ICU Demand Ups COVID-19 Mortality: Colorado Health Study

A new study conducted by researchers at the Colorado School of Public Health has revealed critical insights into how ICU capacity influenced patient mortality during the heights of the COVID-19 pandemic in Colorado. A major public health objective during the pandemic was to 'flatten the curve' to prevent overwhelming hospital and ICU capacities, which would have led to deteriorated standards of care and high mortality rates. While Colorado successfully avoided such a crisis, this study delves into the subtler effects of high ICU occupancy on patient outcomes.

The research, which was published earlier this week by BMJ, spanned from August 2020 to March 2022, tracked patients admitted to intensive care units (ICUs) with COVID-19 across 34 hospital systems with large ICUs in Colorado. By examining ICU occupancy levels during patients' stays, the study aimed to determine whether higher patient loads contributed to increased mortality rates among COVID-19 patients.

Utilizing a robust modeling approach that accounted for patient age, sex, and vaccination status, the study uncovered significant findings:

• Increased Mortality During High ICU Loads: During the Delta variant era, the period marked by the most harmful COVID-19 variant, patients in ICUs operating at high capacity (levels seen above 75% of the time) faced an approximately 26% greater odds of death. This trend was not observed during the pre or post-Delta period.
• Increased mortality with higher Ventilator Use: Across both the Delta and Omicron periods, COVID-19 patients in ICUs with a high number of ventilators in use also experienced a greater risk of death.
• Collaboration between public health and providers is essential: Access to data and a collaborative working partnership proved invaluable to this study. In doing so, each sector can better monitor crisis responses, as with a pandemic and potential other health crises, natural disasters, or community response efforts. A key strength of this study lies in its access to patient-level data, offering detailed insights that align with previous research based on group-level data. These findings underscore the importance of managing ICU capacity not just to avoid surpassing full capacity but also to mitigate the impact on patient survival rates even before maximum capacity is reached.

Quotes from the Research Team:

"Our study highlights that the stress experienced by ICUs operating at high capacity, even if not completely full, can significantly affect patient outcomes," said Elizabeth Carlton, Professor at the Colorado School of Public Health. "This underscores the critical need for tools to anticipate surges and effective resource management in healthcare systems, particularly during pandemics."

Implications for Future Pandemic and Crisis Planning:

These findings provide valuable lessons for planning for future pandemics and infectious disease outbreaks. They show that ICU stress can impact patient outcomes. By recognizing and addressing the nuances of ICU capacity stress, healthcare systems can better prepare for and respond to similar public health crises in the future.

About the Colorado School of Public Health

The Colorado School of Public Health is the first and only accredited school of public health in the Rocky Mountain Region, attracting top tier faculty and students from across the country, and providing a vital contribution towards ensuring our region's health and well-being. Collaboratively formed in 2008 by the University of Colorado, Colorado State University, and the University of Northern Colorado, the Colorado School of Public Health provides training, innovative research and community service to actively address public health issues including chronic disease, access to health care, environmental threats, emerging infectious diseases, and costly injuries.

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado