Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Curr Opin Anaesthesiol. 2021 Apr 1;34(2):149-153. doi: 10.1097/ACO.0000000000000970.
The ICU is a complex ecosystem in which intensive care physicians, advanced practice providers (APPs), pharmacists, and respiratory therapists work in concert to take care of critically ill patients. The SARS COV2 pandemic highlighted weaknesses in the American healthcare system. This article explores the ability of American healthcare to adapt to this challenge.
With the COVID-19 pandemic, intensivists, and ventilators have been identified as the most critical components leading to shortages in ICU capacity. Anesthesiologists play a unique role in being able to provide 'flex capacity' with critical care staffing, space, and equipment (post-anesthesia care units, operating rooms, and ventilators). With the advent of APPs, intensive care physician staffing ratios may potentially be increased to cover patients safely in a physician-led team model. Tele-medicine expands this further and can allow hospital coordination for optimizing ICU bed use.
Although intensivists have been able to take care of the increased ICU caseload during the COVID-19 pandemic through recruiting other specialties, the question of what is the appropriate staffing model for the future is yet to be elucidated. Creating stronger multidisciplinary care teams that have the capacity to flex up critical care capacity may be the most prudent longer-term solution.
重症监护病房（ICU）是一个复杂的生态系统，重症监护医师、高级执业医师（APP）、药剂师和呼吸治疗师共同协作，照顾重症患者。SARS COV2 大流行凸显了美国医疗体系的弱点。本文探讨了美国医疗体系适应这一挑战的能力。
随着 COVID-19 大流行，麻醉师被确定为导致 ICU 容量短缺的最关键因素，他们能够通过提供关键护理人员配备、空间和设备（麻醉后护理单元、手术室和呼吸机）来提供“灵活的容量”。随着 APP 的出现，重症监护医师的人员配备比例可能会增加，以在以医师为主导的团队模式下安全地照顾患者。远程医疗进一步扩大了这一范围，并可以实现医院之间的协调，以优化 ICU 床位的使用。
尽管在 COVID-19 大流行期间，通过招募其他专业人员，麻醉师能够照顾增加的 ICU 患者数量，但未来合适的人员配备模式仍有待阐明。创建具有灵活增加重症监护能力的更强的多学科护理团队可能是更谨慎的长期解决方案。
