Article
Reference
COVID-19 pandemic: A new path to intensive care medicine distinction?
GIRAUD, Raphaël, BENDJELID, Karim
GIRAUD, Raphaël, BENDJELID, Karim. COVID-19 pandemic: A new path to intensive care medicine distinction? Anaesthesia Critical Care & Pain Medicine , 2020
DOI : 10.1016/j.accpm.2020.07.010 PMID : 32712304
Available at:
http://archive-ouverte.unige.ch/unige:142398
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1 / 1
1
Editorial
2
COVID-19 pandemic: A new path to intensive care medicine
3
distinction?
4 ThecurrentCOVID-19pandemiciscausinganunprecedented 5 healthdisasterinourpostmodernworld[1].Neverbeforehasa 6 globalpandemic involvinganewrespiratorydiseasecausedthe 7 globalpopulationtobeinlockdown,withmanypatientsclustered 8 in hospitals [2]. At the forefront and on the front lines, the 9 intensivists at the core of this outbreak are enduring intense 10 workingconditionsandlearningfromtheirexperiences[3].
11 Inthegeneralpopulation,manyarediscoveringthisnew,little- 12 knownmedicalspecialty.Forpatientswhohavegonethroughan 13 intensivecareunit,thisexperienceisoftenablackhole:theyhave 14 littleornomemories,oronlybadones,ofthisepisodeintheirlives.
15 Fortherelativesofthesepatients,thisisoftenatimeofanxiety, 16 distressandpost-traumaticdisorders.However,thevastmajority 17 ofpeopleconfuseintensivecareunitswithemergencyroomsor 18 operatingtheatres.
19 Intensivecaremedicineisarathernewspecialty[4].TheSwiss 20 Societyof IntensiveCare Medicine (Socie´te´ suissede me´decine 21 intensive: SSMI) was created in Basel in 1972 [5]. Scientific 22 knowledge,appliedphysiologyand technological progresshave 23 contributed to the development of modern medicine. Initially, 24 internists,anaesthesiologistsandsurgeonscreated theintensive 25 caremodelandstructuretotreattheirmostseriouslyillpatients.
26 In this regard, organ transplantation and increasingly complex 27 interventions forced these pioneers to extend their know-how 28 beyondtheirrespectivespecialtiestotakecareoftheseseverely 29 sickpatients.Theinventorsofthisdisciplinehadtoconvincetheir 30 peers in these ‘‘mother’’ specialties that this particular, subtle 31 medicinewasadisciplineinitsownrightthatrequireditsown 32 trainingcourseanddefacto,itsownidentity.Itwasonlyafterlong 33 negotiationsinSwitzerlandthatin2001,theSpecialistDiplomain
34 Intensive Medicine was created and recognised by the FMH
35 (FoederatioMedicorumHelveticorum)[6].
36 Our elderswerepassionateaboutthediscoveriesand appli-
37 cations of the specific pathophysiology of shock conditions in
38 intensive care patients, as well as the correct use of new
39 technological devices, especially artificial ventilators [7]. They
40 devotedtheirlivesandcareerstojustifyingdailythemainspringof
41 ourspecialtyandtodevelopingandnourishingitthroughapplied
42 researchworkonthisnew,verytechnicalformofcare[8].Thanks
43 tothem,wearerealspecialistswhoarerecognisedbyourpeersin
44 our institutions, and we have inherited this passion for our
45 vocation.However,intheeyesofthegeneralpublic,ourspecialty
46 remains relatively unknownand, faced withpoliciesand other
47 insurancelobbies,littlerecognised.Proofofthislackofrecognition
48 isthatintensivecaremedicinesuffers,particularlyinSwitzerland,
49 fromacruellackofinterestforthisspecialisation.Indeed,beyond
50 thepassionoftheprofession,wefaceaharshrealityona daily
51 basis: a heavy workload (more than 80h per week for the
52 attendingphysician,includingbothnightandweekendshifts)and
53 anemotionaltoll(managementofthemostseriouslyillpatients
54 with an average of 10% mortality), with little or no visibility,
55 external recognitionorcompensationcommensuratewithmost
56 otheradvancedspecialties.
57 Thehistoryof intensivecaremedicineisevolutionaryrather
58 than revolutionary; it is a history of process and organisation.
59 Intensive caremedicine includesthe prevention, diagnosis and
60 treatment ofallforms ofdysfunctionandfailureofvital organs
61 wheretheprognosisispotentiallyfavourable.Itsexerciserequires
62 specific fundamental and clinical knowledge and management
63 skills.Themanagement ofintensivecarepatients isensuredby
64 specialiseddoctorsinspeciallyequippedpremises.Thewholeis
65 accreditedandregularlyreassessedbytheCertificationCommittee
66 oftheintensivecareunitsoftheSSMIonthebasisofwell-defined
67 and very stable directives and according to an extremely
68 structuredprocess[9].Thiscertificationprocessrespectsallthe
69 publishedrecommendationsinthefieldofhealthservices(2011)
70 oftheSwissAcademyofMedicalSciences(ASSM)[10],anditis
71 unique in theworld.Thespecialists in intensive caremedicine
72 must have the knowledge, skills and competences (medical,
73 ethical,economicandlegal)thatmakethemabletotreatpatients
74 inintensivecareunitsindependently.Additionally,theyshouldbe
75 abletodevelopsocialskillsallowingthemtoleadateamandhave
76 knowledgeinmanagementandcommunication(teamwork,team
77 building, etc.)The related postgraduate training lasts six years AnaesthCritCarePainMedxxx(2020)xxx–xxx
ARTICLE INFO
Keywords:
Intensivecaremedicine COVID-19pandemic GModel
ACCPM-712;No.ofPages2
Pleasecitethisarticleinpressas:Giraud R,Bendjelid K.COVID-19pandemic:Anewpathtointensivecaremedicinedistinction?.
