the role of the anesthesiologist in the icu (.ppt)
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The following slide presentation is part of the ASA Public Education Slide series.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
THE ROLE OF THE THE ROLE OF THE ANESTHESIOLOGIST ANESTHESIOLOGIST
IN THE IN THE INTENSIVE CARE UNIT INTENSIVE CARE UNIT
(ICU)(ICU)American Society of AnesthesiologistsAmerican Society of Anesthesiologists
Public Education SeriesPublic Education Series
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
1998 Demographics of ICU 1998 Demographics of ICU CareCare
• 5,981 adult, non-cardiac ICUs5,981 adult, non-cardiac ICUs• 72,416 ICU beds72,416 ICU beds• 54,829 ICU patients per day54,829 ICU patients per day
20,000,000 patient days per year20,000,000 patient days per year
CCommittee ommittee oon n MManpower for anpower for PPulmonary ulmonary aand nd CCritical ritical CCare are SSocietiesocieties
(COMPACCS)(COMPACCS)
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Intensive Care UnitIntensive Care Unit
• Aging populationAging population• TraumaTrauma• Disaster preparednessDisaster preparedness
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Cost of Critical CareCost of Critical Care
• 5-10% of total beds in the US5-10% of total beds in the US• 15-20% of all hospital costs15-20% of all hospital costs• Hospital cost ~ 38% of total U.S. health care Hospital cost ~ 38% of total U.S. health care
costscosts• Annual cost of critical care ~ $64 billion Annual cost of critical care ~ $64 billion
(1995)(1995)
ATS BOD. ATS BOD. Am J Resp Crit Care MedAm J Resp Crit Care Med. 1997;156:1282-1301. 1997;156:1282-1301
Chalfin. Chalfin. Intensive Care MedIntensive Care Med. 1995;21:952-961. 1995;21:952-961
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Cost of Critical CareCost of Critical Care
• Health care is expensive:Health care is expensive:~ 13.5% GDP on Health Care (~ 7.5% ICU)~ 13.5% GDP on Health Care (~ 7.5% ICU)
• Critical Care Medicine is expensive: Critical Care Medicine is expensive: ~ 1% of Gross National Product~ 1% of Gross National Product
• Costs have increased Costs have increased ~ 6-12% per year~ 6-12% per year
The Expensive Care UnitThe Expensive Care UnitIngelhart NEJM 1999;340:70-76Ingelhart NEJM 1999;340:70-76
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Physicians who specialize in Physicians who specialize in
Critical Care Medicine Critical Care Medicine
play a pivotal role in play a pivotal role in
improving patient outcomesimproving patient outcomes
and and
decreasing the costdecreasing the cost
of intensive care.of intensive care.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
0
0.1
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0.3
0.4
0.5
0 0.1 0.2 0.3 0.4 0.5
Mortality rate for low intensity physician staffing
Mo
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or
hig
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hy
sic
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g
Brown
Manthous
Ghorra
Marini
Pollack
Reich
Al-Asadi
line of equivalency
Favors low intensity physician staffing
Favors high intensity physician staffing
ICU MortalityICU Mortality
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
0
2
4
6
8
10
12
14
0 2 4 6 8 10 12 14
ICU LOS for low intensity staffing
ICU
LO
S f
or
hig
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inte
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y s
taff
ing
Carson
Hanson
Li
Manthous
Marini
Multz1
Multz2
Pronovost
Reynolds
Tai
line of equivalency
Favors high intensity physician staffing
Favors low intensity physician staffing
ICU Length of StayICU Length of Stay
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Leapfrog GroupLeapfrog Group
Recognized the importance of having Recognized the importance of having trained intensivists in ICUs to provide trained intensivists in ICUs to provide
care for critically ill patients.care for critically ill patients.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Management of the critically ill patient Management of the critically ill patient is a challenge. is a challenge.
Anesthesiologists possess the skills Anesthesiologists possess the skills necessary to meet this challenge.necessary to meet this challenge.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
• Anesthesiologists have historically been Anesthesiologists have historically been leaders in providing critical care services.leaders in providing critical care services.
• The first “Respiratory Care Units” were The first “Respiratory Care Units” were established by anesthesiologists in the established by anesthesiologists in the 1950s.1950s.
• Anesthesiologists have played a pivotal role Anesthesiologists have played a pivotal role in the development of monitoring, life in the development of monitoring, life support and resuscitation.support and resuscitation.
