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French ICUs fight back: An example of regional ICU organisation to tackle the SARS-CoV-2 outbreak

DOI:10.1016/j.accpm.2020.03.018
Authors:
Benjamin Terrasi
Benjamin Terrasi
Benjamin Terrasi
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Emilien Arnaud at Centre Hospitalier Universitaire d'Amiens
Emilien Arnaud
Mathieu Guilbart at Centre Hospitalier Universitaire d'Amiens
Mathieu Guilbart
Patricia Besserve
Patricia Besserve
Patricia Besserve
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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Letter
to
the
Editor
French
ICUs
fight
back:
An
example
of
regional
ICU
organisation
to
tackle
the
SARS-CoV-2
outbreak
1.
Introduction
Since
the
beginning
of
the
SARS-CoV-2
(also
called
COVID-19)
outbreak
in
the
Hubei
province
in
China,
half
a
million
people
have
been
infected
and
more
than
25,000
died
worldwide
by
the
end
of
March
2020
[1].
In
Europe,
the
third
most
infected
country
is
France
(after
Italy
and
Spain)
with
more
than
26,000
cases
and
about
1500
deaths
by
the
end
of
the
last
week
of
March
[1].
One
of
the
first
French
regions
hit
by
the
outbreak
was
Picardy,
located
at
the
northeast
of
the
country.
The
first
case
in
Picardy
was
diagnosed
on
February
26
th
,
2020
in
the
Cardiac
Thoracic
and
Respiratory
ICU
of
the
Amiens-Picardy
University
Hospital.
The
number
of
patients
admitted
to
the
region’s
ICUs
rapidly
increased
after
that
first
case.
To
tackle
this
surge,
an
organisation
was
set
in
order
to
coordinate
and
facilitate
the
admission
of
critically
ill
COVID-19
infected
patients,
and
to
avoid
or
at
least
delay
the
overrun
of
ICU
capacities
in
the
region.
The
organisation
has
been
based
on
a
centralised
on-call
dispatch
ICU
consultant
and
efficient
bed
manager
software.
2.
ICU
bed
management
in
Picardy
The
Picardy
sub-region
is
situated
in
the
northern
part
of
France.
Picardy
has
about
2
million
inhabitants
on
19,399
km
2
.
There
are
about
26
public
hospitals
and
19
private
hospitals,
for
a
total
number
of
128
ICU
beds
and
154
post
ICU
beds
[2].
There
is
only
one
tertiary
teaching
hospital:
the
Amiens-Picardy
University
hospital
(CHU
Amiens-Picardie).
To
tackle
the
outbreak,
the
number
of
ICU
beds
doubled
in
less
than
two
weeks
in
these
public
and
private
hospitals.
3.
French
anaesthesiologists
are
also
intensivists
In
France,
all
anaesthesiologists
are
at
the
same
time
intensivists.
Indeed,
anaesthesia
residents
receive
ICU
training
for
at
least
one
and
a
half
year,
and
the
majority
of
French
ICUs
are
managed
by
anaesthesiologists.
After
the
start
of
the
COVID-19
outbreak,
all
non-urgent
surgery
operations
were
delayed.
Hence,
anaesthesiologists
and
anaesthesia
residents
of
Picardy
who
worked
in
operating
theatres
were
made
available
for
ICUs.
Specially
trained
staff
was
immediately
ready
for
the
regional
increase
of
ICU
capacity.
4.
24-h
on-call
regional
ICU
dispatcher
An
ICU
consultant
from
the
Amiens
University
hospital
was
designated
to
centralise
all
calls
from
emergency
departments,
wards,
and
remote
ICUs
of
the
region.
A
unique
phone
number
was
created
and
sent
to
all
public
and
private
hospitals.
The
on-call
intensivist
dispatcher
was
available
24
h
a
day,
7
days
a
week.
This
on-call
intensivist
dispatcher
answers
to
phone
calls,
gives
advices
for
patient
management
and
finds
an
available
ICU
bed
if
required.
During
the
first
two
weeks
of
the
outbreak,
the
on-call
intensivist
dispatcher
answered
12
to
15
calls
daily.
5.
Online
ICU
bed
availability
software
In
order
to
accurately
and
timely
dispatch
patients
on
a
regional
level,
the
on-call
regional
intensivist
dispatcher
needs
to
know
precisely
and
timely
the
number
of
available
beds.
