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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Intensive care during the coronavirus epidemic</title><author><name sortKey="Qiu, Haibo" sort="Qiu, Haibo" uniqKey="Qiu H" first="Haibo" last="Qiu">Haibo Qiu</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.452290.8</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Zhongda Hospital, Southeast University,</institution></institution-wrap>Nanjing, Jiangsu China</nlm:aff></affiliation></author><author><name sortKey="Tong, Zhaohui" sort="Tong, Zhaohui" uniqKey="Tong Z" first="Zhaohui" last="Tong">Zhaohui Tong</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.24696.3f</institution-id><institution-id institution-id-type="ISNI">0000 0004 0369 153X</institution-id><institution>Department of Pulmonary and Critical Care Medicine,</institution><institution>Beijing Chaoyang Hospital, Capital Medical University,</institution></institution-wrap>Beijing, China</nlm:aff></affiliation></author><author><name sortKey="Ma, Penglin" sort="Ma, Penglin" uniqKey="Ma P" first="Penglin" last="Ma">Penglin Ma</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.411642.4</institution-id><institution-id institution-id-type="ISNI">0000 0004 0605 3760</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Peking University Third Hospital,</institution></institution-wrap>Beijing, China</nlm:aff></affiliation></author><author><name sortKey="Hu, Ming" sort="Hu, Ming" uniqKey="Hu M" first="Ming" last="Hu">Ming Hu</name><affiliation><nlm:aff id="Aff4">Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, Hubei China</nlm:aff></affiliation></author><author><name sortKey="Peng, Zhiyong" sort="Peng, Zhiyong" uniqKey="Peng Z" first="Zhiyong" last="Peng">Zhiyong Peng</name><affiliation><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="GRID">grid.413247.7</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Zhongnan Hospital, Wuhan University,</institution></institution-wrap>Wuhan, Hubei China</nlm:aff></affiliation></author><author><name sortKey="Wu, Wenjuan" sort="Wu, Wenjuan" uniqKey="Wu W" first="Wenjuan" last="Wu">Wenjuan Wu</name><affiliation><nlm:aff id="Aff6">Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, Hubei China</nlm:aff></affiliation></author><author><name sortKey="Du, Bin" sort="Du, Bin" uniqKey="Du B" first="Bin" last="Du">Bin Du</name><affiliation><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="GRID">grid.413106.1</institution-id><institution-id institution-id-type="ISNI">0000 0000 9889 6335</institution-id><institution>Medical ICU,</institution><institution>Peking Union Medical College Hospital,</institution></institution-wrap>1 Shuai Fu Yuan, Beijing, 100730 China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32077996</idno><idno type="pmc">7080064</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080064</idno><idno type="RBID">PMC:7080064</idno><idno type="doi">10.1007/s00134-020-05966-y</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000106</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000106</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Intensive care during the coronavirus epidemic</title><author><name sortKey="Qiu, Haibo" sort="Qiu, Haibo" uniqKey="Qiu H" first="Haibo" last="Qiu">Haibo Qiu</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.452290.8</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Zhongda Hospital, Southeast University,</institution></institution-wrap>Nanjing, Jiangsu China</nlm:aff></affiliation></author><author><name sortKey="Tong, Zhaohui" sort="Tong, Zhaohui" uniqKey="Tong Z" first="Zhaohui" last="Tong">Zhaohui Tong</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.24696.3f</institution-id><institution-id institution-id-type="ISNI">0000 0004 0369 153X</institution-id><institution>Department of Pulmonary and Critical Care Medicine,</institution><institution>Beijing Chaoyang Hospital, Capital Medical University,</institution></institution-wrap>Beijing, China</nlm:aff></affiliation></author><author><name sortKey="Ma, Penglin" sort="Ma, Penglin" uniqKey="Ma P" first="Penglin" last="Ma">Penglin Ma</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.411642.4</institution-id><institution-id 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uniqKey="Wu W" first="Wenjuan" last="Wu">Wenjuan Wu</name><affiliation><nlm:aff id="Aff6">Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, Hubei China</nlm:aff></affiliation></author><author><name sortKey="Du, Bin" sort="Du, Bin" uniqKey="Du B" first="Bin" last="Du">Bin Du</name><affiliation><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="GRID">grid.413106.1</institution-id><institution-id institution-id-type="ISNI">0000 0000 9889 6335</institution-id><institution>Medical ICU,</institution><institution>Peking Union Medical College