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Observational Study
. 2012 Jul 9;16(4):R118.
doi: 10.1186/cc11412.

Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic

Jean-Christophe Marie Richard, Tài Pham, Christian Brun-Buisson, Jean Reignier, Alain Mercat, Gaëtan Beduneau, Bernard Régnier, Bruno Mourvillier, Christophe Guitton, Matthias Castanier, Alain Combes, Yves Le Tulzo, Laurent Brochard; REVA study group
Collaborators
Observational Study

Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic

Jean-Christophe Marie Richard et al. Crit Care. .

Abstract

Introduction: The specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs.

Methods: We conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden.

Results: Among the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated in a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. Three hundred ninety-one critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non-University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas.

Conclusions: The peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non-University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.

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Figures

Figure 1
Figure 1
Number of university and non-university hospitals participating in the study and total number of beds of participating intensive care units in the seven 'defense areas'.
Figure 2
Figure 2
Original version of the online registry page dedicated to the screening study for an intensive care unit (ICU) of 10 beds. Each column represents a day of the week, and each line represents a bed of this ICU. Each box of this table gives the birth date and status of the patient occupying this particular bed on this particular day. F, flu; MV, mechanical ventilation; NF, non-flu; SB, spontaneous breathing; 0, unoccupied bed.
Figure 3
Figure 3
Rate of intensive care unit (ICU) bed occupancy by flu-infected patients in the seven 'defense areas'. For each defense area, the table shows the weekly occupancy rate (from week 45 of 2009 to week 3 of 2010) according to the type of ICU (university or non-university) and the rate of ventilated and non-ventilated patients. The black marks indicate the maximal occupancy rate of an ICU of this area.
Figure 4
Figure 4
Comparison of rates of bed occupancy by flu-infected patients (Flu-OR) in university and non-university hospitals after all seven 'defense areas' were pooled together. For each week of the pandemic (from week 45 of 2009 to week 3 of 2010), national Flu-OR of university intensive care units (ICUs) (blue columns) was higher than that of non-university ICUs (red columns). *P < 0.05.
See this image and copyright information in PMC

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