RESUMEN
During the Covid-19 pandemic general interest in intensive care medicine emerged as besides a majority of other diseases and conditions also patients with Covid-19 pneumonia were treated by intensivists. This acute demand was taken as the rationale by the European Society of Intensive Care Medicine (ESICM), which represents only a small portion of all intensivists throughout Europe, to launch an initiative to recognize Intensive Care Medicine in Europe as a medical specialty according to Annexe V of the European Directive on the recognition of professional qualifications. The discussion having intensive care medicine as a primary discipline is old and the disadvantages have been clearly stated long ago. Intensive care medicine according to the Multidisciplinary Joint Committee of Intensive Care Medicine (MJCICM) of the European Union of Medical Specialists (UEMS) should be multidisciplinary as this serves our patients best. During the pandemic, we learned that all specialties that cover Intensive Care Medicine in their training were able to treat affected patients and to provide intensivists to additionally built ICUs. Most of them were anaesthesiologists who were set free from the operating theatres because of the cancellation of many elective operations. However, other disciplines that provide high-level ICU care, such as internal medicine, surgery, neurosurgery and cardiac surgery were also recruited to face the pandemic. With a single, primary specialty, this would have not been possible on that scale. Certainly, for all highly trained specialists, free movement throughout Europe is an important goal. Therefore, training in Intensive Care Medicine throughout Europe should be according to a common competence-based curriculum and this training and examination on top of a mother discipline should be recognized as a ‘particular qualifications’ throughout Europe. From our point of view, regarding Intensive Care Medicine, this approach in combination with competence-based training and examination in tandem with a primary discipline allows free movement of our doctors and also serves our patients best, for the future and also for the current and future pandemics. © Anästh Intensivmed 2021;62:513–516 Aktiv Druck & Verlag GmbH.
RESUMEN
BACKGROUND: A sharp rise in COVID-19 infections threatened to lead to a local overload of intensive care units in autumn 2020. To prevent this scenario a nationwide relocation concept was developed. METHODS: For the development of the concept publicly available infection rates of the leading infection authority in Germany were used. Within this concept six medical care regions (clusters) were designed around a center of maximum intensive care (ECMO option) based on the number of intensive care beds per 100,000 inhabitants. The concept describes the management structure including a structural chart, the individual tasks, the organization and the cluster assignment of the clinics. The transfers of intensive care patients within and between the clusters were recorded from 11 December 2020 to 31 January 2021. RESULT: In Germany and Baden-Württemberg, 1.5% of patients newly infected with SARS-CoV2 required intensive care treatment in mid-December 2020. With a 7-day incidence of 192 new infections in Germany, the hospitalization rate was 10% and 28-35% of the intensive care beds were occupied by COVID-19 patients. Only 16.8% of the intensive care beds were still available, in contrast to 35% in June 2020. The developed relocation concept has been in use in Baden-Württemberg starting from 10 December 2020. From then until 7 February 2021, a median of 24⯱ 5/54 intensive care patients were transferred within the individual clusters, in total 154 intensive care patients. Between the clusters, a minimum of 1 and a maximum of 15 (median 12.5) patients were transferred, 21 intensive care patients were transferred to other federal states and 21 intensive care patients were admitted from these states. The total number of intensive care patients transferred was 261. CONCLUSION: If the number of infections with SARS-CoV2 increases, a nationwide relocation concept for COVID-19 intensive care patients and non-COVID-19 intensive care patients should be installed at an early stage in order not to overwhelm the capacities of hospitals. Supply regions around a leading clinic with maximum intensive care options are to be defined with a central management that organizes the necessary relocations in cooperation with regional and superregional rescue service control centers. With this concept and the intensive care transports carried out, it was possible to effectively prevent the overload of individual clinics with COVID-19 patients in Baden-Württemberg. Due to that an almost unchanged number of patients requiring regular intensive care could be treated.
Asunto(s)
COVID-19 , Pandemias , Cuidados Críticos , Humanos , Unidades de Cuidados Intensivos , SARS-CoV-2RESUMEN
Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas;(b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection;(c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG);(d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.