Hospital,</institution></institution-wrap>1 Shuai Fu Yuan, Beijing, 100730 China</nlm:aff></affiliation></author></analytic><series><title level="j">Intensive Care Medicine</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><date 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Intensive Care Med</journal-id><journal-id journal-id-type="iso-abbrev">Intensive Care Med</journal-id><journal-title-group><journal-title>Intensive Care Medicine</journal-title></journal-title-group><issn pub-type="ppub">0342-4642</issn><issn pub-type="epub">1432-1238</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32077996</article-id><article-id pub-id-type="pmc">7080064</article-id><article-id pub-id-type="publisher-id">5966</article-id><article-id pub-id-type="doi">10.1007/s00134-020-05966-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Editorial</subject></subj-group></article-categories><title-group><article-title>Intensive care during the coronavirus epidemic</article-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Qiu</surname><given-names>Haibo</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Tong</surname><given-names>Zhaohui</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ma</surname><given-names>Penglin</given-names></name><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Hu</surname><given-names>Ming</given-names></name><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Peng</surname><given-names>Zhiyong</given-names></name><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Wenjuan</given-names></name><xref ref-type="aff" rid="Aff6">6</xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-6237-2895</contrib-id><name><surname>Du</surname><given-names>Bin</given-names></name><address><email>Dubin98@gmail.com</email></address><xref ref-type="contrib" rid="IA1"></xref><xref ref-type="aff" rid="Aff7">7</xref></contrib><contrib contrib-type="author" id="IA1"><collab>China Critical Care Clinical Trials Group (CCCCTG)</collab></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.452290.8</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Zhongda Hospital, Southeast University,</institution></institution-wrap>Nanjing, Jiangsu China</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.24696.3f</institution-id><institution-id institution-id-type="ISNI">0000 0004 0369 153X</institution-id><institution>Department of Pulmonary and Critical Care Medicine,</institution><institution>Beijing Chaoyang Hospital, Capital Medical University,</institution></institution-wrap>Beijing, China</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.411642.4</institution-id><institution-id institution-id-type="ISNI">0000 0004 0605 3760</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Peking University Third Hospital,</institution></institution-wrap>Beijing, China</aff><aff id="Aff4"><label>4</label>Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, Hubei China</aff><aff id="Aff5"><label>5</label><institution-wrap><institution-id institution-id-type="GRID">grid.413247.7</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Zhongnan Hospital, Wuhan University,</institution></institution-wrap>Wuhan, Hubei China</aff><aff id="Aff6"><label>6</label>Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, Hubei China</aff><aff id="Aff7"><label>7</label><institution-wrap><institution-id institution-id-type="GRID">grid.413106.1</institution-id><institution-id institution-id-type="ISNI">0000 0000 9889 6335</institution-id><institution>Medical ICU,</institution><institution>Peking Union Medical College Hospital,</institution></institution-wrap>1 Shuai Fu Yuan, Beijing, 100730 China</aff></contrib-group><pub-date pub-type="epub"><day>20</day><month>2</month><year>2020</year></pub-date><fpage>1</fpage><lpage>3</lpage><history><date date-type="received"><day>6</day><month>2</month><year>2020</year></date><date date-type="accepted"><day>10</day><month>2</month><year>2020</year></date></history><permissions><copyright-statement>© Springer-Verlag GmbH Germany, part of Springer Nature 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/501100004751</institution-id><institution>Department of Science and Technology for Social Development</institution></institution-wrap></funding-source><award-id>2020YFC0841300</award-id><principal-award-recipient><name><surname>Du</surname><given-names>Bin</given-names></name></principal-award-recipient></award-group></funding-group></article-meta></front><body><p id="Par1">In late December 2019, a cluster of patients with pneumonia of unknown cause was reported to local healthcare authorities, while a novel coronavirus (SARS-CoV-2) was identified as the etiology [<xref ref-type="bibr" rid="CR1">1</xref>–<xref ref-type="bibr" rid="CR3">3</xref>]. As of February 4, 2020, 20,471 confirmed cases, including 2788 severe cases and 425 deaths, were reported in China [<xref ref-type="bibr" rid="CR4">4</xref>].