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Introduction: Northern Ireland (NI) has 5.5 ICU beds/100 000 population,1 amongst the lowest in Western Europe.2 Alongside ICU bed expansion the Covid-19 response required delivery of advanced Respiratory support (Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO)) outside ICU. ICNARC provides robust data for patients within ICU but this is unavailable for those receiving 'critical care' elsewhere. Objective(s): To evaluate delivery of CPAP/HFNO outside of ICU to Covid-19 patients - focusing on demographics and outcomes including ICU admission and mortality. Method(s): Ward-CPAP for acute hypoxaemic respiratory failure (AHRF) was not previously utilised.3 It was introduced for Covid-19 to Medical wards. Data was analysed using the NI Electronic Care Record, ward electronic note system (EDAMS) and ICU system (ICCA, Koninklijke Philips N.V.). Data was compared between Wave 1 (01/03/2020 - 12/12/2020) and Wave 2 (13/12/2020 - 01/04/2021). Result(s): 215 patients received CPAP/HFNO/Invasive Mechanical Ventilation (IMV) for Covid-19: 103 in Wave 1 and 112 in Wave 2. 75 Covid-19 patients were admitted to the ICU itself (comprising 44 of the study cohort, 11 direct from ED and 20 transferred from other Trusts). Table 1 shows demographics. Fewer patients were female as seen elsewhere,4 there were more young patients in Wave 2. The majority of patients would likely have been ICU candidates pre-pandemic,3 but a subset of 25% were deemed for a ward ceiling-of-care on admission by a Consultant and the proportion of elderly patients was higher than described by ICNARC.4 Comorbidities and obesity were common. Outcomes are shown in Table 2 and Figures 1-3. Close co-operation with ICU saw 61% of patients with a documented ICU review. Overall 20% of patients were admitted to ICU, and 15% received IMV. Mortality was 37%, but 22% if patients with an admission ward ceiling-of-care decision were excluded. Mortality correlated with frailty and age (fig 2&3). Outcomes were generally better in Wave 2. Conclusion(s): This Evaluation documents the huge contribution to the critical care Covid-19 response made by our Medical teams, not captured by ICNARC. Most patients avoided ICU admission and IMV and outcomes were likely at least comparable which undoubtedly freed up vital ICU beds. We thank the teams involved and believe it is vital to evaluate the outcome of all critically ill Covid-19 patients irrespective of their location.
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Aims: High-dose corticosteroids reduce mortality in covid- 19 patients requiring oxygen therapy. Dexamethasone-induced hyperglycaemia is a known complication and linked to increased morbidity and mortality. The National Inpatient Diabetes Covid-19 Response Group produced guidance on corticosteroid therapy in covid-19 patients (June 2020). We assessed using the MicroGuide app® to help implement this guidance. Methods: We audited patients that received Dexamethasone and supplemental oxygen for covid-19 during two admission peaks -Oct/ Nov 2020 and Jan/ Feb 2021 (sample n = 30). Along with education and diabetes team ward-rounds, between peaks our trust introduced a guideline summary using the Microguide® smartphone-app. Results: In Oct/Nov20, 15 had known diabetes vs. 15 patients not known to have diabetes;11 and 19 respectively in Jan/Feb21. Capillary blood glucose (CBG) checks carried out as per guidelines in 27% of patients Oct/Nov20 vs. 64% of patients in Jan/Feb21. 60% experienced CBG >12mmol/l at least once in Oct/Nov20, compared with 70% in Jan/Feb21. Diabetic emergencies (DKA/HHS) were ruled out by ketone/pH testing in 57% in Oct/Nov20, improving to 76% in Jan/Feb21 (all had U+E checked). Of the insulin naïve population who experienced hyperglycaemia (n = 15 both), 27% were commenced on intermediate acting insulin Oct/Nov20 compared to 60% in Jan/ Feb21. Conclusion: Most patients experienced hyperglycaemia during admission. CBG monitoring by nursing staff improved between peaks, as did ruling out emergencies. Commencing intermediate-acting insulin if hyperglycaemic, as recommended, improved too. We believe the MicroGuide® app improved these outcomes as training and education of staff was limited during this time period, and this offered remote digital and easy accessible guidance.