COVID-19 mortality in ICUs associated with critical care staffing

Xi, Jingjing; Zeng, Lin; Li, Shusheng; Ai, Yuhang; He, Xiangjiu; Kang, Yan; Li, Yimin; Mo, Yanping; Peng, Yue; Qian, Kun; Qin, Bingyu; Wang, Chunting; Yan, Jing; Zhou, Fachun; Zhang, Hua; Ma, Pan

doi:10.1093/burnst/tkab006

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…In non‐COVID settings, appropriate nurse and physician staffing levels have been shown to reduce the mortality rate 15–19 . Although there is scarce international evidence regarding the relationship of staffing with COVID‐19‐related mortality, it points to the same direction 20 …”

Section: Discussionmentioning

confidence: 99%

Factors related to COVID‐19 mortality among three Swedish intensive care units—A retrospective study

Taxbro

Hammarskjöld

Nilsson

et al. 2023

Acta Anaesthesiol Scand

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Background: Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with coronavirus disease-19 (COVID-19) differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden.Methods: We retrospectively analyzed ICU patients with COVID-19 and AHRF in Region Jönköping County, Sweden. The primary outcome was the 90-day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes.

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Section: Discussionmentioning

confidence: 99%

Factors related to COVID‐19 mortality among three Swedish intensive care units—A retrospective study

Taxbro

Hammarskjöld

Nilsson

et al. 2023

Acta Anaesthesiol Scand

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“…Our study is to the best of our knowledge among the rst to evaluate the impact of critical care sta ng on the outcomes of critically ill patients during a pandemic. There have been reports highlighting the importance of the nurse-to-patient ratio on the quality of critical care [37][38][39], but most, if not all of them, had been performed outside pandemic conditions [6,27,40]. Usually, studies compared patient outcomes across ICU centres that are run with different sta ng ratio [41,42].…”

Section: Discussionmentioning

confidence: 99%

“…An increase of either patient-to-nurse ratio or patient-tophysician ratio was associated with worse patient outcomes such as transmission of infections, postoperative complications, including pulmonary failure and reintubation, and increased mortality [21][22][23][24][25][26]. Only few reports evaluated the impact of critical care sta ng on ICU mortality during a pandemic [27]. The goal of the present study was to investigate whether the differences in critical care sta ng resource allocation as well as caseload observed across Swiss ICUs during the rst epidemic wave might have affected COVID-19 patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

Jeitziner

Moser

Wendel-Garcia

et al. 2021

Preprint

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Background The modifications to the standard intensive care unit (ICU) organization that had to be urgently implemented worldwide to overcome the surge of ICU admissions due to patients with a severe coronavirus disease 2019 (COVID-19) have resulted in increased workload and patients-to-nurse ratio. The aim of this study was to investigate whether level of critical care staffing could be associated with an increased risk of ICU mortality (primary endpoint), length of stay, mechanical ventilation and the evolution of disease (secondary study endpoints) in critically ill patients with COVID-19. Methods Retrospective multicenter analysis of the international Risk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry that prospectively enrolls patients developing critical illness due to COVID-19 in several countries worldwide. The analysis was limited to the period between March 1st, 2020 and May 31st, 2020, to ICUs in Switzerland that have collected additional data on nurse and physician staffing. Hierarchical regression models were used to investigate crude and adjusted effects of critical care staffing ratio on study endpoints. We adjusted for diseases severity and weekly caseload. Results Among the 38 Swiss participating ICUs, 17 recorded critical care staffing information. The study population included 437 patients and 2342 daily assessments of patient-to-nurse/physician ratio. Median of daily patient-to-nurse ratio started at 1.0 ([IQR] 0.5–1.5; calendar week 9) and peaked at 2.4 (IQR 0.4-2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1-5.0; calendar week 9) and peaked at 6.8 (IQR 6.3–7.3; calendar week 19). Neither the patient-to-nurse ratio [adjusted Odds Ratio (OR) 1.28, 95% confidence interval (CI) 0.85–1.94; doubling of ratio] nor the patient-to-physician ratio [adjusted OR 1.08, 95% CI 0.87–1.32; doubling of ratio] was associated with ICU mortality. We found no association of critical care staffing on the investigated secondary study endpoints in adjusted models. COnclusion The Swiss health care system successfully overcame the first wave of the COVID-19 pandemic with regards to the unprecedented demand for ICU treatments. The reduced availability of critical care staffing resources per critically ill patient in Swiss ICUs did not translate in an overall increased risk of mortality.

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“…The burn injury is recognised as an acute disease associated with many systemic disorders, including acute respiratory distress syndrome (ARDS) and blood coagulation, which happens to be major complications in COVID‐19 patients requiring urgent and efficient treatment 9,10 . Recent studies have suggested alarmingly high admission and mortality rates in severe burn patients from the intensive care unit (ICU) during the pandemic of COVID‐19 11,12 . As one of the most immunosuppressed patient groups, severe burn victims are highly susceptible to respiratory viral infections 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Mining the potential therapeutic targets for COVID‐19 infection in patients with severe burn injuries via bioinformatics analysis

Cai

Deng

Shi

et al. 2023

International Wound Journal

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The Coronavirus Disease‐19 (COVID‐19) pandemic is posing a serious challenge to human health. Burn victims are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection leading to delayed recovery and even profound debilitation. Nevertheless, the molecular mechanisms underlying COVID‐19 and severe burn are yet to be elucidated. In our work, the differentially expressed genes (DEGs) were identified from GSE157852 and GSE19743, and the common DEGs between COVID‐19 and severe burn were extracted. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein–protein interactions (PPI), gene coexpression network, and multifactor regulatory network analysis of hub genes were carried out. A total of 44 common DEGs were found between COVID‐19 and severe burn. Functional analyses indicated that the pathways of immune regulation and cytokine response participated collectively in the development of severe burn and progression of COVID‐19. Ten significant hub genes were identified, including MERTK, SIRPA, TLR3, ITGB1, DPP4, PTPRC, LY75, IFIT1, IL4R, and CD2. In addition, the gene coexpression network and regulatory network were constructed containing 42 microRNAs (miRNAs) and 2 transcription factors (TFs). Our study showed the shared pathogenic link between COVID‐19 and severe burn. The identified common genes and pivotal pathways pave a new road for future mechanistic researches in severe burn injuries complicated with COVID‐19.

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COVID-19 mortality in ICUs associated with critical care staffing

Cited by 6 publications

References 5 publications

Factors related to COVID‐19 mortality among three Swedish intensive care units—A retrospective study

Factors related to COVID‐19 mortality among three Swedish intensive care units—A retrospective study

Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

Mining the potential therapeutic targets for COVID‐19 infection in patients with severe burn injuries via bioinformatics analysis

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