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. 2021 Mar 12;3(3):e0361.
doi: 10.1097/CCE.0000000000000361. eCollection 2021 Mar.

ICU Bed Utilization During the Coronavirus Disease 2019 Pandemic in a Multistate Analysis-March to June 2020

David J Douin  1 , Michael J Ward  2 , Christopher J Lindsell  2 , Michelle P Howell  1 , Catherine L Hough  3 , Matthew C Exline  4 , Michelle N Gong  5 , Michael S Aboodi  5 , Mark W Tenforde  6 , Leora R Feldstein  6 , William B Stubblefield  2 , Jay S Steingrub  7 , Matthew E Prekker  8 , Samuel M Brown  9 , Ithan D Peltan  9 , Akram Khan  3 , D Clark Files  10 , Kevin W Gibbs  10 , Todd W Rice  2 , Jonathan D Casey  2 , David N Hager  11 , Nida Qadir  12 , Daniel J Henning  13 , Jennifer G Wilson  14 , Manish M Patel  6 , Wesley H Self  2 , Adit A Ginde  1
Affiliations

ICU Bed Utilization During the Coronavirus Disease 2019 Pandemic in a Multistate Analysis-March to June 2020

David J Douin et al. Crit Care Explor. .

Abstract

Objectives: Given finite ICU bed capacity, knowledge of ICU bed utilization during the coronavirus disease 2019 pandemic is critical to ensure future strategies for resource allocation and utilization. We sought to examine ICU census trends in relation to ICU bed capacity during the rapid increase in severe coronavirus disease 2019 cases early during the pandemic.

Design: Observational cohort study.

Setting: Thirteen geographically dispersed academic medical centers in the United States.

Patients/subjects: We obtained daily ICU censuses from March 26 to June 30, 2020, as well as prepandemic ICU bed capacities. The primary outcome was daily census of ICU patients stratified by coronavirus disease 2019 and mechanical ventilation status in relation to ICU capacity.

Interventions: None.

Measurements and main results: Prepandemic overall ICU capacity ranged from 62 to 225 beds (median 109). During the study period, the median daily coronavirus disease 2019 ICU census per hospital ranged from 1 to 84 patients, and the daily ICU census exceeded overall ICU capacity for at least 1 day at five institutions. The number of critically ill patients exceeded ICU capacity for a median (interquartile range) of 17 (12-50) of 97 days at these five sites. All 13 institutions experienced decreases in their noncoronavirus disease ICU population, whereas local coronavirus disease 2019 cases increased. Coronavirus disease 2019 patients reached their greatest proportion of ICU capacity on April 12, 2020, when they accounted for 44% of ICU patients across all participating hospitals. Maximum ICU census ranged from 52% to 289% of overall ICU capacity, with three sites less than 80%, four sites 80-100%, five sites 100-128%, and one site 289%.

Conclusions: From March to June 2020, the coronavirus disease 2019 pandemic led to ICU censuses greater than ICU bed capacity at fives of 13 institutions evaluated. These findings demonstrate the short-term adaptability of U.S. healthcare institutions in redirecting limited resources to accommodate a public health emergency.

Keywords: capacity; coronavirus disease 2019; intensive care unit; mechanical ventilation; resource allocation.

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Conflict of interest statement

