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Journal Article Ppublish 3 citations

PubMed: 38095502 DOI: 10.1097/CCM.0000000000006156

Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study.

Crit Care Med 52(4):574-585

Authors: Sylvia Brinkman, Nicolette F de Keizer, Dylan W de Lange, Dave A Dongelmans, Fabian Termorshuizen, Bas C T van Bussel

Affiliations

  • Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
  • National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands.
  • Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
  • University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands.
  • Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands.
  • Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands.
  • Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
  • Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Abstract

OBJECTIVES

Strain on ICUs during the COVID-19 pandemic required stringent triage at the ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, patient selection, and worse outcome of non-COVID-19 patients, especially during the pandemic peaks when the strain on ICUs was extreme. We analyzed this potential impact on the non-COVID-19 patients.

DESIGN

A national cohort study.

SETTING

Data of 71 Dutch ICUs.

PARTICIPANTS

A total of 120,393 patients in the pandemic non-COVID-19 cohort (from March 1, 2020 to February 28, 2022) and 164,737 patients in the prepandemic cohort (from January 1, 2018 to December 31, 2019).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Volume, patient characteristics, and mortality were compared between the pandemic non-COVID-19 cohort and the prepandemic cohort, focusing on the pandemic period and its peaks, with attention to strata of specific admission types, diagnoses, and severity. The number of admitted non-COVID-19 patients during the pandemic period and its peaks were, respectively, 26.9% and 34.2% lower compared with the prepandemic cohort. The pandemic non-COVID-19 cohort consisted of fewer medical patients (48.1% vs. 50.7%), fewer patients with comorbidities (36.5% vs. 40.6%), and more patients on mechanical ventilation (45.3% vs. 42.4%) and vasoactive medication (44.7% vs. 38.4%) compared with the prepandemic cohort. Case-mix adjusted mortality during the pandemic period and its peaks was higher compared with the prepandemic period, odds ratios were, respectively, 1.08 (95% CI, 1.05-1.11) and 1.10 (95% CI, 1.07-1.13).

CONCLUSIONS

In non-COVID-19 patients the strain on healthcare has driven lower patient volume, selection of fewer comorbid patients who required more intensive support, and a modest increase in the case-mix adjusted mortality.

MeSH

Mortality, Cohort Studies, Pandemics, Beds, Intensive Care Units

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