The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists

Hermann, Bertrand; Benghanem, Sarah; Jouan, Youenn; Lafarge, Antoine; Beurton, Alexandra

doi:10.1186/s13613-023-01118-9

Cited by 9 publications

(1 citation statement)

References 151 publications

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“…In recent years, there has been an unprecedented media coverage and visibility of critical care, mainly due to the COVID-19 pandemic [ 1 ]. While survival rates for patients admitted to intensive care units (ICUs) are continuously improving [ 2 ], the quality of survival is commonly suboptimal [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Creating the ICU of the future: patient-centred design to optimise recovery

Tronstad,

Flaws,

Patterson

et al. 2023

Crit Care

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Background Intensive Care survival continues to improve, and the number of ICU services is increasing globally. However, there is a growing awareness of the detrimental impact of the ICU environment on patients, families, and staff. Excessive noise and suboptimal lighting especially have been shown to adversely impact physical and mental recovery during and after an ICU admission. Current ICU designs have not kept up with advances in medical technology and models of care, and there is no current ‘gold-standard’ ICU design. Improvements in ICU designs are needed to optimise care delivery and patient outcomes. Methods This manuscript describes a mixed-methods, multi-staged participatory design project aimed at redesigning and implementing two innovative ICU bedspaces. Guided by the action effect method and the consolidated framework for implementation research, the manuscript describes the processes taken to ensure the patient-centred problems were properly understood, the steps taken to develop and integrate solutions to identified problems, and the process of implementation planning and rebuilding in a live ICU. Results Two innovative ICU bedspaces were rebuilt and implemented. They feature solutions to address all identified problems, including noise reduction, optimisation of lighting, access to nature via digital solutions, and patient connectivity and engagement, with solutions developed from various specialty fields, including IT improvements, technological innovations, and design and architectural solutions. Early evaluation demonstrates an improved lighting and acoustic environment. Conclusions Optimising the ICU bedspace environment and improving the lighting and acoustic environment is possible. The impact on patient outcomes needs to be evaluated.

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Section: Introductionmentioning

confidence: 99%

Creating the ICU of the future: patient-centred design to optimise recovery

Tronstad,

Flaws,

Patterson

et al. 2023

Crit Care

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Use of Rapid Antigen Detection Tests Versus Viral Culture in De-isolation Decision-Making for Critically Ill Patients Infected with Omicron B.1.1.529

Alshukairi

Dada

Aldabbagh

et al. 2023

Dr. Sulaiman Al Habib Med J

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Background COVID-19 vaccination effectively decreased hospitalization and mortality during the surge of infections with the SARS-CoV-2 Omicron variant. However, patients infected with the Omicron variant who did not receive a third COVID-19 vaccine booster often required critical care unit (CCU) admission. The CCU bed utilization of COVID-19 posed a worldwide burden. The decision to stop isolation of patients with COVID-19 in CCUs is challenging, given the variable viral shedding in heterogeneous patient populations. Rapid antigen detection tests (RADTs) have been used in communities to determine patients’ infectiousness and need for quarantine. However, the use of RADTs in the de-isolation of CCU patients had not been studied. Methods Serial RADTs, RT-PCR and viral culturing were performed in a case series of three critically ill patients infected with Omicron variants. Results The duration of infectious viral shedding was 13–46 days post symptom onset (PSO). Concordant negative results were observed between RADTs and viral cultures on D32 PSO in case 1; D13 and D15 PSO in case 2; and D46 and D48 PSO in case 3. In addition, concordant positive results were found between RADTs and viral cultures on D35 PSO in case 2. Significant agreement was observed between RADT and viral culture findings (kappa statistic = 1.0 and p-value = 0.014). Conclusion Given their high positive predictive value with respect to positive viral cultures, RADTs may be a promising and practical tool for ending isolation of patients with COVID-19 and decreasing the burden of CCU bed utilization. Future studies are necessary to confirm our findings.

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Improving The Care of Critically Ill Patients: Lessons Learned from The Promotion of Essential Emergency and Critical Care In Tanzania: A Qualitative Study

Kaliza,

Mlunde,

Schell

et al. 2024

Preprint

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ObjectiveTo describe the lessons learned during the promotion of a new approach to the care of critically ill patients in Tanzania - Essential Emergency and Critical Care (EECC)DesignA descriptive qualitative study using thematic analysis of structured interviewsSetting and ParticipantsThe study was conducted in Tanzania, involving eleven policy makers, researchers and senior clinicians who participated in the promotion of EECC in the country.ResultsThe five thematic lessons that emerged from the promotion of EECC in Tanzania were: (i) ensure early and close collaboration with the government and stakeholders; (ii) conduct research and utilize evidence; (iii) prioritize advocacy and address misconceptions about EECC; (iv) leverage events and embed activities in other health system interventions and (v) employ a multifaceted implementation strategy.ConclusionThe results from this study show the efficacy of a holistic, comprehensive approach in promoting EECC as each strategy reinforces the others. This approach led the to the successful promotion of EECC and the development of a National Strategic Plan for EECC by the government of Tanzania.Article SummaryStrengths and Limitations of this study:StrengthsHigh credibility of findings due to the in-depth qualitative data collection process and the inclusion of diverse participants, which continued until data saturation was reached.Mitigation of personal biases by iterative sharing of findings with participants and key stakeholdersWeaknessesThe purposeful selection of participants may have missed some stakeholders with alternative viewpoints and experiences.We were unable to transcribe the interviews, instead, a codebook and audio recordings were used for cross-referencing which may have led some relevant information being missed.

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The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists

Cited by 9 publications

References 151 publications

Creating the ICU of the future: patient-centred design to optimise recovery

Creating the ICU of the future: patient-centred design to optimise recovery

Use of Rapid Antigen Detection Tests Versus Viral Culture in De-isolation Decision-Making for Critically Ill Patients Infected with Omicron B.1.1.529

Improving The Care of Critically Ill Patients: Lessons Learned from The Promotion of Essential Emergency and Critical Care In Tanzania: A Qualitative Study

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