RESUMEN
Conditions created by the COVID-19 pandemic have impacted many aspects of medical practice. Responding to this crisis has required health systems to rapidly address a multitude of concerns, including workforce safety, staff redeployment, supply shortages and physical space restructuring. The pace of change created by new information and evolving conditions has proven challenging for traditionally-structured academic departments in medicine. Pandemic medicine requires a nimbleness in decision-making, clarity of communication and comprehensiveness of services that may demand a temporary rearrangement of leadership structure and clinical service delivery. Furthermore, the uncertain nature of a pandemic may require reinstitution and dissolution of services as demand sporadically either rises or falls. As the global medical community continues to respond to what may be multiple COVID-19 peaks stretching over months or years, it is important that approaches to preparation and management of the pandemic are shared to enable the identification of best practices and an effective response. With the availability of open access and free communication technologies, these strategies can be easily shared among the global anaesthesia community. The approach outlined here represents one way to organise leadership and streamline communication in order to reinvent an academic department to match the dynamic requirements of crisis conditions. We describe our experience in offering new services such as an airway team, COVID-19 simulation training and personal protective equipment testing, as well as our approach to evaluating the rapid flow of research findings related to SARS-CoV-2 and COVID-19. We summarise lessons learnt and our adaptation to what may be a “new normal” in anaesthesiology practice. © 2021 The Author(s).
RESUMEN
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.