A National Healthcare Response to Intensive Care Bed Requirements During the COVID-19 Outbreak in France

Background: Whereas 5,415 Intensive Care Unit (ICU) beds were initially available, 7,148 COVID-19 patients were hospitalized in ICU at the peak the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods: All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. Results: From 336 institutions with ICU before the outbreak, 315 (94%) participated covering 5,054/5,531 (91%) ICU beds. During the outbreak, 4,806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2,283), Post Anesthetic Care Unit and Operating Theatre (PACU & OT, 1,522), Other Units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9,860, 1,982 and 3,089 ICU, ACU and PACU beds were made available.Before the outbreak, 3,548 physicians (2,224 critical care anesthesiologists, 898 intensivists and 275 from other specialties, 151 pediatrics), 1,785 residents, 11,023 nurses and 6,763 nursing auxiliaries worked in established ICUs. During the outbreak, 2,524 physicians, 715 residents, 7,722 nurses and 3,043 nursing auxiliaries supplemented the usual staff in all ICUs. 3,212 new ventilators were added to the 5,997 initially available in ICU. Conclusion: During the COVID-19 outbreak, the French Health Care system created 4,806 ICU beds (+ 95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anesthesiologists, emergency physicians as well as the mobilization of nursing staff were primordial in this context. Trial Registration: Clinical Trials (NCT04420286) Funding Statement: Logistical support by Nimes University Hospital Declaration of Interests: None. Ethics Approval Statement: This retrospective multicentric observational study was approved by the Institutional Review Board of the French Society of Anesthesia and Critical Care (CERAR# 00010254-2020-094, May 6th 2020).