Dr. Lindsell reports grants from National Institutes of Health and the Department of Defense and other support from Marcus Foundation, Endpoint Health, Entegrion, bioMerieux, and Bioscape Digital, outside the submitted work. Dr. Brown reports grants from National Institutes of Health, Department of Defense, Intermountain Research and Medical Foundation, and Janssen and consulting fees paid to his employer from Faron and Sedana, outside the submitted work. Dr. Peltan reports grants from the National Institutes of Health, Asahi Kasei Pharma, Immunexpress Inc., Janssen Pharmaceuticals, and Regeneron, outside the submitted work. Dr. Rice reports grants from the National Institutes of Health, personal fees from Cumberland Pharmaceuticals, Inc, Cytovale, Inc, and Avisa, LLC, outside the submitted work. Dr. Henning reports personal fees from CytoVale and grants from Baxter, outside the submitted work. Dr. Self reports research funding for the current work from the Centers for Disease Control and Prevention. Dr. Ginde reports grants from the National Institutes of Health and Department of Defense, outside the submitted work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
ICU census and capacity over time during the early coronavirus disease 2019 (COVID-19) pandemic at Montefiore Medical Center. Seven lines are displayed to illustrate changes in COVID-19 cases over time compared with ICU and medical ICU bed capacity and community COVID-19 case burden. These seven lines include the following: 1) counts of ICU COVID-19 patients on invasive mechanical ventilation (red); 2) counts of ICU COVID-19 patients not on invasive mechanical ventilation (yellow); 3) counts of ICU patients without COVID-19 on invasive mechanical ventilation (dark blue); 4) counts of ICU patients without COVID-19 not on invasive mechanical ventilation (light blue); 5) prepandemic capacity of medical ICU beds (medical ICU capacity; black dashed line); 6) prepandemic capacity of total ICU beds (total ICU capacity; black dotted line); 7) community cases of COVID-19 per 100,000 population in the Bronx County, NY (solid black line; right-sided y-axis). Most of the COVID-19–positive patients requiring ICU admission were intubated. Many other patients who would warrant ICU admission under nonpandemic circumstances, but were not intubated, were cared for in non-ICU settings.
Figure 2.
Figure 2.
ICU census and capacity over time during the early coronavirus disease 2019 (COVID-19) pandemic. Each panel represents one hospital. The four hospitals with the highest median COVID-19–positive ICU census besides Montefiore Medical Center are displayed. For each hospital, seven lines are displayed to illustrate changes in COVID-19 cases over time compared with ICU and medical ICU bed capacity and community COVID-19 case burden. These seven lines include the following: 1) counts of ICU COVID-19 patients on invasive mechanical ventilation (red); 2) counts of ICU COVID-19 patients not on invasive mechanical ventilation (yellow); 3) counts of ICU patients without COVID-19 on invasive mechanical ventilation (dark blue); 4) counts of ICU patients without COVID-19 not on invasive mechanical ventilation (light blue); 5) prepandemic capacity of medical ICU beds (medical ICU capacity; black dashed line); 6) prepandemic capacity of total ICU beds (total ICU capacity; black dotted line); (7) community cases of COVID-19 per 100,000 population in the county surrounding the study hospital (solid black line; right-sided y-axis).
Figure 3.
Figure 3.
ICU census and capacity over time during the early coronavirus disease 2019 (COVID-19) pandemic. Each panel represents one hospital. For each hospital, seven lines are displayed to illustrate changes in COVID-19 cases over time compared with ICU and medical ICU bed capacity and community COVID-19 case burden. These seven lines include the following: 1) counts of ICU COVID-19 patients on invasive mechanical ventilation (red); 2) counts of ICU COVID-19 patients not on invasive mechanical ventilation (yellow); 3) counts of ICU patients without COVID-19 on invasive mechanical ventilation (dark blue); 4) counts of ICU patients without COVID-19 not on invasive mechanical ventilation (light blue); 5) prepandemic capacity of medical ICU beds (medical ICU capacity; black dashed line); 6) prepandemic capacity of total ICU beds (total ICU capacity; black dotted line); 7) community cases of COVID-19 per 100,000 population in the county surrounding the study hospital (solid black line; right-sided y-axis).
Figure 4.
Figure 4.
ICU census and capacity over time during the early coronavirus disease 2019 (COVID-19) pandemic. Each panel represents one hospital. The four hospitals with the lowest median COVID-19–positive ICU census are displayed. For each hospital, seven lines are displayed to illustrate changes in COVID-19 cases over time compared with ICU and medical ICU bed capacity and community COVID-19 case burden. These seven lines include the following: 1) counts of ICU COVID-19 patients on invasive mechanical ventilation (red); 2) counts of ICU COVID-19 patients not on invasive mechanical ventilation (yellow); 3) counts of ICU patients without COVID-19 on invasive mechanical ventilation (dark blue); 4) counts of ICU patients without COVID-19 not on invasive mechanical ventilation (light blue); 5) prepandemic capacity of medical ICU beds (MICU capacity; black dashed line); 6) prepandemic capacity of total ICU beds (total ICU capacity; black dotted line); 7) community cases of COVID-19 per 100,000 population in the county surrounding the study hospital (solid black line; right-sided y-axis). OHSU = Oregon Health & Science University, UCLA = University of California at Los Angeles.
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