Intensivist, Cleveland Clinic, Clinical Assistant Professor, Case Western Reserve University Lerner College of Medicine, OH, USA.
Ann Glob Health. 2024 Sep 19;90(1):59. doi: 10.5334/aogh.4506. eCollection 2024.
Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital.
在资源有限的地区（包括 ICU 内外），对危重症患者的护理是不可或缺的。Murthy 和 Adhikari 指出，大约 70%的中低收入国家（LMIC）地区的患者可以从良好的重症监护中受益。许多资源有限的环境中的患者在到达医院之前仍然死亡。通过加强和扩大 ICU 能力以及培训重症监护医师、重症监护护士、呼吸治疗师和其他 ICU 工作人员来进行能力建设投资至关重要，但这一过程需要数年时间。此外，拥有离偏远地区仍很遥远的先进医疗设施，对于缓解距离和交通方式这两个实现良好重症监护的障碍并没有太大帮助。本文讨论了移动重症监护单元（MCCU）在支持和加强现有紧急医疗系统方面的重要性。MCCU 将在解决偏远地区交通和获得适当救命性重症监护方面的严重延误方面发挥关键作用。它们具有难以置信的多功能性，可用于将重病患者从现场转移到更高水平的护理，在医院之间安全转移重症患者，有时更重要的是，在没有 ICU 或 ICU 无法立即获得的地区提供独立的短期重症监护。MCCU 不应作为初级保健的替代品，也不应用于绕过当地医疗中心现有的服务。重新思考传统的“院前急救”和“医院急救”模式至关重要，重点是要改善从现场到医院的危重症患者的护理。