</p><p id="Par2">As a response to the epidemic, the local government had appointed several designated hospitals for patients with SARS-CoV-2 infection. Despite a common coping strategy for mass casualty (earthquake and blast injury) in China, SARI epidemic has proposed a new challenge for healthcare workers, especially intensivists. About 15–20% of suspected and confirmed patients with SARS-CoV-2 infection in fever clinics developed severe hypoxemia (since the second week of disease course), and required some form of ventilatory support such as high-flow nasal cannula, and non-invasive and invasive mechanical ventilation. In addition, other complications might occur, including, but not limited to, shock, acute kidney injury, gastrointestinal bleeding, and rhabdomyolysis. No antiviral agents have been proven to be effective against the coronavirus. Therefore, management of critically ill patients with SARS-CoV-2 infection still remains supportive rather than definitive, indicating remarkable workload for intensive care physicians and nurses. This surge of critically ill patients in designated hospitals as well as fever clinics represents urgent demands for intensive care with regards to space, supplies, and staff (Table <xref rid="Tab1" ref-type="table">1</xref>) [<xref ref-type="bibr" rid="CR5">5</xref>–<xref ref-type="bibr" rid="CR8">8</xref>]. Response to these demands requires cooperation between the medical rescue team, infection control specialists, local health authorities, and center for disease control and prevention [<xref ref-type="bibr" rid="CR9">9</xref>].<table-wrap id="Tab1"><label>Table 1</label><caption><p>Demand for emergency mass critical care and possible solutions in designated hospitals during SARI epidemic</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Demands</th><th align="left">Difficulties</th><th align="left">Potential solutions</th></tr></thead><tbody><tr><td align="left">Space</td><td align="left">Double or triple ICU beds to cope with the surge of critically ill patients requiring mechanical ventilation and other supportive care</td><td align="left"><p>Limited physical space with specific functionalities such as electricity, medical gas, and suction</p><p>Not designed for infectious diseases spreading via respiratory droplets or contact</p></td><td align="left"><p>Post-anesthesia care unit and ED as primary backup space</p><p>General wards with adequately ventilated rooms as secondary backup space after remodeling</p><p>Infection prevention and control measures designed by infection control professionals</p></td></tr><tr><td align="left">Supplies</td><td align="left"><p>Bedside monitors, ventilators, CRRT machine, ECMO, portable X-ray equipment</p><p>PPE, such as N95 mask, googles, face shields, long-sleeved gowns, and gloves</p></td><td align="left"><p>Information about epidemic less predictable during the initial phase</p><p>Information about patient characteristics unavailable during the initial phase</p></td><td align="left"><p>Provision of update and predicted estimates of the epidemic by public health authorities</p><p>List of PPE and medical devices/equipment for stockpiling</p><p>Prediction of supply based on patient volume, staffing, and real-time consumption of PPE</p></td></tr><tr><td align="left">Staff</td><td align="left">Staffing of the medical rescue team, including intensivists, intensive care nurses, and respiratory therapists</td><td align="left"><p>Lack of knowledge about infection control and prevention</p><p>Heavy workload and associated risk of contamination</p><p>Burnout</p></td><td align="left"><p>Training provided by infection control professionals</p><p>Duration of every shift no longer than 6–8 h</p><p>Preparation of reserve medical rescue team for substitution</p><p>Psychological consultation for healthcare workers</p></td></tr></tbody></table><table-wrap-foot><p><italic>CRRT</italic> continuous renal replacement therapy, <italic>ECMO</italic> extracorporeal membrane oxygenation, <italic>ICU</italic> intensive care unit, <italic>PPE</italic> personal protection equipment, <italic>SARI</italic> severe acute respiratory infection</p></table-wrap-foot></table-wrap></p><p id="Par3">Another important strategy is the centralization of critically ill patients with SARS-CoV-2 infection, i.e., transfer of patients requiring intensive care unit (ICU) admission into some designated hospitals with adequate specialist services. Potential benefits of centralized provision of intensive care might include better and more efficient utilization of scarce resources, and improved clinical outcome [<xref ref-type="bibr" rid="CR10">10</xref>]. However, these benefits should be balanced against the risk of inter-hospital transfer, delay in access to intensive care, and de-skilling of staff in other designated hospitals [<xref ref-type="bibr" rid="CR10">10</xref>]. In addition, intensivists are also involved in the inter-hospital transfer such as design of transfer plan, patient screening and evaluation, and escort of patients.