Miró Òscar, Alquézar-Arbé Aitor, Piñera Pascual, Jacob Javier, Martín Alfonso, Llorens Pere, Jiménez Sònia, González Del Castillo Juan, García-Lamberechts Eric Jorge, Martín-Sánchez Francisco Javier, Burillo-Putze Guillermo
Servicio de Urgencias. Hospital Clínic. IDIBAPS. Universitat de Barcelona. Barcelona. España.
Servicio de Urgencias. Hospital de la Santa Creu i Sant Pau. Barcelona. España.
Rev Esp Salud Publica. 2021 Aug 11;95:e202108103.
During the first wave of the COVID-19 pandemic, the availability of a critical care bed was insufficient. The aim of this work was to evaluate the presence of protocols, management in the emergency department (ED) and the availability of intensive care unit (ICU) beds for severe COVID-19 patients attended in Spanish hospital EDs during the first peak of the 2020 pandemic.
Questionnaire collecting data regarding ED care in March-April 2020 aimed at all Spanish public health care EDs. The respondents were the Chiefs of EDs. The variables of interest were: 1) Presence and of compliance with ED protocols for decision making and adequacy of therapeutic effort; 2) management of COVID-19 patients with non-invasive mechanical ventilation (NIMV) or high flow nasal cannula (HFNC) in the ED; and 3) ICU bed accessibility for ED patients. The results were compared based on the characteristics of the hospital, impact of the pandemic and autonomous community. A descriptive and inferential analysis of the variables studied was performed using the chi-square test and analysis of variance.
A total of 246 questionnaires (89%) were received. Protocols were available in 136 EDs (57.1%). Globally, the protocol was applied in >95% of the EDs, although this was less frequent (76%) in EDs with high impact of the pandemic. 53% of the EDs managed patients with severe COVID-19 with NIMV/HFNC in the ED itself, and 19.4% suffered from lack of ICU beds. The lack of ICU beds for severe COVID-19 patients in the ED significantly differed among periods, and more marked in hospitals with ICU and with high pandemic impact.
It is needed to generalize the implementation of protocols in EDs for the management of severe COVID-19 patients and improve the capacity of the ICUs to homogeneously adjust to the needs.
在新冠疫情第一波期间，重症监护床位供应不足。本研究旨在评估2020年疫情首个高峰期间，西班牙医院急诊科针对重症新冠患者的诊疗方案、急诊科管理情况以及重症监护病房（ICU）床位的可获得性。
针对西班牙所有公共卫生保健急诊科，收集2020年3月至4月急诊科护理相关数据的调查问卷。受访者为急诊科主任。感兴趣的变量包括：1）存在并遵守急诊科决策和治疗力度适当性的诊疗方案；2）急诊科对使用无创机械通气（NIMV）或高流量鼻导管（HFNC）的新冠患者的管理；3）急诊科患者使用ICU床位的可及性。根据医院特征、疫情影响和自治区对结果进行比较。使用卡方检验和方差分析对研究变量进行描述性和推断性分析。
共收到246份问卷（89%）。136个急诊科（57.1%）有诊疗方案。总体而言，>95%的急诊科应用了该方案，不过在受疫情影响严重的急诊科，这一比例较低（76%）。53%的急诊科在急诊科本身对重症新冠患者使用NIMV/HFNC进行管理，19.4%的急诊科存在ICU床位短缺的情况。急诊科中重症新冠患者ICU床位短缺在不同时期存在显著差异，在设有ICU且受疫情影响严重的医院更为明显。
需要在急诊科推广针对重症新冠患者管理的诊疗方案的实施，并提高ICU均匀适应需求的能力。
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