Kohler Katharina, De Corte Thomas, Greco Massimiliano, Povoa Pedro, Cecconi Maurizio, Ostermann Marlies, De Waele Jan, Morris Andrew Conway
Perioperative, Acute, Critical Care and Emergency Medicine section, Department of Medicine, University of Cambridge, Level 4 Addenbrooke's Hospital Hills Road, Cambridge, UK.
Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
Crit Care. 2025 Jul 28;29(1):329. doi: 10.1186/s13054-025-05521-5.
Intensive care unit (ICU) strain is associated with increased mortality. Most strain metrics focus on 'simple' measures such as bed occupancy or admission rates. There is limited data on mitigation strategies, such as procedure teams or staff well-being services on strain, or the impact of increased patient-to-nurse ratios and non-ICU trained nurses working in ICU.
Using the multi-national UNITE-COVID study, collecting data from ICUs on their day of peak bed occupancy in two periods (2020 and 2021) of the COVID-19 pandemic, we evaluated metrics of strain (Bed occupancy, patient: nurse ratio, use of non-ICU staff and shortages of consumables) and potential mitigators (procedural support teams and staff well-being interventions). We examined how these related to outcomes (mortality, complications, length of stay).
In both epochs, ICUs experienced significant strain, with ICU bed expansion to 133% and 163% respectively, whilst patient-to-nurse ratios increased by 0.4 and 0.3. Consumable shortages were widespread in 2020. Mortality was inversely correlated with staff well-being interventions in both epochs. Complications were inversely correlated with procedure support teams, and positively correlated with staffing ratios. In regression models, pressure sores were reduced in presence of support teams (p = 0.004) and increased with increasing patients per nurse (p = 0.05) whilst unplanned extubations were related to non-ICU trained staff working in ICU(p = 0.02).
COVID-19 induced ICU strain had effects beyond mortality, including increases in complications. Staff pressure and lack of ICU training were related to specific complications, whilst support teams and well-being interventions were associated with improved outcomes.
重症监护病房（ICU）压力与死亡率上升相关。大多数压力指标侧重于“简单”措施，如床位占用率或收治率。关于缓解策略的数据有限，如程序团队或员工福利服务对压力的影响，以及患者与护士比例增加和在ICU工作的非ICU培训护士的影响。
利用多国联合的COVID研究，收集来自ICU在2019年冠状病毒病大流行的两个时期（2020年和2021年）床位占用高峰日的数据，我们评估了压力指标（床位占用率、患者与护士比例、非ICU工作人员的使用和耗材短缺）和潜在缓解因素（程序支持团队和员工福利干预措施）。我们研究了这些因素与结果（死亡率、并发症、住院时间）之间的关系。
在两个时期，ICU都经历了显著压力，ICU床位分别扩展到133%和163%，而患者与护士比例分别增加了0.4和0.3。2020年耗材短缺普遍存在。在两个时期，死亡率与员工福利干预措施呈负相关。并发症与程序支持团队呈负相关，与人员配备比例呈正相关。在回归模型中，有支持团队时压疮减少（p = 0.004），且随着每名护士护理患者数量增加而增加（p = 0.05），而意外拔管与在ICU工作的非ICU培训员工有关（p = 0.02）。
2019年冠状病毒病导致的ICU压力影响超出死亡率，包括并发症增加。员工压力和缺乏ICU培训与特定并发症相关，而支持团队和福利干预措施与改善结果相关。
