Comparative Outcomes Between Classic and Silent ICU Models During COVID-19 Surge in Taiwan: A Real-World Cohort Analysis from a Dual-Campus Medical Center

<b>Background</b>: During Taiwan's May 2021 COVID-19 surge, hospitals expanded ICU capacity using both conventional and ward-converted ("silent") ICUs. <b>Methods</b>: We retrospectively compared adults with severe COVID-19 admitted to three ICUs (two classic and one ward-based) between May and August 2021. The primary outcome was ICU mortality; secondary outcomes included ventilator-weaning success and complications. <b>Results</b>: Sixty-four patients were included (28 classic, 36 silent ICU). Baseline severity was comparable (median APACHE II 21 vs. 20). ICU mortality was 29% vs. 36% (risk difference 7.5%, 95% CI -18.6 to 33.1). No difference was found in weaning success or complication rates. No staff infections occurred. <b>Conclusions</b>: Outcomes in the ward-converted silent ICU were comparable to those in classic ICUs. With appropriate infection control and staffing, silent ICUs can safely expand surge capacity.