'Significantly lower probability of death' from severe Covid in ICU than wards

A survey has found that demand for treatment of sever Covid was such that non-specialist staff were given crash courses in ICU care in normal ward settings and had to deliver this specialised care without formal training.

People admitted to ICU with severe Covid-19 had a “significantly lower probability of death” compared to critically ill patients treated on adapted hospital wards because of a shortage of ICU beds, a study in 43 countries, including Ireland, has found.

Irish consultants who contributed to the study published in the ERJ Open Research Journal on Wednesday, said Ireland has one of the lowest critical care beds rates per capita in the world, and called for urgent investment in this area.

In hospitals around the world ICUs quickly filled up as the pandemic worsened meaning severely ill Covid patients had to be treated on ordinary wards using adapted beds. This is still happening in many countries, with the HSE for example regularly reporting patients receiving high-flow oxygen support outside of ICUs.

Demand was such that non-specialist staff were given crash courses in ICU care and had to deliver this specialised care without formal training.

The study looked at the impact for patients, noting an ICU bed is more than just a piece of equipment. The Irish doctors were part of an EU project observing 14,000 patients in 43 countries representing six continents.

This found among severely ill patients the 28-day fatality ratio was lower among patients in ICU than those cared for outside the specialised unit, and patients admitted to an ICU had “a significantly lower probability of death than those who were not”.

The study found severe Covid-19 patients were frequently male, older adults with at least one underlying condition.

Researchers found the overall median length of hospital stay was 10 days and was longer in patients admitted to an ICU than in those that were cared for outside of ICU.

Overwhelmed

Clinical care consultants Professor Ignacio Martin-Loeches and Professor Juan Valverde led the investigation of the impact of the “current overwhelmed ICU situation” in Irish hospitals.

“The severity of the disease and the research conducted in critical care has helped to better understand where we have leaks in the provision of care in severe patients,” Prof Martin-Loeches, School of Medicine, Trinity College said.

“Covid has shown us why critical care is important but critical care cannot be provided anywhere. Critical care is not simply a bed and a ventilator; it needs adequate staff including specialised nurses and doctors and an adequate place to deliver care.” 

Professor Martin-Loeches, also an intensive care consultant at St James’s Hospital is concerned research on the problems in ICUs is “not a part of the national discourse throughout this pandemic” and called for a better understanding of the challenges facing these patients.

“Investment in critical care saves lives,” he said bluntly. “Currently most patients in critical care are unvaccinated, and the system is under pressure. Bed occupancy represents a huge concern. Ireland has one of the lowest critical care beds per capita.” 

Prof Martin-Loeches said investment is needed as he said of the improvisation required in so many Irish hospitals during Covid surges, that “(it) is not a good idea when there is a surge of need in ICU beds.” 

The full study ‘Clinical Characteristics, Risk Factors and Outcomes in Patients with Severe Covid-19 Registered in the ISARIC WHO Clinical Characterisation Protocol’ is online at: https://openres.ersjournals.com/content/early/2021/11/18/23120541.00552-2021