Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Dvanaest beba bb, 78000, Banja Luka, Bosnia and Herzegovina.
Medical faculty, University of Heidelberg, Heidelberg, Germany.
Med Klin Intensivmed Notfmed. 2022 May;117(4):269-275. doi: 10.1007/s00063-021-00778-4. Epub 2021 Jan 24.
Critical care medicine is a relatively young discipline, developed in the mid-1950s in response to the outbreak of poliomyelitis. The mass application of mechanical ventilation and its subsequent technical advancement helped manage large numbers of patients with respiratory failure. This branch of medicine evolved much faster in high-income (HIC) than low- and middle-income countries (LMIC). Seventy years later, mankind's encounter with coronavirus disease 2019 (COVID-19) represents another major challenge for critical care medicine especially in LMIC countries where over two thirds of the world population live.
Systematic analysis of written documents related to the establishment of the first multidisciplinary medical intensive care unit (MICU) in Bosnia and Herzegovina and its development to the present day.
We describe the experience of setting up a modern critical care program under LMIC constraints as a promising way forward to meet the increased worldwide demand for critical care. Successful development is contingent on formal education and continued mentorship from HIC, establishment of a multidisciplinary team, the support from local health care authorities, development of a formal subspecialty training, academic faculty development, and research. Novel technologies including tele-education provide additional opportunities for rapid development and dissemination of critical care medicine programs in LMIC.
Critical care medicine is a critical public health need in HIC and LMIC alike. The challenges associated with the coronavirus pandemic should serve as a wakeup call for rapid development of critical care programs around the world.
重症医学是一门相对年轻的学科，于 20 世纪 50 年代中期在小儿麻痹症爆发的背景下发展起来。机械通气的广泛应用及其随后的技术进步，帮助管理了大量呼吸衰竭患者。该医学分支在高收入国家（HIC）的发展速度远远快于中低收入国家（LMIC）。70 年后，人类在 2019 年冠状病毒病（COVID-19）的遭遇，对重症医学特别是在占世界人口三分之二以上的中低收入国家来说，是另一个重大挑战。
对波黑建立第一个多学科医疗重症监护病房（MICU）及其至今的发展情况的相关书面文件进行系统分析。
我们描述了在中低收入国家的限制下建立现代重症监护计划的经验，这是满足全球对重症监护日益增长的需求的一个有希望的途径。成功发展取决于来自 HIC 的正规教育和持续指导、建立多学科团队、获得当地卫生保健当局的支持、建立正式的亚专科培训、学术教师发展和研究。包括远程教育在内的新技术为中低收入国家重症医学项目的快速发展和传播提供了更多机会。
重症医学在 HIC 和 LMIC 都是公共卫生的重要需求。与冠状病毒大流行相关的挑战应该成为全球重症监护计划快速发展的警钟。
