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Chew MS, Kattainen S, Haase N, Buanes EA, Kristinsdottir LB, Hofsø K, Laake JH, Kvåle R, Hästbacka J, Reinikainen M, Bendel S, Varpula T, Walther S, Perner A, Flaatten HK, Sigurdsson MI. A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries. Acta Anaesthesiol Scand 2022; 66:56-64. [PMID: 34570897 PMCID: PMC8652908 DOI: 10.1111/aas.13983] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/12/2021] [Indexed: 12/15/2022]
Abstract
Background We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID‐19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID‐19 disease during the first wave of COVID‐19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS‐CoV‐2, the ratio of requiring ICU admission for COVID‐19 varied substantially (1.6%–6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID‐19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%–85%) in all countries, the proportion of patients receiving renal replacement therapy (7%–26%) and various experimental therapies for COVID‐19 disease varied substantially (e.g. use of hydroxychloroquine 0%–85%). Crude ICU mortality ranged from 11% to 33%. Conclusion There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID‐19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.
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Affiliation(s)
- Michelle S. Chew
- Departments of Anaesthesia and Intensive Care Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Salla Kattainen
- Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
- Faculty of Medicine University of Helsinki Helsinki Finland
| | - Nicolai Haase
- Department of Intensive Care Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Eirik A. Buanes
- Norwegian Intensive Care and Pandemic Registry Helse Bergen Health Trust Bergen Norway
| | - Linda B. Kristinsdottir
- Department of Anaesthesiology and Critical Care Perioperative Services Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Kristin Hofsø
- Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
- Lovisenberg Diaconal University College Oslo Norway
| | - Jon Henrik Laake
- Department of Anaesthesiology and Department of Research and Development Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - Reidar Kvåle
- Norwegian Intensive Care RegistryHelse Bergen HF Bergen Norway
- Department of Anesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
- Faculty of Medicine University of Helsinki Helsinki Finland
| | - Matti Reinikainen
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
| | - Stepani Bendel
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
| | - Tero Varpula
- Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
- Faculty of Medicine University of Helsinki Helsinki Finland
| | - Sten Walther
- Swedish Intensive Care RegistryVärmland County Council Karlstad Sweden
- Department of Cardiothoracic and Vascular Surgery Linköping University Hospital Linköping Sweden
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Anders Perner
- Department of Intensive Care Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Hans K. Flaatten
- Norwegian Intensive Care RegistryHelse Bergen HF Bergen Norway
- Department of Anesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Martin I. Sigurdsson
- Department of Anaesthesiology and Critical Care Perioperative Services Landspitali – The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
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Flaatten HK, Haney MF. Improving reporting of ICU outcome data. Acta Anaesthesiol Scand 2020; 64:280-281. [PMID: 31764993 DOI: 10.1111/aas.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hans K. Flaatten
- Department of Anaesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Michael F. Haney
- Anesthesiology and Intensive Care Medicine Umeå University Umeå Sweden
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Petosic A, Sunde K, Beeckman D, Flaatten HK, Wøien H. Use of social media for communicating about critical care topics: A Norwegian cross-sectional survey. Acta Anaesthesiol Scand 2019; 63:1398-1405. [PMID: 31286474 DOI: 10.1111/aas.13449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Social media (SoMe) might be an alternative platform for communicating critical care topics to implement evidence-based practice in the intensive care unit (ICU). This survey aims to describe ICU nurses' and physicians' use of SoMe in general, and their perception of using closed Facebook-groups for receiving content on critical care topics. METHODS A cross-sectional, web-based, anonymous survey was distributed to ICU physicians and nurses in four ICUs in autumn 2017 via an email-campaign. Descriptive statistics with rates, percentages and median numeric rating scale (NRS) scores, interquartile ranges are presented. RESULTS The response-rate was 64% (253/ 394) including 210 nurses and 43 physicians. Overall, 93% had a SoMe-profile, and 77% had a profile on more than one network site. Facebook was the most used social network site, with 87% having a profile. Totally, 68% were daily users, but more nurses used Facebook daily vs physicians (81% vs 60%, respectively, P = 0.006). Nurses were also more positive toward being members of closed Facebook-groups aimed to exchange content on critical care topics (median NRS 9 (6-10) vs 6 (3-9), respectively, P = 0.014). CONCLUSION The majority of ICU nurses and physicians were active SoMe users, mainly for personal purposes, and Facebook was the most popular SoMe. Nurses used Facebook daily more frequent and were more positive toward content on critical care topics on Facebook than physicians. These findings might be relevant to customize future communication about critical care topics via SoMe.
