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Logistical Considerations and Clinical Outcomes Associated With Converting Operating Rooms Into an Intensive Care
Aaron M Mittel1, Oliver Panzer1, David S Wang1
1From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York.
Insights
During the COVID-19 crisis, operating rooms were converted into intensive care units (ORICUs) to manage patient surges. This innovative approach effectively increased capacity, with survival rates comparable to traditional intensive care units.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Hospital Administration
Background:
- The COVID-19 pandemic created unprecedented demand for intensive care unit (ICU) beds.
- NewYork-Presbyterian/Columbia University Irving Medical Center adapted by converting operating rooms (ORs) into a novel OR ICU (ORICU).
Purpose of the Study:
- To evaluate the effectiveness of the ORICU model in managing critically ill COVID-19 patients.
- To assess patient survival rates within the converted ORICU environment.
- To identify risk factors for mortality in this unique critical care setting.
Main Methods:
- Twenty-three operating rooms were transformed into an 82-bed ORICU, equipped for critical care therapies.
- Anesthesia machines were repurposed as ventilators, with safety modifications.
- Non-ICU trained staff received critical care training and worked in a hybrid model.
- Kaplan-Meier survival analysis and Cox proportional hazard regression were used to analyze patient outcomes, including age, sex, and BMI as covariates.
Main Results:
- The ORICU cared for 133 patients between March 24 and May 14, 2020.
- Overall mortality was 41.4% (55 of 133 patients).
- The estimated 30-day survival probability was 0.61 (95% CI, 0.52-0.69).
- Mortality risk significantly increased with age; patients 65 years and older were 3.17 times more likely to die than younger patients, adjusting for sex and BMI.
Conclusions:
- The ORICU significantly expanded ICU capacity during the COVID-19 surge.
- The 30-day survival rate in the ORICU was comparable to traditional ICUs, indicating its effectiveness.
- This model demonstrated a viable strategy for managing critical care surges during public health crises.
Background:
Coronavirus disease 2019 (COVID-19) emerged as a public health crisis that disrupted normal patterns of health care in the New York City metropolitan area. In preparation for a large influx of critically ill patients, operating rooms (ORs) at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP-Columbia) were converted into a novel intensive care unit (ICU) area, the operating room intensive care unit (ORICU).
Methods:
Twenty-three ORs were converted into an 82-bed ORICU. Adaptations to the OR environment permitted the delivery of standard critical care therapies. Nonintensive-care-trained staff were educated on the basics of critical care and deployed in a hybrid staffing model. Anesthesia machines were repurposed as critical care ventilators, with accommodations to ensure reliable function and patient safety. To compare ORICU survivorship to outcomes in more traditional environments, we performed Kaplan-Meier survival analysis of all patients cared for in the ORICU, censoring data at the time of ORICU closure. We hypothesized that age, sex, and obesity may have influenced the risk of death. Thus, we estimated hazard ratios (HR) for death using Cox proportional hazard regression models with age, sex, and body mass index (BMI) as covariables and, separately, using older age (65 years and older) adjusted for sex and BMI.
Results:
The ORICU cared for 133 patients from March 24 to May 14, 2020. Patients were transferred to the ORICU from other ICUs, inpatient wards, the emergency department, and other institutions. Patients remained in the ORICU until either transfer to another unit or death. As the hospital patient load decreased, patients were transferred out of the ORICU. This process was completed on May 14, 2020. At time of data censoring, 55 (41.4%) of patients had died. The estimated probability of survival 30 days after admission was 0.61 (95% confidence interval [CI], 0.52-0.69). Age was significantly associated with increased risk of mortality (HR = 1.05, 95% CI, 1.03-1.08, P < .001 for a 1-year increase in age). Patients who were ≥65 years were an estimated 3.17 times more likely to die than younger patients (95% CI, 1.78-5.63; P < .001) when adjusting for sex and BMI.
Conclusions:
A large number of critically ill COVID-19 patients were cared for in the ORICU, which substantially increased ICU capacity at NYP-Columbia. The estimated ORICU survival rate at 30 days was comparable to other reported rates, suggesting this was an effective approach to manage the influx of critically ill COVID-19 patients during a time of crisis.
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