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Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland
Near real-time registry data show that the latest COVID-19 patients admitted to ICUs in Switzerland at the onset of the third wave were on average 5 years younger, had a higher body mass index, and presented with lower physiological risk scores but a trend towards more severe lung failure. These differences may primarily be related to the ongoing nationwide vaccination campaign, but the possibility that changes in virus-host interactions may be a co-factor in the age shift and change in disease characteristics is cause for concern, and should be taken into account in the public health and vaccination strategy during the ongoing pandemic.
Importance of critical care staffing and standard intensive care therapy in the COVID-19 era: a descriptive study of the first epidemic wave at a Swiss tertiary intensive care unit
Mortality rates of COVID-19 patients hospitalised in intensive care units (ICUs) are generally high. Availability of ICU resources might influence clinical outcomes. Here the authors report a very low mortality rate of patients treated in a tertiary university ICU in Switzerland. They hypothesise that the sufficient availability of well-trained ICU staff, drugs and special equipment, together with the best standard of ICU supportive care, has been one of the main reasons for the high survival rate observed.
Based on the example of the models implemented on icumonitoring.ch, and on general theoretical considerations, the authors argue that the framework of continuous-time differential equations is not suited to making reliable short-term predictions on quantities such as ICU occupancy in Swiss hospitals. Instead, they propose the use of very simple, hands-on forecasting based on fitting parameters of suitably chosen curves to the observed data, and making the forecast by expert judgement based on the results of the fitted curves.
In the case series presented here, the number of PICU admissions associated with iatrogenic events was significant and comparable to adult data on admission to ICU caused by iatrogenic events. The categories with most potential for improvement are nosocomial infections and the wrong management decisions / delayed diagnoses. Focused measures on these iatrogenic events may have a major impact on patient outcome, availability of PICU resources and healthcare costs.
Haemophagocytic lymphohistiocytosis and liver failure-induced massive hyperferritinaemia in a male COVID-19 patient
The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit.
COVID-19 pandemic: triage for intensive-care treatment under resource scarcity (3rd, updated version)
Given the development of the pandemic in October, the guidelines issued by the Swiss Academy of Medical Sciences (SAMS) and the Swiss Society of Intensive Care Medicine (SSICM) needed to be revised and updated in the light of the experience accumulated since March. There has been no change in the guiding principle that uniform criteria for intensive-care unit (ICU) admission and continued occupancy should be applied throughout Switzerland. The present guidelines provide the necessary basis.
The revised Swiss guidelines bring not only a useful framework for delicate discussions and decisions at the bedside, but hopefully also progress in public awareness of some limits of the best health systems in the world, appearing much faster in a time of scarcity of resources. Based on what we learned from the crisis of this year, several aspects of our and other health systems could benefit from a revision or an update, in line with a recognised truism.
Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult
Multisystem inflammatory syndrome associated with SARS-CoV-2 can occur in adults. The clinical presentation can include severe organ damage with features of incomplete or complete Kawasaki disease, including coronary aneurysm, as well as myocarditis-associated cardiogenic shock and also mononeuritis multiplex.
With the progress in healthcare over recent decades and a growing life expectancy, discussions and decisions regarding end-of-life issues have become increasingly important. Especially in intensive care and emergency medicine there is a growing need of decision making for optimised end-of-life care. Prolonging life and preventing death is considered to be the highest principle of healthcare professionals; however, in some cases alleviation of suffering is a more appropriate goal. This article discusses communication challenges in end-of-life decision making and outlines strategies from an area of growing interest and research.