Critical Care volume 29,
Article number: 329, Published: 28 July 2025
Abstract
Purpose
Intensive care unit (ICU) strain is associated with
increased mortality. Most strain metrics focus on ‘simple’ measures such as bed
occupancy or admission rates. There is limited data on mitigation strategies,
such as procedure teams or staff well-being services on strain, or the impact
of increased patient-to-nurse ratios and non-ICU trained nurses working in ICU.
Methods
Using the multi-national UNITE-COVID study, collecting data
from ICUs on their day of peak bed occupancy in two periods (2020 and 2021) of
the COVID-19 pandemic, we evaluated metrics of strain (Bed occupancy, patient:
nurse ratio, use of non-ICU staff and shortages of consumables) and potential
mitigators (procedural support teams and staff well-being interventions). We
examined how these related to outcomes (mortality, complications, length of
stay).
Results
In both epochs, ICUs experienced significant strain, with
ICU bed expansion to 133% and 163% respectively, whilst patient-to-nurse ratios
increased by 0.4 and 0.3. Consumable shortages were widespread in 2020.
Mortality was inversely correlated with staff well-being interventions in both
epochs. Complications were inversely correlated with procedure support teams,
and positively correlated with staffing ratios. In regression models, pressure
sores were reduced in presence of support teams (p = 0.004)
and increased with increasing patients per nurse (p = 0.05)
whilst unplanned extubations were related to non-ICU trained staff working in
ICU(p = 0.02).
Conclusions
COVID-19 induced ICU strain had effects beyond mortality,
including increases in complications. Staff pressure and lack of ICU training
were related to specific complications, whilst support teams and well-being
interventions were associated with improved outcomes.
