A hospital faced an "overwhelming demand" for critical care services as a result of the coronavirus pandemic.
The Princess Alexandra Hospital, in Harlow, Essex has had 205 deaths of patients with the disease.
A report, marked private but published in hospital board papers, said there was a "high" of 33 Covid-19 positive patients being treated on ventilators.
The hospital trust's chief executive said he was "extremely proud" of how staff had responded to the pandemic.
The report said a "rapid response peer review" of critical care services at the Harlow hospital had been undertaken.
"This was in response to a request from the NHS England critical care incident cell about the impact that the overwhelming demand for critical care services as a result of the Covid-19 pandemic may have had on the care of our patients," it said.
Six recommendations have come from the review, including limiting critical care to 15 patients, setting up a "buddying" system with nearby hospitals, and a planned "cohorting of patients into one covid and one non-covid area".
As of 27 May, the number of patients known to have the virus was down to four, and NHS England figures show no new deaths have been announced at the hospital over the past week.
Chief executive for The Princess Alexandra Hospital NHS Trust, Lance McCarthy, said: "Our colleagues continue to go over and above in delivering care to our patients - or supporting those who are delivering care - and have met the challenges they have faced with energy, effort and above all, dedication to our patients."
Mr McCarthy said they saw a "very high demand for our critical care services at the beginning of the coronavirus pandemic", adding: "Our patients continued to receive safe and high quality care."