The SARS-CoV-2 pandemic that causes COVID-191 has become a challenge for the entire healthcare system and other contexts. The rapid growth in the number of cases that require healthcare, hospitalization, and intensive care has led to implementing unparalleled contingency plans2 in the history of intensive medicine in our setting; the number of ICU beds has grown exponentially in hospitals and multiple areas have changed dramatically to accommodate these beds. Given the exceptional situation lived in Madrid, Spain 2 huge pavilions were opened in a local fairground as dedicated hospitals with 1250 beds and a 16-bed ICU with possibility to increase the number of beds—the so-called «COVID-19 IFEMA Hospital». In barely 24 h, in March 22nd, another interim resource was opened in another pavilion to alleviate pressure on conventional hospitals. At the same time, sectorization, logistics, computing, pharmacy, laboratory, medicinal gases canalization, etc. were set up in the «definitive» hospital that would start receiving patients 4 days later.

Setting up such a huge hospital like this one in such short notice was an enormous challenge as well as the initial selection of patients who needed hospitalization but whose condition was less serious and who were not multi-pathological. Still, both challenges were met, and healthcare was provided with good results. However, the gradual increase of complexity and the inevitable fact that the clinical condition of a percentage of patients would eventually deteriorate required ICU resources 5 days later.

The ICU requirements regarding infrastructure and central services are much more complex compared to conventional hospitalization. The ICU staff needs to work with standardized criteria and protocols beyond the general protocol for the management of COVID-19. Issues as common in the ICU setting as standard perfusions, artificial nutrition protocols, additional tests, procedures to prevent nosocomial infections, Zero projects,3,4 etc. need to be well-defined so critically ill patients can be treated while all safety measures are being observed. With this premise in mind, the possibility of creating or expanding an ICU in the add-on pavilion of a large hospital has numerous advantages. On the other hand, having an ICU with expert personnel available in this 1250-bed center, though an enormous challenge, makes intensivists physically available on location and avoids secondary transfers of patients who remain in critical condition.

The first medical equipment was transferred to the ICU by the Spanish Air Force Air Medical Unit of Assistance to the City of Madrid and it was complemented with donations and resources from other centers (ventilators, screens, anesthesia machines, hemofilters, etc.). The multiplicity of different devices requires special dedication by the health team, which translates into hours of training and rounds of adapted safety.5

The collapse of hospital-based intensive medicine services made it impossible to only have intensivists as the health personnel available. Two intensivists were relocated in this ICU full-time and teamed-up with other intensivists, anesthesiologists, and cardiologists who worked part-time with a mixed on-call system. The nursing team included mostly volunteers with ICU experience and other non-ICU nurses in rotation shifts plus military nurses and troops from the Spanish Air Force Air Medical Unit of Assistance to the City of Madrid.

Bedside blood tests were drawn, and microbiological analyses were conducted at the Hospital Universitario La Paz (8 km away from the pavilion) through a scheduled periodic transportation system of the samples collected. Also, we had ultrasound machines available and a service of radiodiagnosis with simple x-rays and CT scans.

Working in this healthcare setting requires a capacity for adaptation and teamwork. Thanks to the job done, a large number of patients had the invaluable opportunity of receiving treatment in these pavilions.