For
this
purpose,
a
responsive
web
application
based
on
Spring
Framework
[3]
2.2.2
for
the
backend
API
(Application
Program
Interface)
and
React
[4]
16.12.0
for
the
frontend
UI
(User
Interface)
named
COORD-REA
1
was
created
by
a
consultant
(EA).
It
has
been
packaged
in
a
Docker
image
and
secured
using
Keycloak
1
.
The
software
was
hosted
by
Amiens-Picardy
University
Hospital.
Hence,
the
on-call
regional
intensivist
dispatcher
can
access
in
real
time
to
a
synthesis
of
beds
availability
(Fig.
1)
using
a
web
browser
or
a
smartphone.
The
software
was
shared
online
by
all
ICUs
in
Picardy.
It
was
asked
for
all
ICUs
to
timely
update
the
number
of
available
beds.
All
ICUs
are
divided
in
two
areas,
for
COVID-19
infected
and
non-infected
patients,
respectively.
Hence,
the
on-call
regional
intensivist
dispatcher
was
immediately
able
to
find
an
available
ICU
bed
for
every
patient
in
the
region.
6.
Dedicated
regional
mobile
extracorporeal
membrane
oxygenation
(ECMO)
team
The
cardiac
thoracic
and
respiratory
ICU
of
Amiens
University
hospital,
a
30-bed
facility,
is
the
only
ICU
in
Picardy
with
the
ability
to
initiate
ECMO
therapy.
Since
the
beginning
of
the
outbreak,
a
regional
mobile
ECMO
team
was
created
in
the
Amiens
University
medical
centre.
This
team
is
composed
by
an
intensivist,
a
thoracic
surgeon
and
an
ECMO
specialised
nurse.
The
team
is
24/7
available
for
all
emergency
departments
and
ICUs
of
the
region.
The
team
is
able
to
reach
in
less
than
1
h
all
hospitals
in
the
region.
ECMO
is
initiated
on
site
and
patients
are
retrieved
by
helicopter
or
by
road
to
the
cardiac
thoracic
and
respiratory
ICU
of
Amiens
University
Anaesth
Crit
Care
Pain
Med
xxx
(2020)
xxx–xxx
A
R
T
I
C
L
E
I
N
F
O
Keywords:
SARS-CoV-2
Outbreak
Picardy
ICU
organisation
COVID-19
app
G
Model
ACCPM-639;
No.
of
Pages
3
Please
cite
this
article
in
press
as:
Terrasi
B,
et
al.
French
ICUs
fight
back:
An
example
of
regional
ICU
organisation
to
tackle
the
SARS-
CoV-2
outbreak.
Anaesth
Crit
Care
Pain
Med
(2020),
https://doi.org/10.1016/j.accpm.2020.03.018
https://doi.org/10.1016/j.accpm.2020.03.018
2352-5568/
C
2020
Socie
´te
´franc¸aise
d’anesthe
´sie
et
de
re
´animation
(Sfar).
Published
by
Elsevier
Masson
SAS.
All
rights
reserved.
hospital.
Since
the
beginning
of
the
outbreak,
the
team
received
between
one
and
three
calls
every
day
for
ECMO.
In
two
weeks,
seven
ECMO
therapies
were
initiated
for
patients
with
COVID-19
related
ARDS.
7.
COVID-19
patient’s
management
free
app
With
the
help
of
a
local
private
company
(Come-Scape
1
,
Amiens,
France)
a
free
app
named
‘‘COVID-19
practical
Sheets’’
(COVID-19
Fiches
pratiques)
has
been
designed
[5].
After
creating
a
website
on
Wordpress
1
,
an
extension
was
added
in
order
to
build
a
Progressive
Web
App
(WPA).
This
kind
of
application
allows
a
web
page
to
appear
as
a
mobile
application
combining
functionalities
of
a
modern
web
browser
and
usefulness
of
mobile
phones.
An
ICU
consultant
(BT)
was
dedicated
to
daily
update
all
information
given
on
the
app.
The
app
was
initially
designed
for
anaesthesiologists
and
intensivists
from
Picardy.
However,
72
h
after
its
launch,
more
than
100
000
connections
were
registered,
not
only
from
France
but
also
from
several
French-speaking
countries
in
Europe,
North
Africa
and
North
America.
8.
Conclusion
This
letter
describes
an
example
of
regional
organisation
settled
to
tackle
the
COVID-19
outbreak.
