A national healthcare response to intensive care bed requirements during the COVID-19 outbreak in France - 09/12/20

Doi : 10.1016/j.accpm.2020.09.007

Jean-Yves Lefrant ^a,⁎ , Marc-Olivier Fischer ^b, Hugo Potier ^c, Cécile Degryse ^d, Samir Jaber ^e, Laurent Muller ^a, Julien Pottecher ^f, Hélène Charboneau ^g, Eric Meaudre ^h, Pierre Lanot ⁱ, Vincent Bruckert ^j, Benoît Plaud ^k, Bertrand Dureuil ^l, Emmanuel Samain ^m, Hervé Bouaziz ⁿ, Claude Ecoffey ^o, Xavier Capdevila ^p
for the French ICU study investigators group^¹
French ICU investigators: Dr Stéphane Lammens (CH Privé Saint Martin, Caen), Dr Vincent Bonnet (Clinique du Parc, Caen), Dr Fabrice Prevost (CH Bayeux), Dr Philippe Aussant (CH Lisieux), Dr Karim Merouani (CH Alençon), Dr Samir Sidiki Alaoui (CH Flers), Dr Pierre Kalfon (CH Chartres), Dr Willy-Serge Mfam (CHR Orléans), Dr Jean-Ferréol Oilleau (CHRU Brest), Dr Mouhamed Moussa (CHRU Lille), Dr Osama Abou Arab (CHU Amiens), Pr Jean-Luc Fellahi (CHU Lyon), Pr Dr Stéphanie Suzanne (Polyclinique d’Amiens), Dr Jérémy Coucoravas (CH Ajaccio), Dr Fabien Espitalier (CHU Tours), Dr Florent Bavozet (CH Dreux), Dr Brice Fermier (CH Blois), Dr Jean-François Vincent (CH Saintes), Dr Abdelali Ouchikhe (CH Niort), Dr Alexandre Herbland (CH La Rochelle), Dr Fréféric Godde (CH Avranches), Pr Denis Frasca (CHU Poitiers), Dr Oliver Desebe (Clinique de la Sauvegarde, Lyon), Dr Béatrice Riu (CHU Toulouse), Dr Henri Faure (Aulnay/Bois), Dr Dominique Hurel (CH Mantes), Dr Jean-Pierre Bedos (CH Versailles). Dr Antoine Lefevres-Scelles (CHU Rouen), Dr Jan Hayon (CHI Poissy), Dr Gérald Chanques (CHU Montpellier), Pr Mathieu Boutonnet (SSA, Paris), Pr Pierre Pasquier (SSA, Paris). Pr Gérard Audibert (CHRU Nancy), Pr Paul Michel Mertes (CHU Strasbourg), Pr Marie Reine Losser (CHRU Nancy, Pr Olivier Collange (CHU Strasbourg), Pr Thierry Pottecher (CHU Strasbourg), Pr Frédéric Aubrun (CHU Lyon), Pr Jean François Payen (CHU Grenoble), Pr Pierre Albaladejo (CHU Grenoble), Pr Pierre Bouzat (CHU Grenoble), Pr Carole Ichaï (CHU Nice), Pr Marc Leone (APHM Marseille), Pr Nicolas Bruder (APHM Marseille), Pr Lionel Velly (APHM Marseille), Pr Olivier Fourcade (CHU Toulouse), Pr Matthieu Biais (CHU Bordeaux), Pr Alexandre Ouattara (CHU Bordeaux), Pr Bertrand Debaene (CHU Poitiers), Pr Claire Dahyot Fizelier (CHU Poitiers), Pr Karim Asehnoun (CHU Nantes), Pr Sigismond Lasocki (CHU Angers), Pr Antoine Roquilly ( CHU Nantes), Pr Benoit Tavernier (CHU Lille), Pr Eric Kipnis (CHU Lille), Pr Emmanuel Lorne (CHU Amiens), Pr Belaid Bouhemad (CHU Dijon), Pr Hervé Dupont (CHU Amiens), Pr Jérome Morel (CHU Saint-Etienne), Pr Serge Molliex (CHU Saint-Etienne), Dr Pascal Beuret (Roanne), Pr Jean Michel Constantin (APHP Paris), Pr Etienne Gayat (APHP Paris), Pr Alexandre Mebazaa (APHP Paris). Dr Mathieu Schoeffler (CH Montélimar), Dr Nicolas Mongardon (Créteil, APHP), Pr Olivier Langeron (Créteil, APHP), Pr Catherine Paugam (Beaujon, APHP), Pr Jacques Duranteau (Bicêtre, APHP), Dr Philippe Mateu (CH Charleville Mezières), Dr Philippe Verdier (CH Montluçon), Dr Clément Buléon (CHU Caen).
^a EA 2992 IMAGINE, Univ Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France
^b Normandie Univ, UNICAEN, CHU de Caen Normandie, Service d’Anesthésie Réanimation, 14000 Caen, France
^c Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé publique, CHU Nîmes, Nîmes, University of Montpellier, France
^d Service d’Anesthésie Réanimation Pellegrin Tripode, CHU Bordeaux, Bordeaux, France
^e Department of Anaesthesia & Critical Care Medicine, University of Montpellier Saint Eloi Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
^f Hôpitaux Universitaires de Strasbourg, Pôle d’Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d’Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre – Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072, Strasbourg, France
^g Service d’Anesthésie, Clinique Pasteur, 31300 Toulouse, France
^h Fédération d’Anesthésie-Réanimation, Hôpital d’Instruction des Armées Sainte-Anne, Toulon; Chaire d’Anesthésie-réanimation, Médecine d’Urgence, École du Val-de-Grâce, Paris, France
ⁱ GARHPA, groupe de anesthésistes réanimateurs de l’Hôpital Privé d’Antony, 92160 Antony, France
^j Pôle d’Anesthésie-Réanimation Médecine péri-opératoire et Urgences, Hôpital l’Archet 2, Centre Hospitalier Universitaire de Nice, Université de Nice, 06000 Nice, France
^k Paris University & APHP. Nord. DMU PARABOL, Department of Anaesthesiology, Critical Care & Burn Unit, Saint-Louis hospital, 1, Avenue Claude Vellefaux, 75010 Paris, France
^l Departement of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
^m Département d’Anesthésie Réanimation, Hôpital Jean Minjoz - C.H.U. de Besançon, Besançon, France
ⁿ Département d’Anesthésie Réanimation, Hôpital Central – CHRU Nancy, Nancy, France
^o Département d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Pontchaillou, Université Rennes 1, Rennes, France
^p Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital and Montpellier University. INSERM unit 1051, Montpellier Neurosciences Institute, Montpellier, France

^⁎Corresponding author.

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Abstract

Background

Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed.

Methods

All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak.

Results

Among 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5054/5531 (91%) ICU beds. During the outbreak, 4806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9860, 1982 and 3089 ICU, ACU and PACU beds were made available.

Before the outbreak, 3548 physicians (2224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1785 residents, 11,023 nurses and 6763 nursing auxiliaries worked in established ICUs. During the outbreak, 2524 physicians, 715 residents, 7722 nurses and 3043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3212 new ventilators were added to the 5997 initially available in ICU.

Conclusion

During the COVID-19 outbreak, the French Health Care system created 4806 ICU beds (+95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context.

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Keywords : COVID-19, France, ICU, Bed availability