Bennett Suzanne, Grawe Erin, Jones Courtney, Josephs Sean A, Mechlin Maggie, Hurford William E
Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Curr Opin Anaesthesiol. 2018 Apr;31(2):165-171. doi: 10.1097/ACO.0000000000000560.
Given the extremely expensive nature of critical care medicine, it seems logical that intensivists should play an active role in designing efficient systems of care. The true value of intensivists, however, is not well defined.
Anesthesiologists have taken key roles in improving patient safety in the operating room. Anesthesia-related mortality rates have decreased from 20 deaths per 100 000 anesthetics in the early 1980s to less than one death per 100 000 currently. Anesthesiologist-intensivists remain rare (less than 5% of certified anesthesiologists), but increasingly play multiple roles within multidisciplinary teams. This review outlines the roles of intensivists in performance improvement, perioperative assessment; sedation services, extracorporeal and mechanical support, and code/rapid response teams. Critical-care physicians, by definition, work in collaborative multispecialty and multidisciplinary teams that make it difficult to isolate each team member's precise contribution to healthcare value.
Anesthesiologist-intensivists working outside their usual environment provide leadership and clinical guidance towards improving patient outcomes.
鉴于重症监护医学成本极高，重症监护医生在设计高效护理系统中发挥积极作用似乎是合乎逻辑的。然而，重症监护医生的真正价值尚未明确界定。
麻醉医生在提高手术室患者安全方面发挥了关键作用。与麻醉相关的死亡率已从20世纪80年代初每10万例麻醉中有20例死亡降至目前每10万例不到1例死亡。麻醉医生兼重症监护医生仍然很少见（不到5%的认证麻醉医生），但越来越多地在多学科团队中扮演多种角色。本综述概述了重症监护医生在绩效改进、围手术期评估、镇静服务、体外和机械支持以及代码/快速反应团队中的作用。根据定义，重症监护医生在协作的多专科和多学科团队中工作，这使得很难孤立每个团队成员对医疗价值的确切贡献。
在其通常环境之外工作的麻醉医生兼重症监护医生为改善患者预后提供领导和临床指导。