We
advise
our
colleagues
from
all
over
the
world
to
adapt
this
organisation
to
their
area.
Nevertheless,
the
increase
of
patients
with
COVID-19
related
ARDS
may
overrun
ICU
capacity
whatever
the
organisation.
We
are
confident
that
the
commitment
and
seriousness
of
ICU
staff
will
prevail.
Disclosure
of
interest
Benjamin
Terrasi
is
an
active
member
of
Come-Scape
1
.
The
other
authors
declare
that
they
have
no
competing
interest.
Fig.
1.
Front
page
of
COORDREA
1
Software
displaying
total
bed
availability
and
details
of
each
ICU
showing
the
number
of
beds
available
for
COVID-19
infected
and
non-
infected
patients
(English
translation).
Letter
to
the
Editor
/
Anaesth
Crit
Care
Pain
Med
xxx
(2020)
xxx–xxx
2
G
Model
ACCPM-639;
No.
of
Pages
3
Please
cite
this
article
in
press
as:
Terrasi
B,
et
al.
French
ICUs
fight
back:
An
example
of
regional
ICU
organisation
to
tackle
the
SARS-
CoV-2
outbreak.
Anaesth
Crit
Care
Pain
Med
(2020),
https://doi.org/10.1016/j.accpm.2020.03.018
Acknowledgment
The
authors
thank
Pr
Herve
´Dupont,
Pr
Vincent
Jounieaux
and
Dr
Genevie
`ve
Barjon
for
their
insight.
References
[1]
John
Hopkins
University
Coronavirus
Resource
Center;
2020,
https://
coronavirus.jhu.edu/map.html/
[accessed
29
March
2020].
[2]
DREES.
Statistique
annuelle
des
e
´tablissements
de
sante
´(SAE);
2020,
https://
www.sae-diffusion.sante.gouv.
fr/sae-diffusion/accueil.html/
[accessed
29
March
2020].
[3]
Johnson
R,
Hoeller
J,
Arendsen
A,
Thomas
R.
Professional
Java
development
with
the
Spring
framework.
Indianapolis:
Wiley;
2009.
[4]
Banks
A,
Porcello
E.
Learning
React:
functional
web
development
with
React
and
Redux.
Sebastopol:
O’Reilly
Media;
2017.
[5]
Covid-19.
Fiches
pratiques;
2020,
https://covid.com-scape.fr/
[accessed
29
March
2020].
Benjamin
Terrasi
a
,
Emilien
Arnaud
b
,
Mathieu
Guilbart
a
,
Patricia
Besserve
a
,
Yazine
Mahjoub
a,
*
a
Department
of
anaesthesia
and
critical
care,
Amiens
University
Hospital,
80054
Amiens,
France
b
Emergency
department,
Amiens
University
Hospital,
80054
Amiens,
France
*Corresponding
author
at:
Service
d’anesthe
´sie-re
´animation,
unite
´de
re
´animation
cardiaque
thoracique
vasculaire
et
respiratoire,
CHU
Amiens-Picardie,
1,
rond
pont
du
professeur
Cabrol,
80054
Amiens
cedex
1,
France
E-mail
address:
mahjoub.yazine@chu-amiens.fr
(Y.
Mahjoub).
Available
online
xxx
Letter
to
the
Editor
/
Anaesth
Crit
Care
Pain
Med
xxx
(2020)
xxx–xxx
3
G
Model
ACCPM-639;
No.
of
Pages
3
Please
cite
this
article
in
press
as:
Terrasi
B,
et
al.
French
ICUs
fight
back:
An
example
of
regional
ICU
organisation
to
tackle
the
SARS-
CoV-2
outbreak.
Anaesth
Crit
Care
Pain
Med
(2020),
https://doi.org/10.1016/j.accpm.2020.03.018
... Some regions organised a daily assessment of regional bed capacity in order to balance ICU admissions over this area [20]. ...
... Third, the COVID-19 outbreak has highlighted the need for more local and regional management of the ICU bed capacity [20] involving both public and private institutions and all physicians implied in the management of the critically ill patients (anaesthesiologists, intensivists, surgeons, and physician involved in Emergency Department and in patient transfer organisation). ...
