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Analysis

Coronavirus: How to Redeploy Anesthesiology Resources to the ICU Setting

By Christopher Cheney  
   April 09, 2020

With the coronavirus pandemic creating shortages of critical care staff and ventilators, anesthesiology resources can fill the gaps.

Operating room anesthesiologists and their equipment are well-suited to help treat coronavirus disease 2019 (COVID-19) patients, an anesthesiology expert says.

In COVID-19 hotspots such as New York City, there are shortages of critical care personnel and ventilators to treat severely ill coronavirus patients, and these shortages are expected to spread nationwide. To help address these shortages, OR anesthesiologists and their anesthesia gas machines, which include a ventilator function, are being shifted to ICU settings.

"People are now seeing that anesthesiologists are critical care medicine physicians. We deal with patients in the OR, and now we are happy to help in the ICU to manage patients," says Mary Dale Peterson, MD, president of the American Society of Anesthesiologists (ASA), and executive vice president and chief operating officer of Corpus Christi, Texas-based Driscoll Health System.

She says OR anesthesiologists have the training and experience to transition to ICU care. All anesthesiologists get a minimum of four months of concentrated work in intensive care units during a residency, and many other anesthesiologists also complete a fellowship year in critical care medicine and become board-certified in critical care medicine, Peterson says.

"It's common in large medical systems or smaller organizations where the anesthesiologists may have the most experience in critical care medicine. Every day, we deal with patients coming to us from critical care units or patients who are transitioning after major operations to critical care. Essentially, we provide bedside critical care while patients are in the OR getting major operations done," she says.

For anesthesiologists who have not practiced for several years or had their critical care training many years ago, the ASA and partner organizations have developed training resources to get them prepared for working in the ICU setting, Peterson says.

ASA, the Society of Critical Care Medicine, the Anesthesia Patient Safety Foundation, and the Society of Critical Care Anesthesiologists put together a specialized training just for anesthesiologists going back into the ICUs. It is basically a quick refresher course on managing patients in an ICU, she says.

Anesthesiologists can play several critical care roles to help treat COVID-19 patients, Peterson says.

"Hospitals have taken their anesthesia resources and used them in different ways. Some are deploying anesthesiologists full time to ICUs to take care of patients alongside their critical care medicine colleagues. Others are creating teams of anesthesiologists to relieve the burden of doing some procedures on COVID-19 patients such as intubation and putting in special monitoring lines."

Converting anesthesia gas machines to ICU ventilators

The ASA and the Anesthesia Patient Safety Foundation have established guidelines for redeploying anesthesia gas machines as ventilators in ICUs.

Primary considerations for converting anesthesia gas machines to ICU ventilators include installing extra filters to prevent contaminating the machines with coronavirus and setting humidification properly to ensure COVID-19 patients are not receiving too much dry air in their lungs, Peterson says.

Anesthesia gas machines also have advanced capabilities that are beneficial under coronavirus pandemic conditions such as vaporizers for delivering anesthetics that are in liquid form, she says. "For the most part, we do not need that in the ICU; but some ICUs are running out of sedative drugs, so we can deliver very low doses of our general anesthetic to keep patients sedated while they are on breathing machines."

At least initially, it is recommended to have OR anesthesiologists set up and monitor anesthesia gas machines that have been redeployed for ICU use, Peterson says. "They are different from ICU ventilators. We want the personnel who are most familiar with these machines to be the ones doing the conversion."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Anesthesiologists are trained in critical care medicine and provide beside critical care in operating rooms during major operations.

Specialized critical care training is available to refresh anesthesiologists who have not practiced for several years or had their critical care training many years ago.

With many hospitals facing shortages of ICU ventilators to care for severely ill coronavirus patients, OR anesthesia gas machines can be converted for the ICU setting.

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