Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital
Background: The COVID-19 pandemic has strained ICUs worldwide. To learn from our experience, we described the critical care response to the outbreak. Methods: This is a case study of the response of the Intensive Care Department (75-bed capacity) at a tertiary-care hospital to COVID-19 pandemic, whi...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-11-01
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| Series: | Journal of Infection and Public Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034121003087 |
| _version_ | 1818602491043905536 |
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| author | Hasan M. Al-Dorzi Abdulaziz S. Aldawood Amal Almatrood Victoria Burrows Brintha Naidu John D. Alchin Haifaa Alhumedi Nabeeha Tashkandi Hamdan Al-Jahdali Arif Hussain Mohammed K. Al Harbi Muayed Al Zaibag Salih Bin Salih Majid M. Al Shamrani Abdulmohsen Alsaawi Yaseen M. Arabi |
| author_facet | Hasan M. Al-Dorzi Abdulaziz S. Aldawood Amal Almatrood Victoria Burrows Brintha Naidu John D. Alchin Haifaa Alhumedi Nabeeha Tashkandi Hamdan Al-Jahdali Arif Hussain Mohammed K. Al Harbi Muayed Al Zaibag Salih Bin Salih Majid M. Al Shamrani Abdulmohsen Alsaawi Yaseen M. Arabi |
| author_sort | Hasan M. Al-Dorzi |
| collection | DOAJ |
| description | Background: The COVID-19 pandemic has strained ICUs worldwide. To learn from our experience, we described the critical care response to the outbreak. Methods: This is a case study of the response of the Intensive Care Department (75-bed capacity) at a tertiary-care hospital to COVID-19 pandemic, which resulted in a high number of critically ill patients. Results: Between March 1 and July 31, 2020, 822 patients were admitted to the adult non-cardiac ICUs with suspected (72%)/confirmed (38%) COVID-19. At the peak of the surge, 125 critically ill patients with COVID-19 were managed on single day. To accommodate these numbers, the bed capacity of 4 ICUs was increased internally from 58 to 71 beds (+40%) by cohorting 2 patients/room in selected rooms; forty additional ICUs beds were created in 2 general wards; one cardiac ICU was converted to managed non-COVID-19 general ICU patients and one ward was used as a stepdown for COVID-19 patients. To manage respiratory failure, 53 new ICU ventilators, 90 helmets for non-invasive ventilation and 47 high-flow nasal cannula machines were added to the existing capacity. Dedicated medical teams cared for the COVID-19 patients to prevent cross-contamination. The nurse-to-patient and RT-to-patient ratio remained mostly 1:1 and 1:6, respectively. One-hundred-ten ward nurses were up-skilled to care for COVID-19 and other ICU patients using tiered staffing model. Daily executive rounds were conducted to identify patients for transfer and at least 10 beds were made available for new COVID-19 admissions/day. The consumption of PPE increased multiple fold compared with the period preceding the pandemic. Regular family visits were not allowed and families were updated daily by videoconferencing and phone calls. Conclusions: Our ICU response to the COVID-19 pandemic required almost doubling ICU bed capacity and changing multiple aspects of ICU workflow to be able to care for high numbers of affected patients. |
| first_indexed | 2024-12-16T13:08:07Z |
| format | Article |
| id | doaj.art-9249bd7ab1404a8eb77f291425070181 |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-12-16T13:08:07Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-9249bd7ab1404a8eb77f2914250701812022-12-21T22:30:42ZengElsevierJournal of Infection and Public Health1876-03412021-11-01141116351641Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospitalHasan M. Al-Dorzi0Abdulaziz S. Aldawood1Amal Almatrood2Victoria Burrows3Brintha Naidu4John D. Alchin5Haifaa Alhumedi6Nabeeha Tashkandi7Hamdan Al-Jahdali8Arif Hussain9Mohammed K. Al Harbi10Muayed Al Zaibag11Salih Bin Salih12Majid M. Al Shamrani13Abdulmohsen Alsaawi14Yaseen M. Arabi15College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaNursing Services/Critical Care, King Abdulaziz Medical City, Riyadh, Saudi ArabiaNursing Services/Critical Care, King Abdulaziz Medical City, Riyadh, Saudi ArabiaNursing Services/Critical Care, King Abdulaziz Medical City, Riyadh, Saudi