View
... To prevent ICUs from being overwhelmed, national and regional healthcare institutions (the French Health Ministry and all Regional Health Agencies) decided to increase the availability of ICU beds by creating new temporary ICU beds in institutions that may or may not have had an ICU prior to the outbreak. The availability of ICU beds was assessed daily in each institution and at the regional level to organise, if necessary, potential patient transfers between regional and national hospitals (6)(7)(8). The unprecedented overall mobilisation and joint efforts of various medical, paramedical and administrative staffs enabled caregivers to manage the most serious cases in each ICU (9). ...
... Following the example of Bergamo hospital in Italy, all physicians who could manage ICU patients were involved in dealing with the crisis (10,11). French anaesthesiologists (with a minimum of two years' ICU training during their curriculum) were also involved, since surgical activities were reduced to emergencies and procedures difficult to postpone (such as J o u r n a l P r e -p r o o f cancer) (6,11). On the 8 th of April, thanks to this overall organisation, 7,148 patients were hospitalised in ICU beds, whereas the official national capacity before COVID-19 outbreak was only 5,432 ICU beds (12,13). ...
A National Healthcare Response to Intensive Care Bed Requirements during the COVID-19 Outbreak in France
Article
Full-text available
  • Oct 2020
Background: Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods: All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. Results: Among 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5054/5531 (91%) ICU beds. During the outbreak, 4806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9860, 1982 and 3089 ICU, ACU and PACU beds were made available. Before the outbreak, 3548 physicians (2224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1785 residents, 11,023 nurses and 6763 nursing auxiliaries worked in established ICUs. During the outbreak, 2524 physicians, 715 residents, 7722 nurses and 3043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3212 new ventilators were added to the 5997 initially available in ICU. Conclusion: During the COVID-19 outbreak, the French Health Care system created 4806 ICU beds (+95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context.
View
... American burn centers validated such a system to help prepare for military conflicts or disasters [69]. Similar software proved helpful in managing ICU bed availability during the COVID-19 crisis at the regional level in France [70]. Special attention should then be paid to system robustness and resilience. ...
European Burn Association guidelines for the management of burn mass casualty incidents within a European response plan
Article
Full-text available
Background A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. Methods The European Burn Association’s disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burn Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. Recommendations The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.
View
... The dashboard showed the occupancy of all regional ICUs and the dispatcher could therefore select the most appropriate hospital for all announced COVID-19 patients. 26 In the Netherlands, regional and national coordination networks were set up; the early experiences of the Acute Care Organization in the Amsterdam region have been published earlier. 18 The method of coordination and transfer in the early experiences in Amsterdam was similar to the method reported in the current study. ...
Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic
Article
Full-text available
  • Aug 2022
Introduction The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists. Hypothesis A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity. Methods The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands. Results From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity. Conclusion The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.
View
... Both require regional (indeed national) coordination and planning of patient flow and hospital transfers. For instance, centralized systems that monitor ICU bed availability and triage critically ill patients across hospitals have been rapidly implemented in many regions; transfer of patients by collective air transport and highspeed train, meanwhile, has been used to load balance between regions in Europe (Table 1) (13)(14)(15). In contrast, during surges in many U.S. locales, physicians at overflowing hospitals were often forced to frantically dial every available hospital to find a safer destination for their patients (not always succeeding). ...
View
... Role of the sponsors: none The number of patients admitted to the intensive care units (ICUs) in our tertiary hospital increased dramatically at this time, and forced us to reorganize our regional resources.3,4 By April 21 st , 2020, 81 COVID-19 patients had been admitted to our ICU. ...
Dissociation between the clinical course and chest imaging in severe COVID-19 pneumonia: A series of five cases
Article
Background Although an RT-PCR test is the “gold standard” tool for diagnosing an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), chest imaging can be used to support a diagnosis of coronavirus disease 2019 (COVID-19) – albeit with fairly low specificity. However, if the chest imaging findings do not faithfully reflect the patient's clinical course, one can question the rationale for relying on these imaging data in the diagnosis of COVID-19. Aims To compare clinical courses with changes over time in chest imaging findings among patients admitted to an ICU for severe COVID-19 pneumonia. Methods We retrospectively reviewed the medical charts of all adult patients admitted to our intensive care unit (ICU) between March 1, 2020, and April 15, 2020, for a severe COVID-19 lung infection and who had a positive RT-PCR test. Changes in clinical, laboratory and radiological variables were compared, and patients with discordant changes over time (e.g. a clinical improvement with stable or worse radiological findings) were analyzed further. Results Of the 46 included patients, 5 showed an improvement in their clinical status but not in their chest imaging findings. On admission to the ICU, three of the five were mechanically ventilated and the two others received high-flow oxygen therapy or a non-rebreather mask. Even though the five patients’ radiological findings worsened or remained stable, the mean ± standard deviation partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2:FiO2) ratio increased significantly in all cases (from 113.2 ± 59.7 mmHg at admission to 259.8 ± 59.7 mmHg at a follow-up evaluation; p=0.043). Interpretation Our results suggest that in cases of clinical improvement with worsened or stable chest imaging variables, the PaO2:FiO2 ratio might be a good marker of the resolution of COVID-19-specific pulmonary vascular insult.
