Increasing ICU capacity to accommodate higher demand during the COVID-19 pandemic.

Litton, Edward; Huckson, Sue; Chavan, Shaila; Bucci, Tamara; Holley, Anthony; Everest, Evan; Kelly, Sean; McGloughlin, Steven; Millar, Johnny; Nguyen, Nhi; Nicholls, Mark; Secombe, Paule; Pilcher, David

OBJECTIVES To describe the short term capability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID-19 pandemic. DESIGN Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data. SETTING All 194 public and private Australian ICUs. MAIN OUTCOME MEASURES Numbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU-relevant equipment and staff. RESULTS All 194 ICUs Australian responded to the survey. The total number of currently open staffed ICU beds was 2183, 195 fewer (8.2%) than in 2020; the decline was greater for rural/regional (18%) and private ICUs (18%). The reported maximal ICU bed capacity (5623) included 813 additional physical ICU bed spaces and 2627 "surge areas" outside ICUs. The number of available ventilators (7196) exceeded the maximum number of ICU beds. However, the reported available number of additional nursing staff would facilitate the immediate opening of 383 additional physical ICU beds (47%), but not the additional bed spaces outside ICUs. CONCLUSIONS The number of currently available staffed ICU beds was lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff levels while maintaining pre-pandemic models of care.