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Affiliation(s)
- Antonija Petosic
- Department of Postoperative and Intensive Care Oslo University Hospital Oslo Norway
- Institute of Health and Society University of Oslo Oslo Norway
| | - Kjetil Sunde
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | | | | | - Hilde Wøien
- Department of Postoperative and Intensive Care Oslo University Hospital Oslo Norway
- Institute of Health and Society University of Oslo Oslo Norway
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Nygård ST, Langeland N, Flaatten HK, Fanebust R, Haugen O, Skrede S. Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital. BMC Infect Dis 2014; 14:121. [PMID: 24588984 PMCID: PMC3975934 DOI: 10.1186/1471-2334-14-121] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 02/21/2014] [Indexed: 01/20/2023] Open
Abstract
Background Severe sepsis is recognized as an inflammatory response causing organ dysfunction in patients with infection. Antimicrobial therapy is the mainstay of treatment. There is an ongoing demand for local surveillance of sepsis aetiology and monitoring of empirical treatment recommendations. The present study was established to describe the characteristics, quality of handling and outcome of patients with severe sepsis admitted to a Norwegian university hospital. Methods A one year prospective, observational study of adult community acquired case-defined severe sepsis was undertaken. Demographics, focus of infection, microbiological findings, timing and adequacy of empirical antimicrobial agents were recorded. Clinical diagnostic practice was evaluated. Differences between categorical groups were analysed with Pearson’s chi-squared test. Predictors of in-hospital mortality were identified in a multivariate stepwise backward logistic regression model. Results In total 220 patients were identified, yielding an estimated annual incidence of 0.5/1000 inhabitants. The focus of infection was established at admission in 69%. Respiratory tract infection was present in 52%, while genitourinary, soft tissue and abdominal infections each were found in 12-14%. Microbiological aetiology was identified in 61%; most prevalent were Streptococcus pneumoniae, Escherichia coli and Staphylococcus aureus. Independent predictors of in-hospital mortality were malignancy, cardiovascular disease, endocarditis, abdominal infections, undefined microbiological aetiology, delay in administration of empirical antimicrobial agents ≥ 6 hours and use of inadequate antimicrobial agents. In patients ≥ 75 years, antimicrobial therapy was less in compliance with current recommendations and more delayed. Conclusions Community acquired severe sepsis is common. Initial clinical aetiology is often revised. Compliance with recommendations for empirical antimicrobial treatment is lowest in elderly patients. Our results emphasizes that quick identification of correct source of infection, proper sampling for microbiological analyses, and fast administration of adequate antimicrobial agents are crucial points in the management of severe sepsis.
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Affiliation(s)
| | | | | | | | | | - Steinar Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway.
