Intensive care units, the Achilles heel of France in the COVID-19 battle.
Intensive care units, the Achilles heel of France in the COVID-19 battle.
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DOI：
10.1016/j.lanepe.2021.100046
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Trade Union of Intensive Care Physicians
中科院分区：
文献类型：
--
作者：
Annane D;Federici L;Chagnon JL;Diehl JL;Dreyfuss D;Guiot P;Javouhey E;Joram N;Lesieur O;Rigaud JP;Outin H;Sement A;Sevens C;Thévenin D;Touati S;Terzi N;Trade Union of Intensive Care Physicians
期刊主页：www.爱思唯尔。Com/lanepe与更差的结果相关[8]。最近的一项研究表明，与ICU人满为患和临时ICU床位相关的住院死亡率增加[9]。10月1日至1月12日期间与新冠肺炎相关的死亡人数明显多于3月1日至9月30日期间[5]。增加ICU永久床位容量的主要缺点是工作人员资源短缺。法国法规规定护士与ICU患者的比例为2比5[6]。13%的ICU主任表示，他们无法全天候满足这一要求，并频繁使用加班。同样，规模不大的医疗团队，即每4张ICU床位不到3名全职主治医生，管理着大多数ICU[10]。这些恶化的工作条件是护士职业倦怠和不满的主要决定因素[11]，这可能解释了在第一次大流行浪潮之后，护理人员(2.8%的医生和3.5%的护士)离开重症监护的比例高得令人无法接受。由于预计会出现第三波大流行或新的新威胁，法国应该紧急恢复平均每10万居民12张ICU永久床位，确保在各领土上均匀分布。为此，应立即将靠近ICU围墙或在ICU围墙内设置的670张临时床位改为永久床位。法国应该使ICU的资源与其他国家的资源[3，4]保持一致，承认ICU护士的特殊能力[12]，并增加工资，增加人力资源，使每个班次护士与病人的比例至少为1：2，每个ICU的医生与病人的比例至少为3：4。训练有素的ICU医生的年产量应立即翻一番，从每年74人增加到2021年的至少150人。
journal homepage: www. elsevier. com/lanepe associated with worse outcomes [8]. A recent study suggested increased in-hospital mortality associated to ICU overflow and temporary ICU beds [9]. There were significantly more COVID-19 related deaths between October 1st and January 12 than between March 1st and September 30 [5]. The major drawback to increasing permanent ICU beds capacity was the shortage in staff resources. French regulation set the nurses to ICU patients ratio at two for five [6]. Thirteen percent of ICU directors declared that they cannot meet this requirement on a 24/7 basis and the frequent use of overtime. Likewise, undersized medical teams, ie less than three full time attending physicians per 4 ICU beds, ran most ICUs [10]. These degraded working conditions are a major determinant of nurse burnout and dissatisfaction [11], and may explain the unacceptably high proportion of caregivers (2.8% of physicians and 3.5% of nurses) having left intensive care following the first pandemic wave. In anticipation of a third pandemic waves or new emergent threats, France should urgently restore an average of 12 permanent ICU beds per 100,000 inhabitants ensuring homogeneous distributions across territories. To this end, the 670 temporary beds set-up closed to or within ICU walls should be immediately converted to permanent beds. France should align ICU resources to those of other countries [3, 4] with recognizing the specific competencies of ICU nurses [12] and salary increase, increasing staff resources with ratios of nurses to patients of at least 1: 2 per shift, and of physician to patients of 3: 4 per ICU. The annual output of trained ICU physicians should immediately double from 74 per year to at least 150 in 2021.
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发表时间：
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