Friday, August 6, 2021

How Bad is the Crisis? ICU Crisis?

What percent of ICU beds are currently in use by all patients not just those with COVID-19?

Some states are clearly operating with limited expansion capacity.  But how unusual is this?  Interestingly, demand for and availability of ICU beds is elastic:

The authors also demonstrated that when the ICU occupancy rate was greater than 70% (or fewer than five open ICU beds), the odds of ICU admission decreased linearly. This finding illustrates how sensitive we intensivists are to ICU bed availability. When several ICU beds are available, we may admit patients to the ICU who are not critically ill—our threshold for ICU admission may be too low. When there are few beds available, we may refuse admission to patients who are critically ill—our threshold may be too high (6). This study highlights that we have yet to determine which patients are particularly vulnerable to these system-level influences on ICU triage. Which patients would be admitted to the  ICU under low-strain conditions but refused ICU care under high strain conditions? Is ICU care best for these patients? Existing studies conflict regarding this so-called “discretionary” use of the ICU, with some revealing no difference in mortality while others suggest a benefit (7, 8).

So the several states with 70% and above ICU bed utilization are likely reaching this point where the  ICU care decision may not be elastic.

Is this percentage of ICU usage unusual?

Over the three years studied [2005-7], total ICU occupancy ranged from 57.4% to 82.1% and the number of beds filled with mechanically ventilated patients ranged from 20.7% to 38.9%. There was no change in occupancy across years and no increase in occupancy during influenza seasons. ...

The United States has more intensive care unit (ICU) beds – approximately 20 per 100,000 population – than most other nations (), and the number of ICU beds in the country has steadily increased over time (). Despite an overall occupancy estimated at 68% in 2005, many clinicians and policymakers, and perhaps even patients, perceive that the supply of US ICU beds is still insufficient to meet normal temporal variation in critical care demand (). 

I cannot find ICU percentage use for all patients nationally.  Here it is: 61%.  But looking at map suggests our ICU use percentage is typical, not elevated by COVID-19.  Panic mongering in full force.

Thanks to Dave G. for finding this data. 

1 comment:

  1. They forget that we have data, still, from previous spikes. No one was talking about ICU being swamped when usage was 4X what it is now. There was a new president to inaugurate.