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Haug JB, Berild D, Blomberg B, Bruun JN, Flaatten HK, Leiva RA, Skrede S, Torfoss D, Undseth Ø. Aminoglykosider ved alvorlig sepsis. Tidsskriftet 2013; 133:1553-4. [DOI: 10.4045/tidsskr.13.0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Skrede S, Nygård ST, Langeland N, Flaatten HK. Aminoglykosider kan redusere risiko. Tidsskriftet 2013; 133:1554. [DOI: 10.4045/tidsskr.13.0868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Strand K, Walther SM, Reinikainen M, Ala-Kokko T, Nolin T, Martner J, Mussalo P, Søreide E, Flaatten HK. Variations in the length of stay of intensive care unit nonsurvivors in three Scandinavian countries. Crit Care 2010; 14:R175. [PMID: 20920348 PMCID: PMC3219277 DOI: 10.1186/cc9279] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 06/07/2010] [Accepted: 10/04/2010] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The length of stay (LOS) in intensive care unit (ICU) nonsurvivors is not often reported, but represents an important indicator of the use of resources. LOS in ICU nonsurvivors may also be a marker of cultural and organizational differences between units. In this study based on the national intensive care registries in Finland, Sweden, and Norway, we aimed to report intensive care mortality and to document resource use as measured by LOS in ICU nonsurvivors. METHODS Registry data from 53,305 ICU patients in 2006 were merged into a single database. ICU nonsurvivors were analyzed with regard to LOS within subgroups by univariate and multivariate analysis (Cox proportional hazards regression). RESULTS Vital status at ICU discharge was available for 52,255 patients. Overall ICU mortality was 9.1%. Median LOS of the nonsurvivors was 1.3 days in Finland and Sweden, and 1.9 days in Norway. The shortest LOS of the nonsurvivors was found in patients older than 80 years, emergency medical admissions, and the patients with the highest severity of illness. Multivariate analysis confirmed the longer LOS in Norway when corrected for age group, admission category, sex, and type of hospital. LOS in nonsurvivors was found to be inversely related to the severity of illness, as measured by APACHE II and SAPS II. CONCLUSIONS Despite cultural, religious, and educational similarities, significant variations occur in the LOS of ICU nonsurvivors among Finland, Norway, and Sweden. Overall, ICU mortality is low in the Scandinavian countries.
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Affiliation(s)
- Kristian Strand
- Health Services Research Centre, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.
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Abstract
BACKGROUND A high birth rate during the first two decades following World War II has increased the proportion of elderly people in present-day society and, consequently, the demand for health-care services. The impact on intensive care services may become dramatic because the age distribution of critically ill patients is skewed towards the elderly. We have used registry data and population statistics to forecast the demand for intensive care services in Norway up until the year 2025. METHODS Data collected by the Norwegian intensive care registry (NIR), showing the age distribution in Norwegian intensive care units (ICU) during the years 2006 and 2007, were used with three different Norwegian prognostic models of population growth for the years 2008-2025 to compute the expected increase in intensive care unit bed-days (ICU bed-days). RESULTS The elderly were overrepresented in Norwegian ICUs in 2006-2007, with patients from 60 to 79 years of age occupying 44% of ICU bed-days. Population growth from 2008 to 2025 was estimated to be from 11.1 to 26.4%, depending on the model used. Growth will be much larger in the age group 60-79 years. Other factors kept unchanged, this will result in an increase in the need for intensive care (ICU bed-days) of between 26.1 and 36.9%. CONCLUSION The demand for intensive care beds will increase markedly in Norwegian hospitals in the near future. This will have serious implications for the planning of infrastructure, education of health care personnel, as well as financing of our health care system.
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Affiliation(s)
- J H Laake
- Department of Anaesthesia and Intensive Care Medicine, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway.
