Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France

Annals of Intensive Care

Louis Soulat¹  Stephane Ehrmann²  Hélène Messet³  Maeva Rodriguez⁴  Arnaud W. Thille⁴  Delphine Chatellier⁴  Thomas Lebouvier⁵  Benoit Painvin⁶  Jean-Marc Tadie⁷  Arnaud Gacouin⁷ 

[1] Service Samu-Smur-Urgences médico-chirurgicales adultes, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France;Service de Médecine Intensive et Réanimation, CIC INSERM 1415, CRICS-Triggersep Research Network, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France;Centre d’étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France;Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France;Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86000, Poitiers, France;Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France;Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France;Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France;Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France;

关键词: COVID-19;    Intensive care unit;    Hospital transport;    Mechanical ventilation;    ARDS;    Mortality;   

DOI  :  10.1186/s13613-021-00841-5

来源: Springer

【 摘 要 】

BackgroundThe COVID-19 pandemic led authorities to evacuate via various travel modalities critically ill ventilated patients into less crowded units. However, it is not known if interhospital transport impacts COVID-19 patient’s mortality in intensive care units (ICUs). A cohort from three French University Hospitals was analysed in ICUs between 15th of March and the 15th of April 2020. Patients admitted to ICU with positive COVID-19 test and mechanically ventilated were recruited.ResultsAmong the 133 patients included in the study, 95 (71%) were male patients and median age was 63 years old (interquartile range: 54–71). Overall ICU mortality was 11%. Mode of transport included train (48 patients), ambulance (6 patients), and plane plus helicopter (14 patients). During their ICU stay, 7 (10%) transferred patients and 8 (12%) non-transferred patients died (p = 0.71). Median SAPS II score at admission was 33 (interquartile range: 25–46) for the transferred group and 35 (27–42) for non-transferred patients (p = 0.53). SOFA score at admission was 4 (3–6) for the transferred group versus 3 (2–5) for the non-transferred group (p = 0.25). In the transferred group, median PaO2/FiO2 ratio (P/F) value in the 24 h before departure was 197 mmHg (160–250) and remained 166 mmHg (125–222) in the first 24 h post arrival (p = 0.13). During the evacuation 46 (68%) and 21 (31%) of the patients, respectively, benefited from neuromuscular blocking agents and from vasopressors. Transferred and non-transferred patients had similar rate of nosocomial infections, 37/68 (54%) versus 34/65 (52%), respectively (p = 0.80). Median length of mechanical ventilation was significantly increased in the transferred group compared to the non-transferred group, 18 days (11–24) and 14 days (8–20), respectively (p = 0.007). Finally, ICU and hospital length of stay did not differ between groups.ConclusionsIn France, inter-hospital evacuation of COVID-19 ventilated ICU patients did not appear to increase mortality and therefore could be proposed to manage ICU surges in the future.

【 授权许可】

CC BY