ArabiaNursing Services/Critical Care, King Abdulaziz Medical City, Riyadh, Saudi ArabiaNursing Services/Critical Care, King Abdulaziz Medical City, Riyadh, Saudi ArabiaNursing Services/Critical Care, King Abdulaziz Medical City, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Medicine, Division of Pulmonology, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Cardiac Sciences Department, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Anaesthesia, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Cardiac Sciences Department, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Infection Prevention and Control Program, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Medical Services, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, Riyadh, Saudi Arabia; Corresponding author at: College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard — Health Affairs, ICU 1425 PO Box 22490, Riyadh, 11426, Saudi Arabia.Background: The COVID-19 pandemic has strained ICUs worldwide. To learn from our experience, we described the critical care response to the outbreak. Methods: This is a case study of the response of the Intensive Care Department (75-bed capacity) at a tertiary-care hospital to COVID-19 pandemic, which resulted in a high number of critically ill patients. Results: Between March 1 and July 31, 2020, 822 patients were admitted to the adult non-cardiac ICUs with suspected (72%)/confirmed (38%) COVID-19. At the peak of the surge, 125 critically ill patients with COVID-19 were managed on single day. To accommodate these numbers, the bed capacity of 4 ICUs was increased internally from 58 to 71 beds (+40%) by cohorting 2 patients/room in selected rooms; forty additional ICUs beds were created in 2 general wards; one cardiac ICU was converted to managed non-COVID-19 general ICU patients and one ward was used as a stepdown for COVID-19 patients. To manage respiratory failure, 53 new ICU ventilators, 90 helmets for non-invasive ventilation and 47 high-flow nasal cannula machines were added to the existing capacity. Dedicated medical teams cared for the COVID-19 patients to prevent cross-contamination. The nurse-to-patient and RT-to-patient ratio remained mostly 1:1 and 1:6, respectively. One-hundred-ten ward nurses were up-skilled to care for COVID-19 and other ICU patients using tiered staffing model. Daily executive rounds were conducted to identify patients for transfer and at least 10 beds were made available for new COVID-19 admissions/day. The consumption of PPE increased multiple fold compared with the period preceding the pandemic. Regular family visits were not allowed and families were updated daily by videoconferencing and phone calls. Conclusions: Our ICU response to the COVID-19 pandemic required almost doubling ICU bed capacity and changing multiple aspects of ICU workflow to be able to care for high numbers of affected patients.http://www.sciencedirect.com/science/article/pii/S1876034121003087Severe acute respiratory infectionCOVID-19Saudi ArabiaCritical careDisease outbreakDisaster planning |
| spellingShingle | Hasan M. Al-Dorzi Abdulaziz S. Aldawood Amal Almatrood Victoria Burrows Brintha Naidu John D. Alchin Haifaa Alhumedi Nabeeha Tashkandi Hamdan Al-Jahdali Arif Hussain Mohammed K. Al Harbi Muayed Al Zaibag Salih Bin Salih Majid M. Al Shamrani Abdulmohsen Alsaawi Yaseen M. Arabi Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital Journal of Infection and Public Health Severe acute respiratory infection COVID-19 Saudi Arabia Critical care Disease outbreak Disaster planning |
| title | Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital |
| title_full | Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital |
| title_fullStr | Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital |
| title_full_unstemmed | Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital |
| title_short | Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital |
| title_sort | managing critical care during covid 19 pandemic the experience of an icu of a tertiary care hospital |
| topic | Severe acute respiratory infection COVID-19 Saudi Arabia Critical care Disease outbreak Disaster planning |
| url | http://www.sciencedirect.com/science/article/pii/S1876034121003087 |
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