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Laake JH, Flaatten HK. Influenza and the anaesthesiologist. Acta Anaesthesiol Scand 2010; 54:3-5. [PMID: 19961438 DOI: 10.1111/j.1399-6576.2009.02167.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rubulotta F, Flaatten HK, Capuzzo M. Training for intensive care medicine in Europe: state of the art skills. Minerva Anestesiol 2008; 74:503-505. [PMID: 18464682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Aardal S, Berge K, Breivik K, Flaatten HK. [Medical records, DRG and intensive care patients]. Tidsskr Nor Laegeforen 2005; 125:903-6. [PMID: 15815740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND In order to control the quality of the medical report after a hospital stay with regards to the stay in the intensive care unit (ICU), and to cheque for correct DRG grouping, this study of 428 patients treated in our ICU in 2003 was conducted. MATERIAL AND METHODS All ICU patients from 2003 were found in our database, which includes specific ICD-10 diagnosis and specific ICU procedures. The medical record summarising the hospital stay (epicrisis) was retrieved for each patient from the hospital's electronic patient files and controlled for correct information regarding the ICU stay. DRG groups for each patient were retrieved from the hospital's administrative database. All stays were re-coded, with all information about the ICU stay was also included. The new DRG codes were compared with the old ones, and the difference in DRG points computed. RESULTS The description of the stay in the ICU was missing or very insufficient in 46% of the records. In the DRG control we found that an additional 347.37 DRG points (18.4% of the original sum of all DRG points) were missing, corresponding to a loss to the hospital of 6.2 million NOK. In addition we discovered missing codes for tracheostomy corresponding to 2.8 million NOK, giving a total loss of 9 million NOK. CONCLUSION This study confirms that an adequate description of the stay in the ICU is insufficient in a large number of medical records. This also leads to incorrect DRG grouping of many patients and significant financial losses to the hospital.
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Affiliation(s)
- Sidsel Aardal
- Intensivmedisinsk seksjon, Kirurgisk serviceklinikk, Haukeland Universitetssykehus, 5021 Bergen
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Andersen FA, Guttormsen AB, Flaatten HK. High frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome--a retrospective study. Acta Anaesthesiol Scand 2002; 46:1082-8. [PMID: 12366502 DOI: 10.1034/j.1399-6576.2002.460905.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND At present there are limited data about the effects of high frequency oscillatory ventilation (HFOV) in adult patients with acute respiratory distress syndrome (ARDS). This study evaluates efficacy of HFOV in such patients. METHODS Sixteen ARDS patients, mean age 38.2 years (range 18-76), that underwent HFOV between 1997 and 2001 were enrolled in the study and evaluated in retrospect. FIo2, arterial blood gases, mean airway pressure (mean Paw), blood pressure, heart rate and central venous pressure were recorded by 4, 8, 12, 24, 48 and 72 h of HFOV and compared to conventional mechanical ventilation (CMV) at baseline (4 h prior to HFOV). RESULTS On admission to the ICU, mean Simplified Acute Physiology score (SAPS II) was 40.3 (SD 12.6). Main causes of ARDS were pneumonia (9/16) and burn injuries (4/16). At baseline the patients had severe ARDS as noted by a mean lung injury score (LIS) of 3.2 (SD 0.3) and Pao2/FIo2 ratio 12.2 (SD 3.2) kPa. Within 4 h of HFOV, Pao2/FIo2 increased to 17.3 (SD 5.9) kPa (P = 0.016). Throughout HFOV, Pao2/FIo2 was significantly higher than at baseline. There were no significant changes in haemodynamic parameters. Ending HFOV after 6.6 (SD 3.2) days, survivors (n = 11) significantly reduced their Sequential Organ Failure Assessment Score (SOFA) compared to baseline. Survival at 3 months was 68.8%. CONCLUSION HFOV effectively improves oxygenation without haemodynamic compromise. During HFOV, the SOFA score may predict outcome.
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Affiliation(s)
- F A Andersen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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Abstract
The use of anaesthesiologists in prehospital emergency care is controversial. We wanted to assess the impact of an anaesthesiologist and a short time interval from acceptance of a mission to take-off at survival rates in a rural/urban emergency medical service. Prospectively registered data for 991 consecutive patients through a 12-month period were retrospectively evaluated by an independent foreign expert. Of all primary missions, 3.3% were considered probably lifesaving from site of injury to receiving hospital. Of these, the lifesaving result in 50% were dependent on both the qualifications of the anaesthesiologist and a short response time. Survival from hospital admission to discharge was 44%. All patients were discharged to their own homes, able to live a fully functional life. The consistent use of anaesthesiologists compared to less qualified personnel and the maintaining of response times below presently required minima doubles the potential for lives saved in services comparable to the one studied.
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