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The Future of Critical Care Medicine: A Difficult Reality to Predict?

Federico Acharta MD, an Argentinian physician, addresses the profound dichotomy in the future of Critical Medicine due to advances in tech, coupled with significant decreases critical care personnel.

During the last 20 years that I have been working as a Specialist Physician in Intensive Care with exhausting days at the bedside of patients, I did not experience the sensations that I have had in the last 3 or 4 years in my medical practice.

In recent years I feel that there is a profound dichotomy in the future of Critical Medicine. The have been enormous advances in the technological field that generate an evolutionary control never seen before on the patient with the generation of large amounts of data for their critical management. There’s also a marked, sustained and significant decrease in the number of Health Personnel dedicated to Critical Medicine.

I’m torn. On one hand, there is an incredible and exciting advance in technologies.

These allow monitoring, diagnosing and treating each patient in the most individualized way possible, seeking the best possible result with this form of personalized therapy (or at least that’s what we want to believe…).

 

Among these advances are:

  • Continuous hemodynamic monitoring
  • Continuous EEG at the patient’s bedside
  • Electrical Impedance Tomography and continuous and real-time monitoring of respiratory dys-synchrony (that allows for the most detailed non-invasive respiratory monitoring in the respiratory field to date)
  • Critical Ultrasound performed in a focused way and oriented to the clinical situation of the patient

.. and more.

 

However, all of this highly complex monitoring generates an enormous amount of information.

This information must be evaluated by trained Health Personnel with experience in Critical Care because, without that, it can lead to serious therapeutic errors if this large amount of information is misinterpreted or biased just by looking some highly complex continuous monitoring variables.

“There will be a lot more real-time patient information available from the biosensors than ever before. The intensivists will not have the capacity to process all this information to draw insights into the patient’s condition for follow-up action. To provide real-time insights into this deluge of information, AI-based tools will become a necessity,” tells Srinivas Prasad, founder and CEO of Neusights.

“As the need for intensive care continues to increase, key challenges for the future will be to ensure that sufficient ICU beds are available for those who can benefit, with adequate numbers of trained physicians and nurses,” says Vincent, Jean-Louis, and Jacques Creteur, from Paradigm Shifts in Critical Care Medicine: The Progress We Have Made.

On the other hand, there is a continuous and permanent decrease in the Health Personnel dedicated to Critical Care, throughout the world.

 

The reasons are simple and easy to understand.

 

  • High degree of stress associated with the workplace.
  • Constant and multiple emergencies during the long shift hours in the Critical Units.
  • Little recognition of the specialty without remuneration according to the physical-psychological wear and tear suffered after performing this type of Intensive Medicine throughout the years.

 

This is just to name some of the causes, although there are many others that could come into consideration, especially in underdeveloped countries like the one I live in. If you want to know where, it’s Argentina.

This explosive cocktail of problems within Critical Medicine already existed even before the Sars-Cov2 pandemic, as can be seen in an older article from the Chest Journal (Special Report. Volume 125. ISSUE 4. P1518-1521. April 01, 2004).

This is of vital importance, because if actions had been taken in due time and form, the incidence of Burnout and abandonment of the specialties within Critical Medicine that is produced and experienced today could have been reduced.

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