Preparing your intensive care unit for the COVID-19 pandemic: practical considerations and strategies

Abstract

The coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic. Preparing intensive care units (ICU) is an integral part of any pandemic response. In this review, we discuss the key principles and strategies for ICU preparedness. We also describe our initial outbreak measures and share some of the challenges faced. To achieve sustainable ICU services, we propose the need to 1) prepare and implement rapid identification and isolation protocols, and a surge in ICU bed capacity; (2) provide a sustainable workforce with a focus on infection control; (3) ensure adequate supplies to equip ICUs and protect healthcare workers; and (4) maintain quality clinical management, as well as effective communication.

Keywords: Coronavirus disease 2019; Critical care; Infection control; Pandemic preparedness; SARS-CoV-2.

Fig. 1

Infection control and prevention. a Negative pressure airborne infection isolation rooms (AIIRs) used for our isolation ICUs. b Cardiac arrest simulation training with disposable caps, gloves, and fluid-resistant gowns, eye protection along with respiratory protection using a fit-tested National Institute of Occupational Safety and Health (NIOSH) certified disposable N95 filtering facepiece respirator and powered air-purifying respirators (PAPRs). c Transport checklists and protocols (movement plans) were determined and rehearsed before actual implementation. d Operative procedures performed with PAPR in preparation for the COVID-19 pandemic

Fig. 2

Breathing circuit filters. Connections should be tightly fitted to avoid disconnections during movement. Dead space and circuit resistance will increase with the use of filters. a Hydrophobic mechanical filter at the bag-valve-mask interface (black arrow) to reduce dispersion of respiratory droplets during manual ventilation with a positive end expiratory pressure (PEEP) valve (white arrow) to optimise pre-oxygenation. b HEPA (high-efficiency particulate air) filters used on the inspiratory and expiratory ports of mechanical ventilators. c Hydrophobic mechanical filter used before the external expiratory port on a single-limb non-invasive ventilator circuit. d HEPA filters used at the air inlet (solid black arrow) and before the exhalation valve (dashed black arrow) ports of a single-limb transport ventilator circuit. A standard HME (heat and moisture exchanger) (white arrow) is attached at the Y-piece of the breathing circuit. e An alternative combination is the use of HEPA filter at the air inlet and a hydrophobic mechanical HME filter (HMEF) (black arrow) at the Y-piece, nearest to the patient