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This article examines the use of nonconventional ventilators (NCVs) during the early days of the COVID-19 pandemic in New York. The study found that patients ventilated exclusively with NCVs had higher mortality rates compared to those using conventional ventilators. However, the study has limitations, such as the absence of emergent viral variants, evidence-based therapies, vaccination, and immunity in the population studied. The article also discusses the challenges of conducting research on nonstandard therapies during public health emergencies and suggests adaptive platform trials as a potential solution. Additionally, the text mentions the shortage of intensivists in ICUs and the increasing role of advanced practice providers in critical care. [Extracted from the article]

Objectives: Here, we report the management of a catastrophic COVID-19 Delta variant surge, which overloaded ICU capacity, using crisis standards of care (CSC) based on a multiapproach protocol.Design: Retrospective observational study.Setting: University Hospital of Guadeloupe.Patients: This study retrospectively included all patients who were hospitalized for COVID-19 pneumonia between August 11, 2021, and September 10, 2021, and were eligible for ICU admission.Intervention: Based on age, comorbidities, and disease severity, patients were assigned to three groups: Green (ICU admission as soon as possible), Orange (ICU admission after the admission of all patients in the Green group), and Red (no ICU admission).Measurements and Main Results: Among the 328 patients eligible for ICU admission, 100 (30%) were assigned to the Green group, 116 (35%) to the Orange group, and 112 (34%) to the Red group. No patient in the Green group died while waiting for an ICU bed, whereas 14 patients (12%) in the Orange group died while waiting for an ICU bed. The 90-day mortality rates were 24%, 37%, and 78% in the Green, Orange, and Red groups, respectively. A total of 130 patients were transferred to the ICU, including 79 from the Green group, 51 from the Orange group, and none from the Red group. Multivariate analysis revealed that among patients admitted to the ICU, death was independently associated with a longer time between ICU referral and ICU admission, the Sequential Organ Failure Assessment score, and the number of comorbidities, but not with triage group.Conclusions: CSC based on a multiapproach protocol allowed admission of all patients with a good prognosis. Higher mortality was associated with late admission, rather than triage group. [ABSTRACT FROM AUTHOR]

In most jurisdictions, disaster triage under CSC is conducted by triage teams who are similarly removed from direct patient care. Keywords: COVID-19; crisis standards of care; disaster; ethics; triage EN COVID-19 crisis standards of care disaster ethics triage 1824 1827 4 11/21/22 20221201 NES 221201 The COVID-19 pandemic has stressed health systems around the world to an unprecedented degree. Unfortunately, although changes in SOFA over time appear to be predictive of outcomes in a general critical care population ([9]), analyses in patients with COVID-19 do not support the prognostic value of serial SOFA measurements ([10]). [Extracted from the article]

Keywords: COVID-19; crisis standards of care; disaster; intensive care unit preparedness; surge; triage EN COVID-19 crisis standards of care disaster intensive care unit preparedness surge triage 148 150 3 12/19/22 20230101 NES 230101 In mid-2001, the Johns Hopkins Center for Health Security in conjunction with the National Security Council of the United States engaged in a table-top exercise to inform debate on the threat posed by biologic agents and to simulate challenges in decision making during times of healthcare strain. In this case, the system described for access to an ICU bed applied only to patients with COVID-19, and there were significant numbers of non-COVID-19 patients competing for the same beds. During the study period, patients were assigned to one of three color-coded ICU admission priority groups based on age, comorbidities, and disease severity: green - ICU admission as soon as possible; orange - admission after all patients in green were admitted; and red - no ICU admission. [Extracted from the article]

Objectives: The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital.Design: We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals.Setting: An urban safety-net hospital ICU.Patients: All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search.Interventions: None.Measurements and Main Results: Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories.Conclusions: Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models. [ABSTRACT FROM AUTHOR]