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Observational Study
. 2021 Apr 30;47(2):e20200545.
doi: 10.36416/1806-3756/e20200545. eCollection 2021.

Implementation of Tele-ICU during the COVID-19 pandemic

[Article in English, Portuguese]
Bruno Rocha de Macedo  1 , Marcos Vinicius Fernandes Garcia  1 , Michelle Louvaes Garcia  1 , Marcia Volpe  1   2 , Mayson Laércio de Araújo Sousa  1 , Talita Freitas Amaral  1 , Marco Antônio Gutierrez  1 , Antonio Pires Barbosa  1 , Paula Gobi Scudeller  1 , Pedro Caruso  1 , Carlos Roberto Ribeiro Carvalho  1
Affiliations
Observational Study

Implementation of Tele-ICU during the COVID-19 pandemic

[Article in English, Portuguese]
Bruno Rocha de Macedo et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To describe the implementation of a Tele-ICU program during the COVID-19 pandemic, as well as to describe and analyze the results of the first four months of operation of the program.

Methods: This was a descriptive observational study of the implementation of a Tele-ICU program, followed by a retrospective analysis of clinical data of patients with COVID-19 admitted to ICUs between April and July of 2020.

Results: The Tele-ICU program was implemented over a four-week period and proved to be feasible during the pandemic. Participants were trained remotely, and the program had an evidence-based design, the objective being to standardize care for patients with COVID-19. More than 100,000 views were recorded on the free online platforms and the mobile application. During the study period, the cases of 326 patients with COVID-19 were evaluated through the program. The median age was 60 years (IQR, 49-68 years). There was a predominance of males (56%). There was also a high prevalence of hypertension (49.1%) and diabetes mellitus (38.4%). At ICU admission, 83.7% of patients were on invasive mechanical ventilation, with a median PaO2/FiO2 ratio < 150. It was possible to use lung-protective ventilation in 75% of the patients. Overall, in-hospital mortality was 68%, and ICU mortality was 65%.

Conclusions: Our Tele-ICU program provided multidisciplinary training to health care professionals and clinical follow-up for hundreds of critically ill patients. This public health care network initiative was unprecedented and proved to be feasible during the COVID-19 pandemic, encouraging the creation of similar projects that combine evidence-based practices, training, and Tele-ICU.

Objetivo:: Descrever a implantação de um serviço de telemedicina de UTI durante a pandemia de COVID-19, assim como descrever e analisar os resultados dos primeiros quatro meses de funcionamento do programa.

Métodos:: Estudo observacional descritivo da implantação de um serviço de telemedicina de UTI seguido de análise retrospectiva dos dados clínicos de pacientes com COVID-19 internados em UTI entre abril e julho de 2020.

Resultados:: O serviço foi implantado em quatro semanas e mostrou-se viável em meio à pandemia. O treinamento foi desenhado para ser remoto e baseado em evidências, promovendo a padronização do atendimento aos pacientes com COVID-19. Mais de 100.000 visualizações foram registradas nas plataformas on-line de acesso livre e no aplicativo móvel. Durante o período do estudo, os casos de 326 pacientes com COVID-19 foram avaliados no programa. A mediana de idade foi de 60 anos (variação: 49-68 anos). Houve predomínio do sexo masculino (56%) e alta prevalência de hipertensão arterial (49,1%) e diabetes mellitus (38,4%). Na admissão na UTI, 83,7% dos pacientes estavam em ventilação mecânica invasiva, com uma mediana da relação PaO2/FiO2 < 150. Ventilação pulmonar protetora foi possível em 75% dos casos. A mortalidade na UTI foi de 65%, e a mortalidade hospitalar foi de 68%.

Conclusões:: A telemedicina de UTI forneceu treinamento multidisciplinar aos profissionais de saúde e acompanhamento clínico de centenas de pacientes críticos. A iniciativa na rede pública foi pioneira e mostrou-se viável em meio à pandemia de COVID-19, incentivando a criação de projetos semelhantes que combinem práticas baseadas em evidências, treinamento e telemedicina.

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Figures

Figure 1
Figure 1. Flow chart of evaluation via the Tele-ICU program during the study period.
Figure 2
Figure 2. ICU mortality (in A) and overall in-hospital mortality (in B) during the study period.
Figure 3
Figure 3. Length of ICU stay (in A) and length of hospital stay (in B) during the study period.
See this image and copyright information in PMC

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