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Pandemic influenza and hospital resources.

Nap RE, Andriessen MP, Meessen NE, van der Werf TS - Emerging Infect. Dis. (2007)

Bottom Line: We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area.We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support.Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.

View Article: PubMed Central - PubMed

Affiliation: University Medical Center Groningen, Groningen, the Netherlands. r.e.nap@rvb.umcg.nl

ABSTRACT
Using estimates from the Centers for Disease Control and Prevention, the World Health Organization, and published models of the expected evolution of pandemic influenza, we modeled the surge capacity of healthcare facility and intensive care unit (ICU) requirements over time in northern Netherlands (approximately 1.7 million population). We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area. We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support. Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.

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A) Effect of intensified treatment decision (25% intensive care unit [ICU] admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks; B) effect of intensified treatment decision (50% ICU admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks.
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Figure 2: A) Effect of intensified treatment decision (25% intensive care unit [ICU] admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks; B) effect of intensified treatment decision (50% ICU admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks.

Mentions: HCWs would become ill in the pandemic in proportion to the attack rate in the general population, and we illustrated the impact of HCW absenteeism on loss of ICU bed capacity for all presented scenarios (Figures 1, 2). Furthermore, we visualized the effect of intensified treatment decisions on the occupancy of ICU beds (Figure 2). For this situation, we used the representative case scenario estimate data, i.e., 30% attack rate and a mean length of stay of 8 days, and show the effect of intensified treatment decision resulting in reduction of ICU occupancy by 5% and 20%. Intensified treatment decision was defined as discontinuation of mechanical ventilation after 48 hours, based on ample consultations within ICU teams and with partners and next of kin of patients that the patients are deemed to have no realistic hope for recovery. Finally, we made sensitivity analyses, with changing assumptions within the model; this additional material is presented in an online Technical Appendix (available from www.cdc.gov/EID/content/13/11/zzz-Techapp.pdf).


Pandemic influenza and hospital resources.

Nap RE, Andriessen MP, Meessen NE, van der Werf TS - Emerging Infect. Dis. (2007)

A) Effect of intensified treatment decision (25% intensive care unit [ICU] admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks; B) effect of intensified treatment decision (50% ICU admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3375786&req=5

Figure 2: A) Effect of intensified treatment decision (25% intensive care unit [ICU] admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks; B) effect of intensified treatment decision (50% ICU admission rate, mean length of stay of 8 days) without antiviral medication, pandemic period 9 weeks.
Mentions: HCWs would become ill in the pandemic in proportion to the attack rate in the general population, and we illustrated the impact of HCW absenteeism on loss of ICU bed capacity for all presented scenarios (Figures 1, 2). Furthermore, we visualized the effect of intensified treatment decisions on the occupancy of ICU beds (Figure 2). For this situation, we used the representative case scenario estimate data, i.e., 30% attack rate and a mean length of stay of 8 days, and show the effect of intensified treatment decision resulting in reduction of ICU occupancy by 5% and 20%. Intensified treatment decision was defined as discontinuation of mechanical ventilation after 48 hours, based on ample consultations within ICU teams and with partners and next of kin of patients that the patients are deemed to have no realistic hope for recovery. Finally, we made sensitivity analyses, with changing assumptions within the model; this additional material is presented in an online Technical Appendix (available from www.cdc.gov/EID/content/13/11/zzz-Techapp.pdf).

Bottom Line: We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area.We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support.Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.

View Article: PubMed Central - PubMed

Affiliation: University Medical Center Groningen, Groningen, the Netherlands. r.e.nap@rvb.umcg.nl

ABSTRACT
Using estimates from the Centers for Disease Control and Prevention, the World Health Organization, and published models of the expected evolution of pandemic influenza, we modeled the surge capacity of healthcare facility and intensive care unit (ICU) requirements over time in northern Netherlands (approximately 1.7 million population). We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area. We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support. Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.

Show MeSH
Related in: MedlinePlus