</p><p id="Par4">Like any natural disasters, epidemics, or other kinds of mass casualties, local healthcare capacity became overwhelmed by the COVID-19 epidemic, which necessitated a request for external assistance at the national level [<xref ref-type="bibr" rid="CR11">11</xref>]. As part of the national response to inadequate local intensive care resources, 31 deployed support medical teams including 598 intensivists and 2319 ICU nurses from other cities have been dispatched to ICUs of the designated hospitals since early January 2020. However, it is not uncommon for them to spend some time to get familiar with colleagues, environment, and local hospital administration before working as a team. Furthermore, different personal experience and lack of knowledge of this novel disease often result in different, and sometimes conflicting, treatment plans within the same team. Therefore, a national intensive care expert team has been developed, with some experts working in ICUs as attendings, while other more senior experts make regular inspections of all hospitals and fever clinics with critically ill patients with SARS-CoV-2 infection, providing consultation for some difficult cases, discussing strengths and weaknesses of the patient management strategy, and providing suggestions to the national and local health authorities. In addition, the volume of critically ill patients with SARS-CoV-2 infection has surpassed the intensive care supply for quite a long period of time, meaning that only a small proportion of critically ill patients could get access to intensive care services. Under these circumstances, patient triage and provision of essential rather than limitless intensive care would be very important [<xref ref-type="bibr" rid="CR7">7</xref>].</p><p id="Par5">Last, but not least, the COVID-19 epidemic has provided clinicians an opportunity to answer some important questions: is lopinavir/ritonavir or remdesivir effective against the SARS-Cov-2 infection? Does corticosteroid therapy improve lung injury in viral pneumonia? What is the effect of immune checkpoint inhibitors or thymosin in immunosuppression induced by the SARS-CoV-2 infection? There are some ongoing clinical trials in Wuhan and other cities in China, and we hope that results from these studies will help us to fight against the COVID-19 epidemic and other viral infections.</p></body><back><fn-group><fn><p><bold>Publisher's Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn><fn><p>Haibo Qiu and Zhaohui Tong contributed to the work equally.</p></fn></fn-group><ack><title>Acknowledgement</title><p>This study was supported, in part, by the research Grant 2020YFC0841300 from Ministry of Science and Technology of the People’s Republic of China.</p></ack><notes notes-type="ethics"><title>Compliance with ethical standards</title><notes notes-type="COI-statement"><title>Conflicts of interest</title><p id="Par60">All authors report no conflicts of interest to declare.</p></notes></notes><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>N</given-names></name><name><surname>Zhang</surname><given-names>D</given-names></name><name><surname>Wang</surname><given-names>W</given-names></name><etal></etal></person-group><article-title>A novel coronavirus from patients with pneumonia in China, 2019</article-title><source>N Engl J Med</source><year>2020</year><pub-id pub-id-type="doi">10.1056/NEJMoa2001017</pub-id><pub-id pub-id-type="pmid">31978945</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>C</given-names></name><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>X</given-names></name><etal></etal></person-group><article-title>Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China</article-title><source>Lancet</source><year>2020</year><volume>395</volume><issue>10223</issue><fpage>497</fpage><lpage>506</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30183-5</pub-id><pub-id pub-id-type="pmid">31986264</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>N</given-names></name><name><surname>Zhou</surname><given-names>M</given-names></name><name><surname>Dong</surname><given-names>X</given-names></name><etal></etal></person-group><article-title>Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study</article-title><source>Lancet</source><year>2020</year><volume>395</volume><issue>10223</issue><fpage>507</fpage><lpage>513</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30211-7</pub-id><pub-id pub-id-type="pmid">32007143</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><mixed-citation publication-type="other">World Health Organization. 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