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... Ephemeral intensive care units during an exceptional sanitary situation L'anes thésie-réanimation a été confrontée par le passé à différents afflux massifs de patients lors de catastrophes ou d'attentats [1,2] dont les caractéristiques principales étaient leur temporalité courte et leur localisation circonscrite au niveau d'une ville et/ou d'un territoire. Mais lors de la pandémie de COVID-19, la discipline a été confrontée pour la première fois à une situation sanitaire exceptionnelle à l'échelle nationale, voire internationale tant par sa durée que son caractère global [3]. La prise en charge de l'afflux massif de patients relevant de réanimation aiguë n'a été possible qu'au prix d'un travail exemplaire des soignants de première ligne et de la coordination de l'ensemble des acteurs soignants et administratifs des structures hospitalières publiques et privées. ...
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Use of Artificial Intelligence to Manage Patient Flow in Emergency Department during the COVID-19 Pandemic: A Prospective, Single-Center Study
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Full-text available
Background: During the coronavirus disease 2019 (COVID-19) pandemic, calculation of the number of emergency department (ED) beds required for patients with vs. without suspected COVID-19 represented a real public health problem. In France, Amiens Picardy University Hospital (APUH) developed an Artificial Intelligence (AI) project called "Prediction of the Patient Pathway in the Emergency Department" (3P-U) to predict patient outcomes. Materials: Using the 3P-U model, we performed a prospective, single-center study of patients attending APUH's ED in 2020 and 2021. The objective was to determine the minimum and maximum numbers of beds required in real-time, according to the 3P-U model. Results A total of 105,457 patients were included. The area under the receiver operating characteristic curve (AUROC) for the 3P-U was 0.82 for all of the patients and 0.90 for the unambiguous cases. Specifically, 38,353 (36.4%) patients were flagged as "likely to be discharged", 18,815 (17.8%) were flagged as "likely to be admitted", and 48,297 (45.8%) patients could not be flagged. Based on the predicted minimum number of beds (for unambiguous cases only) and the maximum number of beds (all patients), the hospital management coordinated the conversion of wards into dedicated COVID-19 units. Discussion and conclusions: The 3P-U model's AUROC is in the middle of range reported in the literature for similar classifiers. By considering the range of required bed numbers, the waste of resources (e.g., time and beds) could be reduced. The study concludes that the application of AI could help considerably improve the management of hospital resources during global pandemics, such as COVID-19.
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A National Healthcare Response to Intensive Care Bed Requirements During the COVID-19 Outbreak in France
Article
  • Dec 2020
Background: Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods: All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. Results: Among 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5054/5531 (91%) ICU beds. During the outbreak, 4806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9860, 1982 and 3089 ICU, ACU and PACU beds were made available. Before the outbreak, 3548 physicians (2224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1785 residents, 11,023 nurses and 6763 nursing auxiliaries worked in established ICUs. During the outbreak, 2524 physicians, 715 residents, 7722 nurses and 3043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3212 new ventilators were added to the 5997 initially available in ICU. Conclusion: During the COVID-19 outbreak, the French Health Care system created 4806 ICU beds (+95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context. © 2020 Société française d'anesthésie et de réanimation (Sfar)
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Statistique annuelle des é tablissements de santé (SAE)
  • Mar 2020
  • 29
  • Drees
DREES. Statistique annuelle des é tablissements de santé (SAE); 2020, https:// www.sae-diffusion.sante.gouv. fr/sae-diffusion/accueil.html/ [accessed 29 March 2020].
Learning React: functional web development with React and Redux
  • Jan 2017
  • A Banks
  • E Porcello
Banks A, Porcello E. Learning React: functional web development with React and Redux. Sebastopol: O'Reilly Media; 2017.