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Wednesday, November 11, 2020
Intensive care beds at a glance
This is how it is in German clinics
By Martin Morcinek and Christoph Wolf
The high number of cases in Germany has long been noted in hospitals, and the number of intensive care patients from Covid is increasing. How many ventilation positions are occupied? Divi register data shows available capacities.
The high number of potentially endangered people makes the Sars-CoV-2 coronavirus so threatening: as long as there is no vaccine and no effective antidote, it must be tested under all circumstances to keep the number of infected people as low as possible . The experience of regions such as northern Italy or New York shows what scenarios would be expected in the event of a hospital overload. The death toll would inevitably increase significantly.
The map from ntv.de Germany shows exactly how clinics are used in Germany:
The basis for displaying the map is the so-called Divi-Register of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi). There, the information provided by the participating hospitals on intensive care treatment capacities is recorded and evaluated daily.
Given the recent rapid increase in new corona cases in Germany, the warnings of a catastrophic collapse in public health are becoming more urgent and louder. The imminent overload and the foreseeable consequences are one of the main arguments in favor of the significant contact restrictions decided on October 28, 2020 at the federal-state summit, which came into effect on November 2.
It is clear to all those responsible: an uncontrolled rise in coronavirus infections would overwhelm even the best healthcare system in the world within a few weeks.
“The objective of the Divi Intensive Care Registry is to make visible the availability of ventilation beds and advanced therapy measures for acute pulmonary insufficiency in Germany”, this is how the association of intensive care physicians, specialists and emergencies summarizes the idea behind the project . Behind the data collection there are about 2300 members, from individual specialists to researchers and professional associations to large professional associations and scientific institutes.
Divi parameters: the most important ratios
Analogous to the pandemic parameters of ntv.de, the Divi parameters show the most important key figures for clinical occupation. The basis is the information from the latest daily report. It shows the total number of Covid-19 intensive care cases and ventilated Covid-19 intensive care cases, as well as the number of occupied and free intensive care beds as reported to the intensive care registry.
The trend graph shows the evolution of the number of intensive care patients and ventilated Covid-19 cases over time. The time series begins in late April, the high phase of the first wave. At that time, more than 2,500 intensive care beds in Germany were occupied with corona cases at times.
The coronavirus pandemic gives Divi’s intensive care registry overview an additional importance: a lifting of requirements or further relaxation of protective measures is only medically justified as long as no overloads can be detected. in affected regions.
Data from the Divi Intensive Care Registry is much more reliable than other indicators for the infection process: here, specialists work with precisely determinable parameters and precisely documented case data. Unlike the infection rate, these are not estimates. There is also no unreported number as officially registered new infections for beds, supply capacities, or ventilation sites. However, there may be fluctuations in the report values, as the latest figures for all the reporting areas are not received every day before the daily report is published.
Intensive occupation according to federal states
That is why the intensive registry also offers a tabular summary by federal state, which is updated several times a day. In addition to the number of Covid intensive care patients and intensive care beds by federal state, the number of emergency reserves of intensive care beds that could be additionally provided within seven days is shown.
To monitor the performance data of the German healthcare system, intensive care physicians work closely with clinic operators, professional associations and scientists. There is also a cooperation with the Robert Koch Institute (RKI). Furthermore, participation in the Divi Register notification procedure has been mandatory for all hospitals with intensive care beds since mid-April by emergency ordinance.
As a result, politicians, experts, and the general public will have a monitoring tool at their fingertips to utilize German treatment capabilities. Furthermore, the recorded data also provides accurate figures on the intensive care performance of participating hospitals in almost all regions of Germany. If the crown crisis were to get worse again, this information can sometimes save lives: Which region of Germany is currently threatened with overload? In return, where are beds or even ventilation places available?
The Divi Register’s own specialists speak of a “milestone” regarding their data offering that is now also available to the public: the data provided gives physicians, hospital administrators, and planners for the first time a comprehensive overview of the pandemic situation. “What was and what is important for intensive care physicians to present the situation in the vicinity of each individual hospital. ‘What do I have to prepare for?’ It is an essential question in the pandemic situation, “a Divi spokesperson described the considerations in late May. “I can see what is happening in my clinic right now, but I also have to keep an eye on what is happening with my neighbors and beyond. Will they send me several serious cases in a few hours? Or is it more likely to happen? there? calm? “
The detailed map of intensive occupancy rates by clinic breaks down the current performance data of the German health system:
In the Divi Register system, the capabilities of the clinic differ, among other things, depending on the equipment. “Low care” refers to intensive care beds where simple ventilators are available, for example for the administration of additional oxygen through a mask.
The term “intensive care”, in turn, includes all those intensive care beds where so-called invasive ventilation is possible. Here, mechanical ventilation is provided through tubes that are inserted through the nose, mouth, or through an incision in the windpipe. Such places require considerably more complex equipment: the patient is usually in an artificial coma, connected to a large number of devices to monitor his vital data.
The third category describes the places called ECMO. The abbreviation stands for “Extracorporeal Membrane Oxygenation” and is the most expensive means of rescuing a patient from Covid 19. For people whose lungs are already badly damaged, this technology is often the last hope.
In principle, the ECMO device takes over the function of the lungs: to do this, the patient’s blood circulation is interrupted, the blood outside the body is enriched with oxygen, and then it is immediately pumped back to a suitable artery.
