Preparedness and Reorganization of Care for Coronavirus Disease 2019 Patients in a Swiss ICU: Characteristics and Outcomes of 129 Patients

Abstract

Objectives: In many countries, large numbers of critically ill patients with coronavirus disease 2019 are admitted to the ICUs within a short period of time, overwhelming usual care capacities. Preparedness and reorganization ahead of the wave to increase ICU surge capacity may be associated with favorable outcome. The purpose of this study was to report our experience in terms of ICU organization and anticipation, as well as reporting patient characteristics, treatment, and outcomes.

Design: A prospective observational study.

Setting: The division of intensive care at the Geneva University Hospitals (Geneva, Switzerland).

Patients: All consecutive adult patients with acute respiratory failure due to coronavirus disease 2019 admitted in the ICU between March 9, 2020, and May 19, 2020, were enrolled. Patients' demographic data, comorbidities, laboratory values, treatments, and clinical outcomes were collected.

Interventions: None.

Measurements and main results: The ICU was reorganized into cells of six to eight patients under the care of three physicians and five nurses. Its capacity increased from 30 to 110 beds, fully equipped and staffed, transforming the surgical intermediate care unit, the postoperative care facility, and operating theaters into ICUs. Surge capacity has always exceeded the number of patients hospitalized. Among 129 critically ill patients with severe acute hypoxemic respiratory failure, 96% required invasive mechanical ventilation. A total of 105 patients (81%) were discharged alive and 24 died, corresponding to a mortality of 19%. Patients who died were significantly older, with higher severity scores at admission, had higher levels of d-dimers, plasma creatinine, high-sensitive troponin T, C-reactive protein, and procalcitonin, and required more frequent prone sessions.

Conclusions: A rapid increase in ICU bed capacity, including adequate equipment and staffing, allowed for a large number of critically ill coronavirus disease 2019 patients to be taken care of within a short period of time. Anticipation and preparedness ahead of the wave may account for the low mortality observed in our center. These results highlight the importance of resources management strategy in the context of the ongoing coronavirus disease 2019 pandemic.

Keywords: acute respiratory distress syndrome; coronavirus disease 2019; intensive care unit; mortality; severe acute respiratory syndrome coronavirus 2; surge capacity.

Figure 1.

Shock room with two patients requiring intubation by a dedicated team of intensivists and anesthetists, wearing Tyvek gowns, filter facepiece class 2 masks, gloves, and goggles.

Figure 2.

Cumulative mortality rate within the ICU by time from admission and the cumulative incidence of patients discharged alive from the ICU. The gray line represents the cumulative mortality rate in the ICU by time of admission, and the black line shows the cumulative incidence of patients discharged alive from the ICU.

Figure 3.

Capacity and occupancy of ICU beds by coronavirus disease 2019 patients, and balance of patients with time. A, Capacity and occupancy of ICU beds by coronavirus disease 2019 patients. Navy blue bars represent the actual bed occupancy across time. The light blue area represents the total bed capacity. Total bed capacity constantly exceeded the number of occupied beds. B, Balance (black line) of patients across time between admissions (red bars), patients discharged from the ICU (blue bars), and deaths (gray bars).