the role of the anesthesiologist in the icu (.ppt)

The following slide presentation is part of the ASA Public Education Slide series.

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

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)

Intensive Care UnitIntensive Care Unit

• Aging populationAging population• TraumaTrauma• Disaster preparednessDisaster preparedness

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

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

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.

0 0.1 0.2 0.3 0.4 0.5

Mortality rate for low intensity physician staffing

Manthous

Ghorra

Marini

Pollack

Al-Asadi

line of equivalency

Favors low intensity physician staffing

Favors high intensity physician staffing

ICU MortalityICU Mortality

0 2 4 6 8 10 12 14

ICU LOS for low intensity staffing

Carson

Hanson

Manthous

Marini

Multz1

Multz2

Pronovost

Reynolds

line of equivalency

Favors high intensity physician staffing

Favors low intensity physician staffing

ICU Length of StayICU Length of Stay

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.

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.

• 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.

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.

RISK OF ANESTHESIARISK OF ANESTHESIA

Anesthetic Mortality

2.20.040.7

101214161820

1950 1975 1980 1989

Severinghaus Pontoppidan

Bendixen

Anesthesiologist Contributions to Anesthesiologist Contributions to ICU CareICU Care

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

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

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

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

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.

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

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

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

the role of the anesthesiologist in the icu (.ppt)

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