How the COVID-19 pandemic will change the future of critical care

Yaseen M Arabi¹, Elie Azoulay², Hasan M Al-Dorzi³, Jason Phua⁴, Jorge Salluh⁵, Alexandra Binnie^{6

7}, Carol Hodgson^{8

9

10

11}, Derek C Angus¹², Maurizio Cecconi^{13

14}, Bin Du¹⁵, Rob Fowler^{16

17

18}, Charles D Gomersall¹⁹, Peter Horby²⁰, Nicole P Juffermans²¹, Jozef Kesecioglu²², Ruth M Kleinpell²³, Flavia R Machado²⁴, Greg S Martin²⁵, Geert Meyfroidt²⁶, Andrew Rhodes²⁷, Kathryn Rowan²⁸, Jean-François Timsit²⁹, Jean-Louis Vincent³⁰, Giuseppe Citerio^{31

32}

Affiliations

¹ Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. arabi@ngha.med.sa.
² Medical Intensive Care Unit, Saint Louis University Hospital and Paris 7 University, 1 avenue Claude Vellefaux, 75010, Paris, France.
³ Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
⁴ FAST and Chronic Programmes, Alexandra Hospital, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.
⁵ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
⁶ Critical Care Department, William Osler Health System, Etobicoke, ON, Canada.
⁷ Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal.
⁸ Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
⁹ The Alfred Hospital, Melbourne, Australia.
¹⁰ Monash University, Melbourne, Australia.
¹¹ Monash Partners Academic Health Science Centre, Prahran, Australia.
¹² Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
¹³ Deparment of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.
¹⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.
¹⁵ State Key Laboratory of Complex, Severe and Rare Diseases, and Medical ICU, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁶ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
¹⁷ Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, Canada.
¹⁸ Department of Medicine, Sunnybrook Hospital, Toronto, Canada.
¹⁹ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
²⁰ Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
²¹ Department of Intensive Care, OLVG Hospital and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
²² Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²³ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37203, USA.
²⁴ Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil.
²⁵ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Emory Critical Care Center and Grady Memorial Hospital, Atlanta, GA, USA.
²⁶ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
²⁷ Adult Critical Care, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.
²⁸ Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK.
²⁹ AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM, 75018, Paris, France.
³⁰ Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.
³¹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
³² Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy.

PMID: 33616696
PMCID: PMC7898492
DOI: 10.1007/s00134-021-06352-y

Review

How the COVID-19 pandemic will change the future of critical care

Yaseen M Arabi et al. Intensive Care Med. 2021 Mar.

. 2021 Mar;47(3):282-291.

doi: 10.1007/s00134-021-06352-y. Epub 2021 Feb 22.

Authors

Affiliations

¹ Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. arabi@ngha.med.sa.
² Medical Intensive Care Unit, Saint Louis University Hospital and Paris 7 University, 1 avenue Claude Vellefaux, 75010, Paris, France.
³ Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
⁴ FAST and Chronic Programmes, Alexandra Hospital, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.
⁵ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
⁶ Critical Care Department, William Osler Health System, Etobicoke, ON, Canada.
⁷ Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal.
⁸ Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
⁹ The Alfred Hospital, Melbourne, Australia.
¹⁰ Monash University, Melbourne, Australia.
¹¹ Monash Partners Academic Health Science Centre, Prahran, Australia.
¹² Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
¹³ Deparment of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.
¹⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.
¹⁵ State Key Laboratory of Complex, Severe and Rare Diseases, and Medical ICU, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁶ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
¹⁷ Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, Canada.
¹⁸ Department of Medicine, Sunnybrook Hospital, Toronto, Canada.
¹⁹ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
²⁰ Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
²¹ Department of Intensive Care, OLVG Hospital and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
²² Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²³ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37203, USA.
²⁴ Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil.
²⁵ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Emory Critical Care Center and Grady Memorial Hospital, Atlanta, GA, USA.
²⁶ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
²⁷ Adult Critical Care, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.
²⁸ Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK.
²⁹ AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM, 75018, Paris, France.
³⁰ Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.
³¹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
³² Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy.

PMID: 33616696
PMCID: PMC7898492
DOI: 10.1007/s00134-021-06352-y

Abstract

Coronavirus disease 19 (COVID-19) has posed unprecedented healthcare system challenges, some of which will lead to transformative change. It is obvious to healthcare workers and policymakers alike that an effective critical care surge response must be nested within the overall care delivery model. The COVID-19 pandemic has highlighted key elements of emergency preparedness. These include having national or regional strategic reserves of personal protective equipment, intensive care unit (ICU) devices, consumables and pharmaceuticals, as well as effective supply chains and efficient utilization protocols. ICUs must also be prepared to accommodate surges of patients and ICU staffing models should allow for fluctuations in demand. Pre-existing ICU triage and end-of-life care principles should be established, implemented and updated. Daily workflow processes should be restructured to include remote connection with multidisciplinary healthcare workers and frequent communication with relatives. The pandemic has also demonstrated the benefits of digital transformation and the value of remote monitoring technologies, such as wireless monitoring. Finally, the pandemic has highlighted the value of pre-existing epidemiological registries and agile randomized controlled platform trials in generating fast, reliable data. The COVID-19 pandemic is a reminder that besides our duty to care, we are committed to improve. By meeting these challenges today, we will be able to provide better care to future patients.

Keywords: COVID-19; Critical care; Intensive care; Pandemic; Technology.

PubMed Disclaimer

Conflict of interest statement

YA is a member of a national committee for COVID-19 response, a Lead-Co Chair of the Think20 (T20) Taskforce for COVID-19, Saudi Arabia, an investigator on A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) and a Board Member of the International Severe Acute Respiratory and Emerging Infection Consortium. J-F T is a member of Advisory Boards not directly related to the submitted manuscript but related to COVID-19: MSD, Gilead. His academic COI includes being an advisory member of the “haut conseil de santé publique”; a governmental advisory board on COVID-19 management and PI of the COVIDICUS study (PHRC 2020 NCT04344730) funded by the French Ministry of Health. EA has received fees for lectures from Gilead, Pfizer, Baxter, and Alexion. His research group has been supported by Ablynx, Fisher and Payckle, Jazz Pharma, and MSD. The other authors did not declare conflicts of interests.

Figures

**Fig. 1**
How the COVID-19 pandemic will shape the future of critical care in the post-COVID-19 era

See this image and copyright information in PMC

References

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How the COVID-19 pandemic will change the future of critical care

Affiliations

How the COVID-19 pandemic will change the future of critical care

Authors

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Abstract

Conflict of interest statement

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