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. 2022 Apr 26;12(1):37.
doi: 10.1186/s13613-022-01011-x.

The resilient intensive care unit

Jorge I F Salluh  1   2 , Pedro Kurtz  1   3   4 , Leonardo S L Bastos  5 , Amanda Quintairos  6   7 , Fernando G Zampieri  1   8 , Fernando A Bozza  1   9
Affiliations

The resilient intensive care unit

Jorge I F Salluh et al. Ann Intensive Care. .

Abstract

Background: The COVID-19 pandemic tested the capacity of intensive care units (ICU) to respond to a crisis and demonstrated their fragility. Unsurprisingly, higher than usual mortality rates, lengths of stay (LOS), and ICU-acquired complications occurred during the pandemic. However, worse outcomes were not universal nor constant across ICUs and significant variation in outcomes was reported, demonstrating that some ICUs could adequately manage the surge of COVID-19.

Methods: In the present editorial, we discuss the concept of a resilient Intensive Care Unit, including which metrics can be used to address the capacity to respond, sustain results and incorporate new practices that lead to improvement.

Results: We believe that a resiliency analysis adds a component of preparedness to the usual ICU performance evaluation and outcomes metrics to be used during the crisis and in regular times.

Conclusions: The COVID-19 pandemic demonstrated the need for a resilient health system. Although this concept has been discussed for health systems, it was not tested in intensive care. Future studies should evaluate this concept to improve ICU organization for standard and pandemic times.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Resilience in Intensive Care Units. In A, we show the proposed framework of evaluating the resiliency of an ICU, based on the four pillars of Hollnagel’s Resilience Assessment Grid (Respond, Learn, Anticipate, and Monitor) and the 4 S (Staff, stuff, space, systems). A resilient ICU should respond to sudden periods of crisis with adequate management of its resources, including the staff wellness and leadership, to provide improved outcomes. Resilience should be maintained by continuously monitoring ICU data (increased volumes, case-mix changes, and outcomes), the learning process based on science, evidence-based practices, clinical research, and effective communication. Finally, a resilient ICU must be prepared to maintain health services outcomes during surge periods with adequate staff training, management of processes of care and ICU resources, thus reducing the impact on clinical and staff outcomes. We show two examples of ICUs resilience expected behaviors, comparing the dynamics of mortality of non-COVID-19 patients (measured in Variable-Life Adjustment Display—VLAD) and the surge of COVID-19 admissions from January to December 2020: the high resilience ICU B shows a steady progression of mortality in non-COVID-19 cases during the pandemic period; whereas in the low resilient ICU C the mortality of non-COVID-19 patients shows high variability, with a decrease in VLAD in the COVID-19 surge peak
See this image and copyright information in PMC

References

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