: The coronavirus disease 2019 pandemic led to changes in individuals' behaviors and healthcare delivery. We examined the impact of these changes on the rates and clinical course of acute pancreatitis (AP).Methods: Hospitalizations for AP from March 1 through August 31 in 2019 (baseline group) and the same period in 2020 (pandemic group) were retrospectively reviewed. Univariate and multivariate analyses were used for demographics and outcomes.Results: Two hundred eighty subjects (315 admissions) were identified in 2019 and 237 subjects (264 admissions) in 2020. Subjects in the pandemic group were more likely to have systemic inflammatory response syndrome (40% vs 25%, P < 0.01), pancreatic necrosis (14% vs 10%, P = 0.03), and persistent organ failure (17% vs 9%, P = 0.01) compared with prepandemic. There was no difference in etiology of AP. A multivariable model indicates that increased comorbidities, prior pancreatitis, pancreatic necrosis, and prescription of opiates at discharge were associated with 30-day readmissions during the pandemic.Conclusions: Fewer patients were admitted for AP during the pandemic, suggesting that patients with milder symptoms avoided hospital interaction. Practices followed during the pandemic, especially avoidance of hospitalization and improved efficiency of hospital management, may reduce the burden of pancreatitis care in the future.

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A National Healthcare Response to Intensive Care Bed Requirements During the COVID-19 Outbreak in France

Cited by 5 publications

References 0 publications

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

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

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Hospital Trends of Acute Pancreatitis During the Coronavirus Disease 2019 Pandemic

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