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Caring for COVID-19 patients through a pandemic in the intensive care setting: a narrative review

Caring for COVID-19 patients through a pandemic in the intensive care setting: a narrative review
Caring for COVID-19 patients through a pandemic in the intensive care setting: a narrative review
Since the declaration of the novel SARS-CoV-2 virus pandemic, health systems/ health-care-workers globally have been overwhelmed by a vast number of COVID-19 related hospitalizations and intensive care unit (ICU) admissions. During the early stages of the pandemic, the lack of formalized evidence-based guidelines in all aspects of patient management was a significant challenge. Coupled with a lack of effective pharmacotherapies resulted in unsatisfactory outcomes in ICU patients. The anticipated increment in ICU surge capacity was staggering, with almost every ICU worldwide being advised to increase their capacity to allow adequate care provision in response to multiple waves of the pandemic. This increase in surge capacity required advanced planning and reassessments at every stage, taking advantage of experienced gained in combination with emerging evidence. In University Hospital Southampton General Intensive Care Unit (GICU), despite the initial lack of national and international guidance, we enhanced our ICU capacity and developed local guidance on all aspects of care to address the rapid demand from the increasing COVID-19 admissions. The main element of this success was a multidisciplinary team approach intertwined with equipment and infrastructural reorganization. This narrative review provides an insight into the approach adopted by our center to manage patients with COVID-19 critical illness, exploring the initial planning process, including contingency preparations to accommodate (360% capacity increment) and adaptation of our management pathways as more evidence emerged throughout the pandemic to provide the most appropriate levels of care to our patients. We hope our experience will benefit other intensive care units worldwide. This article is categorized under: Infectious Diseases > Genetics/Genomics/Epigenetics.
COVID-19, critical care, planning, surge capacity, training
2692-9368
Dushianthan, Ahilanadan
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Griffiths, Melanie
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Hall, Fiona
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Nolan, Kathleen
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Richardson, Dominic
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Skinner, Benjamin
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Matthews, Lewis
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Charles, David
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Elsheikh, Razaz
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Pignatari, Renato
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Rahman, Rezaur
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Theivendrampillai, Shenthiuiyan
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Egglestone, Rebecca
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Stokes, Aaron
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Danibenvenutti, Giovani
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Stewart, Michael
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Celinski, Michael
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Cusack, Rebecca
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Gupta, Sanjay
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Saeed, Kordo
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et al.
Dushianthan, Ahilanadan
013692a2-cf26-4278-80bd-9d8fcdb17751
Griffiths, Melanie
3ef3d6e9-64f2-4a49-8fee-ca0711bc8dcf
Hall, Fiona
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Nolan, Kathleen
bb292810-9276-4f26-8e03-8a26a02ff028
Richardson, Dominic
7cd9c5ab-76ed-4310-b1c8-531711c55cc7
Skinner, Benjamin
0bc5553d-5f76-47ab-b4a6-42d6a26083b6
Matthews, Lewis
81327a4c-b2a8-44f9-b5b2-fc04f856a930
Charles, David
4c08fc1f-6b79-4bc7-9542-634798faeff8
Elsheikh, Razaz
4a17db52-9bd4-4f69-b161-179633454133
Pignatari, Renato
1498e256-8c84-4abc-a1f2-ae4d0fed99cb
Rahman, Rezaur
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Theivendrampillai, Shenthiuiyan
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Egglestone, Rebecca
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Stokes, Aaron
fbc188f9-5914-4c4e-bdc1-c487baa32045
Danibenvenutti, Giovani
4c446890-844b-47bf-ab36-8eeb47013c53
Stewart, Michael
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Celinski, Michael
f5ddadb6-e935-476c-ab46-0423a031a83b
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Gupta, Sanjay
3eae7ae7-8915-4c1f-8f28-2882160b9a62
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39

Dushianthan, Ahilanadan, Griffiths, Melanie and Hall, Fiona , et al. (2022) Caring for COVID-19 patients through a pandemic in the intensive care setting: a narrative review. WIREs mechanisms of disease, 14 (6), [e1577]. (doi:10.1002/wsbm.1577).

Record type: Review

Abstract

Since the declaration of the novel SARS-CoV-2 virus pandemic, health systems/ health-care-workers globally have been overwhelmed by a vast number of COVID-19 related hospitalizations and intensive care unit (ICU) admissions. During the early stages of the pandemic, the lack of formalized evidence-based guidelines in all aspects of patient management was a significant challenge. Coupled with a lack of effective pharmacotherapies resulted in unsatisfactory outcomes in ICU patients. The anticipated increment in ICU surge capacity was staggering, with almost every ICU worldwide being advised to increase their capacity to allow adequate care provision in response to multiple waves of the pandemic. This increase in surge capacity required advanced planning and reassessments at every stage, taking advantage of experienced gained in combination with emerging evidence. In University Hospital Southampton General Intensive Care Unit (GICU), despite the initial lack of national and international guidance, we enhanced our ICU capacity and developed local guidance on all aspects of care to address the rapid demand from the increasing COVID-19 admissions. The main element of this success was a multidisciplinary team approach intertwined with equipment and infrastructural reorganization. This narrative review provides an insight into the approach adopted by our center to manage patients with COVID-19 critical illness, exploring the initial planning process, including contingency preparations to accommodate (360% capacity increment) and adaptation of our management pathways as more evidence emerged throughout the pandemic to provide the most appropriate levels of care to our patients. We hope our experience will benefit other intensive care units worldwide. This article is categorized under: Infectious Diseases > Genetics/Genomics/Epigenetics.

This record has no associated files available for download.

More information

e-pub ahead of print date: 14 July 2022
Published date: 1 November 2022
Additional Information: Funding Information: Authors would like to thank the following groups and staff in non-COVID intensive care units including cardiac, neuro and pediatric intensive cares, staff in emergency medicine and admission units including point of care team. We also would like to thank all laboratory staff, physiotherapy, radiology, orthopedics, general medicine, anesthetics, palliative care teams, pharmacy colleagues, IT department, human resources, REACT-COVID-19 study team, Research and Development, infection prevention teams, managers, patients, relatives, and everyone who supported us through those challenging times. Publisher Copyright: © 2022 Wiley Periodicals LLC.
Keywords: COVID-19, critical care, planning, surge capacity, training

Identifiers

Local EPrints ID: 476494
URI: http://eprints.soton.ac.uk/id/eprint/476494
ISSN: 2692-9368
PURE UUID: e34654b2-3a44-4ac1-b573-85289a57f0b0
ORCID for Ahilanadan Dushianthan: ORCID iD orcid.org/0000-0002-0165-3359
ORCID for Rebecca Cusack: ORCID iD orcid.org/0000-0003-2863-2870
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

Catalogue record

Date deposited: 03 May 2023 18:05
Last modified: 08 Oct 2024 01:59

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Contributors

Author: Ahilanadan Dushianthan ORCID iD
Author: Melanie Griffiths
Author: Fiona Hall
Author: Kathleen Nolan
Author: Dominic Richardson
Author: Benjamin Skinner
Author: Lewis Matthews
Author: David Charles
Author: Razaz Elsheikh
Author: Renato Pignatari
Author: Rezaur Rahman
Author: Shenthiuiyan Theivendrampillai
Author: Rebecca Egglestone
Author: Aaron Stokes
Author: Giovani Danibenvenutti
Author: Michael Stewart
Author: Michael Celinski
Author: Rebecca Cusack ORCID iD
Author: Sanjay Gupta
Author: Kordo Saeed ORCID iD
Corporate Author: et al.

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