COVID surge in critical care: admission criteria and drug shortage

Abstract

The health crisis linked to COVID-19 has put the whole hospital in tension. Intensive care units (ICU) have been on the front line to take care of the most serious cases. The number of new admission together with cumulative number of occupied intensive care beds have been and still are a key element in measuring the intensity of the crisis. Intensive care is a specialty largely unknown to the general public which is problematic when dealing with such difficult questions as should we give priority to health or the economy; is there a loss of chance for non-COVID patients?

The increase in the demand for critical care has necessitated an extension of hospitalization capacities by transforming intermediate care beds into ICU beds, by creating neo-ICU, or in some regions by carrying out care in regular wards that are usually performed in ICU ( prone positioning, CPAP, humidified high flow oxygen). Inter-regional but also international transfer has been organized in order alleviating pressure for region with massive surge. 

Among the several limiting factors, human resources with qualified personnel was a key element together the relative shortage of drugs. The mismatch between demand and supply has led to the proposal of rules for prioritizing access to ICU.

This review addresses all of these questions and can contribute to a reflection on the adaptation of the hospital to cope with a second epidemic period.