Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia.


  • 影响因子:1.23
  • DOI:10.5694/mja2.50596
  • 作者列表:"Litton E","Bucci T","Chavan S","Ho YY","Holley A","Howard G","Huckson S","Kwong P","Millar J","Nguyen N","Secombe P","Ziegenfuss M","Pilcher D
  • 发表时间:2020-06-01

OBJECTIVES:To assess the capacity of intensive care units (ICUs) in Australia to respond to the expected increase in demand associated with COVID-19. DESIGN:Analysis of Australian and New Zealand Intensive Care Society (ANZICS) registry data, supplemented by an ICU surge capability survey and veterinary facilities survey (both March 2020). SETTINGS:All Australian ICUs and veterinary facilities. MAIN OUTCOME MEASURES:Baseline numbers of ICU beds, ventilators, dialysis machines, extracorporeal membrane oxygenation machines, intravenous infusion pumps, and staff (senior medical staff, registered nurses); incremental capability to increase capacity (surge) by increasing ICU bed numbers; ventilator-to-bed ratios; number of ventilators in veterinary facilities. RESULTS:The 191 ICUs in Australia provide 2378 intensive care beds during baseline activity (9.3 ICU beds per 100 000 population). Of the 175 ICUs that responded to the surge survey (with 2228 intensive care beds), a maximal surge would add an additional 4258 intensive care beds (191% increase) and 2631 invasive ventilators (120% increase). This surge would require additional staffing of as many as 4092 senior doctors (245% increase over baseline) and 42 720 registered ICU nurses (269% increase over baseline). An additional 188 ventilators are available in veterinary facilities, including 179 human model ventilators. CONCLUSIONS:The directors of Australian ICUs report that intensive care bed capacity could be near tripled in response to the expected increase in demand caused by COVID-19. But maximal surge in bed numbers could be hampered by a shortfall in invasive ventilators and would also require a large increase in clinician and nursing staff numbers.


目的: 评估澳大利亚重症监护病房 (icu) 应对与新型冠状病毒肺炎相关的预期需求增长的能力。 设计: 分析澳大利亚和新西兰重症监护协会 (ANZICS) 登记数据,并辅以ICU激增能力调查和兽医设施调查 (均为 2020 年 3 月)。 设置: 所有澳大利亚icu和兽医设施。 主要观察指标: ICU病床、呼吸机、透析机、体外膜肺氧合机、静脉输液泵和工作人员 (高级医务人员、注册护士) 的基线数量; 通过增加ICU床数量增加容量 (浪涌) 的增量能力; 呼吸机与床的比率; 兽医设施中的呼吸机数量。 结果: 澳大利亚的 191 ICU在基线活动期间提供了 2378 张重症监护床位 (每 9.3 000 人口 100 张ICU床位)。在对激增调查做出回应的 175 个icu中 (拥有 2228 张重症监护病床),最大的激增将增加 4258 张重症监护病床 (增加 191% 张) 2631 台有创呼吸机 (增加 120%)。这一激增将需要增加多达 4092 名高级医生 (比基线增加 245%) 和 42 720 名注册ICU护士 (比基线增加 269%) 的人员配置。兽医设施还提供另外 188 台呼吸机,包括 179 台人体模型呼吸机。 结论: 澳大利亚icu的主管报告说,重症监护床的容量可能接近三倍,以应对新型冠状病毒肺炎导致的需求预期增加。但是床位数量的最大激增可能会受到有创呼吸机短缺的阻碍,也需要大量增加临床医生和护理人员的数量。



作者列表:["Lim J","Jeon S","Shin HY","Kim MJ","Seong YM","Lee WJ","Choe KW","Kang YM","Lee B","Park SJ"]

METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

作者列表:["Zhang W","Du RH","Li B","Zheng XS","Yang XL","Hu B","Wang YY","Xiao GF","Yan B","Shi ZL","Zhou P"]

METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.

翻译标题与摘要 下载文献
作者列表:["Cheng ZJ","Shan J"]

METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.