• Anesthesiologists are leaders in the science Anesthesiologists are leaders in the science of safe systems in health care.of safe systems in health care.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Anesthesiologists have made significant Anesthesiologists have made significant contributions to the understanding of contributions to the understanding of
critical illnesses and in the development of critical illnesses and in the development of effective treatment methods.effective treatment methods.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
RISK OF ANESTHESIARISK OF ANESTHESIA
Anesthetic Mortality
17.9
2.20.040.7
02468
101214161820
1950 1975 1980 1989
Dea
ths
per
10,
000
anes
thet
ics
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Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Severinghaus Pontoppidan
Downs
Kirby
Bendixen
Safar
Anesthesiologist Contributions to Anesthesiologist Contributions to ICU CareICU Care
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Recent Advances in Critical Care Recent Advances in Critical Care MedicineMedicine
• Respiratory management in acute lung injuryRespiratory management in acute lung injury• Treatment of sepsisTreatment of sepsis• Management of sedation and analgesiaManagement of sedation and analgesia• Management of blood sugarManagement of blood sugar• Transfusion therapyTransfusion therapy
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Recent Advances in Critical Care Recent Advances in Critical Care MedicineMedicine
• Development of strategies to reduce the Development of strategies to reduce the incidence of ventilator-associated pneumoniaincidence of ventilator-associated pneumonia
• Therapies to prevent deep venous thrombosisTherapies to prevent deep venous thrombosis• Therapies to prevent gastrointestinal bleedingTherapies to prevent gastrointestinal bleeding• Treatment of cardiac dysfunction and rhythm Treatment of cardiac dysfunction and rhythm
abnormalitiesabnormalities
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Anesthesiologists have particular Anesthesiologists have particular expertise in:expertise in:
• Physiology of all organ systemsPhysiology of all organ systems– Normal physiologyNormal physiology– Physiology related to disease, illness, surgery, Physiology related to disease, illness, surgery,
traumatrauma– ResuscitationResuscitation
• PharmacologyPharmacology– SedativesSedatives– AnalgesicsAnalgesics– Muscle relaxantsMuscle relaxants– Resuscitation medicationsResuscitation medications
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Anesthesiologists have particular Anesthesiologists have particular expertise in:expertise in:
• Airway management and respiratorsAirway management and respirators• Management of painManagement of pain• Invasive monitoringInvasive monitoring• Management of the surgical patientManagement of the surgical patient• Patient safetyPatient safety
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
The American Board of Anesthesiology The American Board of Anesthesiology was the first specialty board to offer a was the first specialty board to offer a
special qualification examination special qualification examination process in process in
Critical Care Medicine.Critical Care Medicine.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
THE ANESTHESIOLOGISTTHE ANESTHESIOLOGISTPHYSICIANPHYSICIAN / MEDICAL SPECIALIST / MEDICAL SPECIALIST
• 4 years college4 years college• 4 years medical school4 years medical school• 1 year internship1 year internship• 3 years residency training in 3 years residency training in
anesthesiologyanesthesiology• 6 months critical care 6 months critical care
medicinemedicine• 1 year subspecialty fellowship 1 year subspecialty fellowship
training in Critical Care training in Critical Care MedicineMedicine
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
THE ANESTHESIOLOGISTTHE ANESTHESIOLOGISTPHYSICIAN / MEDICAL SPECIALISTPHYSICIAN / MEDICAL SPECIALIST
American Board of AnesthesiologyAmerican Board of Anesthesiology
written examinationwritten examination oral examinationoral examination
recertification examinationrecertification examination subspecialty certificationsubspecialty certification
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
THE ANESTHESIOLOGISTTHE ANESTHESIOLOGISTNOT JUST IN THE OPERATING ROOMNOT JUST IN THE OPERATING ROOM
• Operating roomOperating roomhospitalhospital
surgical centersurgical center
physician officephysician office• Labor & delivery suiteLabor & delivery suite• Other procedural areasOther procedural areas• Intensive care unitIntensive care unit• PACUPACU• Pain managementPain management
acuteacute
chronic / cancerchronic / cancer
• ““Code Blue” teamCode Blue” team• Respiratory therapyRespiratory therapy• AdministrationAdministration
operating roomoperating room
hospitalhospital
medical schoolmedical school• EducationEducation
health professionalshealth professionals
publicpublic• ResearchResearch
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.