Pandemic Research

We are investigating how restricted visitation policies have affected ICU patients, family members of patients, healthcare providers, administrators and decision makers in Canadian ICUs across Canada. 

We assembled a multidisciplinary team with clinicians, researchers, patient partners and knowledge users across Canada. Using a phased approach we aim to create evidence-informed consensus statements.

You can follow the study's social media channels to keep up to date with new updates on our study. Follow us on twitter: @ICU_Visitation.

Study Description

Background: On March 11, 2020 the World Health Organization declared the COVID-19 disease outbreak a global pandemic. Approximately 14% of people infected with SARS-COV-2 will develop severe disease that requires hospitalization, and 5% require admission to an intensive care unit (ICU). In severe cases, COVID-19 can be complicated by acute respiratory distress syndrome (ARDS), which carries a high risk of death. Most patients with ARDS require intubation and mechanical ventilation in the ICU. Prone positioning (PP) for >12-16 hours per day reduces mortality by approximately 26% in mechanically ventilated patients with ARDS. It stands to reason that the benefits of PP in hypoxemic respiratory failure patients would hold true in those who are not receiving mechanical ventilation. The possible benefits of PP for non-mechanically ventilated patients include:

1. Reduced atelectasis of dependant posterior lung regions
2. Improved oxygenation through better ventilation / perfusion matching
3. Reduced work of breathing from improved lung compliance
4. Reduced self induced lung injury from large pleural pressure swings
5. Improved secretion clearance from dependant lung regions.

There have been no prior randomized studies evaluating PP for non-intubated patients on regular hospital wards, where the majority of affected COVID-19 patients will be treated. There are currently no other registered randomized controlled trials evaluating PP during the COVID-19 pandemic.

Objective: Determine whether PP improves clinical outcomes for non-intubated hospitalized patients with hypoxemic respiratory failure due to COVID-19. We hypothesize that PP will reduce in-hospital mortality compared with usual care for non-intubated patients with hypoxemic respiratory failure due to COVID-19.

Design & Setting: This will be a multi-centre, open-label randomized trial at 4 hospitals in Calgary, Alberta comparing PP to usual care. This study will inform the scale up to additional hospital sites across Alberta.

Population: 

• Inclusion Criteria: Adult patients with confirmed or suspected COVID-19 admitted to Calgary hospitals will be enrolled if they provide verbal consent, are physically capable of self positioning into PP and require more than 2L of oxygen to maintain saturations >92%. 
• Exclusion Criteria: Patients will be excluded if they are admitted directly to the ICU or have hemodynamic instability, cardiogenic pulmonary edema, hypercapnic respiratory failure (PaCO2>45 mmHg), decreased level of consciousness, are unable to reposition themselves, or have other contraindications to prolonged PP (i.e. pregnancy, recent surgery).

Intervention and Standard Care Groups: The intervention group will receive instructions to assume a PP four times per day from nursing staff and respiratory therapists. Adherence and changes in oxygenation 5-10 min after PP will be recorded. The targeted duration of PP is ≥8 hours per day. Patients will be asked to self-position in a PP for 2-hour sessions, four-times per day during the day. The standard care group will receive usual medical care without prompting to assume a PP.

Study Description

We investigated the impact of COVID-19 on Intensive Care Units (ICU’s) and ICU physicians. Canadian Critical Care physicians participated in brief, semi-structured, telephone interviews and spoke about 1) perceived factors affecting the capacity of ICUs to manage patient with COVID-19 2) personal and professional implications of working during an infectious disease outbreak.

Study Objective

Explore critical care physicians’ perceptions, experiences and implications of resource strain in the context of caring for critically ill patients with COVID-19, including implications for patient care, and the impact on physicians; professional and personal lives.

Eligibility

ICU physician working in Canadian Universities with adult critical care training programs.

Next Steps

We are currently in the process of submitting this manuscript for publication. Future work in this area will include a longitudinal component of the changing impacts on healthcare providers during the COVID-19 pandemic and how strategies to ameliorate and manage negative impacts.

Study Description:

Worldwide spread of the novel coronavirus that causes COVID-19 has been fast and severe. Frequent updates from government, health, and social media help keep the public informed. Yet, the spread of misleading and incorrect information is also common. Incomplete information can negatively impact how individuals and communities respond to the outbreak. Our research team conducted a national survey (April 26 to May 1^st) to identify and understand the many factors that may be influencing Canadians actions and reactions to this pandemic. 

Study Objectives

Capture a broad snapshot of public perceptions, knowledge, and behaviors related to the COVID-19 pandemic.

Study Eligibility

• Adult (18 years or older)
• Reside in Canada
• Read English or French

Next Steps

1. Data collection is completed (access aggregate study findings)
2. One manuscript submitted for publication and second manuscript in development
3. Further explore survey results (click to complete questionnaire to participate in other studies)