AnaesthCritCarePainMed(2020),https://doi.org/10.1016/j.accpm.2020.07.010 https://doi.org/10.1016/j.accpm.2020.07.010
2352-5568/C 2020Socie´te´ franc¸aised’anesthe´sieetdere´animation(Sfar).PublishedbyElsevierMassonSAS.Allrightsreserved.
78 [11].Thistrainingmustprovidecandidateswiththetheoretical 79 knowledgeandpracticalskillstoenablethemtopracticeintensive 80 medicineindependentlyandresponsiblyundertheirownauthori- 81 ty.Inparticular,itincludesanatomy,physiology,pathophysiology 82 andpharmacology,ethics,healtheconomics,communicationand 83 thecareofterminallyillintensivecarepatientsandtheirrelatives.
84 This training must also enable the candidates to acquire the 85 capacitiestomanagepatientproblems,diseasesandthestructural 86 aspects of intensive care medicine in an interdisciplinary 87 collaboration.Thistraining is sanctioned by a writtenand oral 88 examorganisedeachyearbytheExamCommissionoftheSSMI.As 89 evidenced by the curriculum required to obtain the federal 90 specialist’sdiploma,intensivecaremedicineisamedical-technical 91 specialty in the same way as anaesthesiology, cardiology, 92 pulmonology,etc.are.
93 TheCOVID-19healthcrisishasbroughtintensivecaremedicineto 94 the forefront, turning its actors, including us, the intensive care 95 physicians,fromstrangersinto"heroes".However,makenomistake:
96 the artificial increase in the number of ‘‘intensive care’’ beds to 97 accommodate all these patients with acute respiratory distress 98 syndrome (ARDS) requiring the use of mechanical ventilation 99 (becauseusually,apartfromsurgical operations, itis only inthe 100 intensivecareunitsthatthistherapyshouldbedelivered)wasnot 101 donebymagic.Wedidnot,inafewdays,traindozensofintensive 102 carephysicianscapableoftreatingthistypeofverycomplexand 103 criticallyillpatients[12].Tomanagetheseintubatedandventilated 104 patients,wecalledonouranaesthesiologistcolleagues,andespecially 105 sinceelectivesurgeryprogramswerestoppedinthecontextofthis 106 healthcrisis.Ifsomeoftheseindividualshave,inthepast,obtained, 107 inadditiontotheirspecialistdiplomainanaesthesiology,thetitleof 108 specialistinintensivemedicine,givingthemdistantmemoriesabout 109 themechanicalventilationof ARDSpatients, mostarenotaccus- 110 tomedtotakingchargeofthisparticulartypeofpatients.Unlikeour 111 neighbouring countries such as France and Germany, where 112 anaesthesiologytrainingaccountsforalmostathirdoftherotations 113 inintensivecareunits,givingthemarealdiplomaandcompetencies 114 inanaesthesiologyandintensivecaremedicine,inSwitzerland,over 115 the 6-year postgraduate training course, only 6 months are 116 mandatorily dedicated to intensive care medicine [13], which is 117 onlyavagueinitiation.Therefore,abedequippedwithaventilatoris 118 notequivalenttoapatientmanagedbyanintensivecarephysician.
119 Thesameistrueforthenursingstaff.Fortunately,aclosepartnership 120 has been established within the various anaesthesiology and 121 intensive care departments in Swiss hospitals to optimise the 122 complexmanagementofthesepatients.Theassociationofourtwo 123 specialties and the present useful teamwork are very much 124 appreciated. May the future be supported and celebrate this 125 exceptionalepisodeofourprofessionallives.Perhapsthiswillhelp
126 toincreasetherecognition,visibilityandinterestinourbeautifuland
127 richspecialty.Goodlucktoall!
128 Financial/non-financialdisclosures
129 Theauthordeclaresthatnopotentialconflictsofinterestexist
130 withanycompanies/organisationswhoseproductsorservicesmay
131 bediscussedinthisarticle.
132 References
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163 Raphae¨lGirauda,b,c,d,*,KarimBendjelida,b,c
aIntensiveCareUnit,GenevaUniversityHospitals,Geneva,Switzerland 164
bFacultyofMedicine,UniversityofGeneva,Switzerland 165
cGenevaHaemodynamicResearchGroup,Switzerland 166
dPresidentoftheExamCommitteeoftheSwissSocietyofIntensiveCare 167 168 Medicine,Switzerland
*Correspondingauthorat:IntensiveCareService,GenevaUniversity 169 170 Hospitals,RueGabriellePerret-Gentil4,CH-1211Geneva,
171 Switzerland
172 E-mailaddress:Raphael.Giraud@hcuge.ch(R.Giraud)
173 Availableonlinexxx
Editorial/AnaesthCritCarePainMedxxx(2020)xxx–xxx 2
GModel
ACCPM-712;No.ofPages2
Pleasecitethisarticleinpressas:Giraud R,Bendjelid K.COVID-19pandemic:Anewpathtointensivecaremedicinedistinction?.
AnaesthCritCarePainMed(2020),https://doi.org/10.1016/j.accpm.2020.07.010
