Maintenance of the critical care system during the pandemic in non-COVID-19 patients requiring continuous renal replacement therapy: a single center experience

Abstract

Background: During the COVID-19 pandemic, maintenance of essential healthcare systems became very challenging. We describe the triage system of our institute, and assess the quality of care provided to critically ill non-COVID-19 patients requiring continuous renal replacement therapy (CRRT) during the pandemic.

Methods: We introduced an emergency triage pathway early in the pandemic. We retrospectively reviewed the medical records of patients who received CRRT in our hospital from January 2016 to March 2021. We excluded end-stage kidney disease patients on maintenance dialysis. Patients were stratified as medical and surgical patients. The time from hospital arrival to intensive care unit (ICU) admission, the time from hospital arrival to intervention/operation, and the in-hospital mortality rate were compared before (January 2016 to December 2019) and during (January 2021 to March 2021) the pandemic.

Results: The mean number of critically ill patients who received CRRT annually in the surgical department significantly decreased during the pandemic in (2016-2019: 76.5 ± 3.1; 2020: 56; p < 0.010). Age, sex, and the severity of disease at admission did not change, whereas the proportions of medical patients with diabetes (before: 44.4%; after: 56.5; p < 0.005) and cancer (before: 19.4%; after: 32.3%; p < 0.001) increased during the pandemic. The time from hospital arrival to ICU admission and the time from hospital arrival to intervention/operation did not change. During the pandemic, 59.6% of surgical patients received interventions/operations within 6 hours of hospital arrival. In Cox's proportional hazard modeling, the hazard ratio associated with the pandemic was 1.002 (0.778-1.292) for medical patients and 1.178 (0.783-1.772) for surgical patients.

Conclusion: Our triage system maintained the care required by critically ill non-COVID-19 patients undergoing CRRT at our institution.

Keywords: COVID-19 pandemic; Continuous renal replacement therapy; Critical care; Essential healthcare system; Health care system; Triage system.

Fig. 1

Flow chart showing our management of new, critically ill patients during the COVID-19 pandemic: ER, emergency room; ICU, intensive care unit; CT, computed tomography; PPE, personal protection equipment

Fig. 2

A consort diagram of the included patients

Fig. 3

A The average monthly numbers of patients receiving continuous renal replacement therapy before and during the pandemic, stratified by the department of care. Blue line: before the pandemic; red line: during the pandemic. B The intensive care unit admission routes before and during the pandemic, stratified by the department of care. Navy line: admitted via the emergency department; orange line: transferred from other hospitals; green line: admitted via our outpatient department

Fig. 4

The numbers of interventions/surgeries implemented over time before and during the pandemic. Black: within 1 h of hospital arrival; dark gray: within 1 to 3 h; mid-gray: within 3 to 6 h; light gray: within 6 to 24 h; olive green: after 24 h