Guidet B
Inserm, service de réanimation, Sorbonne Université, hôpital Saint-Antoine, institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
Bull Acad Natl Med. 2022 Jan;206(1):65-72. doi: 10.1016/j.banm.2021.09.013. Epub 2021 Nov 1.
The health crisis linked to COVID-19 has put the whole hospital under stress. Intensive care units (ICU) have been on the front line to manage the most serious cases. The number of new admissions together with cumulative number of occupied intensive care beds have been and still are a key element in measuring the intensity of the crisis. Intensive care is a specialty largely unknown to the general public which is problematic when dealing with such difficult questions as should we give priority to health or to the economy; is there a loss of chance for non-COVID patients due to deprogramming? The increase in the demand for critical care has necessitated an extension of hospitalization capacities by transforming intermediate care beds into ICU beds, by creating neo-ICU, or in some regions by carrying out critical care, usually performed in ICU, in regular wards. Among the several limiting factors, human resources with qualified personnel was a key element together with the relative shortage of drugs. The mismatch between demand and supply has led to the establishment of rules for prioritizing access to ICU. This review deals with all these issues and can contribute to a reflection on the adaptation of the critical care department to cope with major sanitary crisis.
与新冠疫情相关的健康危机使整个医院都处于压力之下。重症监护病房(ICU)一直处于应对最严重病例的前沿。新入院患者数量以及重症监护床位的累计占用数量一直且仍然是衡量危机严重程度的关键因素。重症监护是一个大众普遍不太了解的专业领域,在处理诸如我们应该优先考虑健康还是经济;由于计划变更,非新冠患者是否失去了治疗机会等难题时,这会带来问题。重症监护需求的增加使得有必要通过将中级护理床位改造成ICU床位、创建新的ICU,或者在某些地区通过在普通病房开展通常在ICU进行的重症监护来扩大住院能力。在几个限制因素中,具备合格人员的人力资源以及药品相对短缺是关键因素。供需不匹配导致制定了ICU准入优先级规则。本综述探讨了所有这些问题,并有助于思考重症监护部门如何适应重大卫生危机。