The following slide presentation is part of the
ASA Public Education Slide series.
Copyright © 2003 American Society of An...
THE ROLE OF THETHE ROLE OF THE
ANESTHESIOLOGISTANESTHESIOLOGIST
IN THEIN THE
INTENSIVE CARE UNIT (ICU)INTENSIVE CARE UNIT ...
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
1998 Demographics of ICU Care1998 Demographics of ICU Care
• 5,981 adult, non-cardiac ICUs5,981 adult, non-cardiac ICUs
• ...
Intensive Care UnitIntensive Care Unit
• Aging populationAging population
• TraumaTrauma
• Disaster preparednessDisaster p...
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 ho...
Cost of Critical CareCost of Critical Care
• Health care is expensive:Health care is expensive:
~ 13.5% GDP on Health Care...
Physicians who specialize inPhysicians who specialize in
Critical Care MedicineCritical Care Medicine
play a pivotal role ...
0
0.1
0.2
0.3
0.4
0.5
0 0.1 0.2 0.3 0.4 0.5
Mortality rate for low intensity physician staffing
Mortalityrateforhighintens...
0
2
4
6
8
10
12
14
0 2 4 6 8 10 12 14
ICU LOS for low intensity staffing
ICULOSforhighintensitystaffing
Carson
Hanson
Li
M...
Leapfrog GroupLeapfrog Group
Recognized the importance of having trainedRecognized the importance of having trained
intens...
Management of the critically ill patient is aManagement of the critically ill patient is a
challenge.challenge.
Anesthesio...
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
• Anesthesiologists have historically been leadersAnesthesiologists have historically been leaders
in providing critical c...
Anesthesiologists have made significantAnesthesiologists have made significant
contributions to the understanding of criti...
RISK OF ANESTHESIARISK OF ANESTHESIA
Anesthetic Mortality
17.9
2.2
0.040.7
0
2
4
6
8
10
12
14
16
18
20
1950 1975 1980 1989...
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
Severinghaus Pontoppidan
Downs
Kirby
Bendixen
Safar
Anesthesiologist Contributions to ICU CareAnesthesiologist Contributio...
Recent Advances in Critical Care MedicineRecent Advances in Critical Care Medicine
• Respiratory management in acute lung ...
Recent Advances in Critical Care MedicineRecent Advances in Critical Care Medicine
• Development of strategies to reduce t...
Anesthesiologists have particular expertise in:Anesthesiologists have particular expertise in:
• Physiology of all organ s...
Anesthesiologists have particular expertise in:Anesthesiologists have particular expertise in:
• Airway management and res...
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 wasThe American Board of Anesthesiology was
the first specialty board to offer a spec...
THE ANESTHESIOLOGISTTHE ANESTHESIOLOGIST
PHYSICIANPHYSICIAN / MEDICAL SPECIALIST/ MEDICAL SPECIALIST
• 4 years college4 ye...
THE ANESTHESIOLOGISTTHE ANESTHESIOLOGIST
PHYSICIAN / MEDICAL SPECIALISTPHYSICIAN / MEDICAL SPECIALIST
American Board of An...
THE ANESTHESIOLOGISTTHE ANESTHESIOLOGIST
NOT JUST IN THE OPERATING ROOMNOT JUST IN THE OPERATING ROOM
• Operating roomOper...
Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
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  • Anesthesiologists adhere to strict standards of care which are defined by the American Society of Anesthesiologists.
  • The anesthesiologist has very sophisticated equipment and monitors to ensure a safe experience for the mother.
  • The Role of the Anesthesiologist in the ICU (.ppt)

    1. 1. The following slide presentation is part of the ASA Public Education Slide series. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    2. 2. THE ROLE OF THETHE ROLE OF THE ANESTHESIOLOGISTANESTHESIOLOGIST IN THEIN THE INTENSIVE CARE UNIT (ICU)INTENSIVE CARE UNIT (ICU) American Society of AnesthesiologistsAmerican Society of Anesthesiologists Public Education SeriesPublic Education Series Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    3. 3. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    4. 4. 1998 Demographics of ICU Care1998 Demographics of ICU Care • 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 CCommitteeommittee oonn MManpower foranpower for PPulmonaryulmonary aandnd CCriticalritical CCareare SSocietiesocieties (COMPACCS)(COMPACCS) Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    5. 5. Intensive Care UnitIntensive Care Unit • Aging populationAging population • TraumaTrauma • Disaster preparednessDisaster preparedness Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    6. 6. 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 costsHospital cost ~ 38% of total U.S. health care costs • Annual cost of critical care ~ $64 billion (1995)Annual cost of critical care ~ $64 billion (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.
    7. 7. 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 increasedCosts have increased ~ 6-12% per year~ 6-12% per year The Expensive Care UnitThe Expensive Care Unit Ingelhart NEJM 1999;340:70-76Ingelhart NEJM 1999;340:70-76 Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    8. 8. Physicians who specialize inPhysicians who specialize in Critical Care MedicineCritical Care Medicine play a pivotal role inplay a pivotal role in improving patient outcomesimproving patient outcomes andand decreasing the costdecreasing the cost of intensive care.of intensive care. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    9. 9. 0 0.1 0.2 0.3 0.4 0.5 0 0.1 0.2 0.3 0.4 0.5 Mortality rate for low intensity physician staffing Mortalityrateforhighintensityphysicianstaffing 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.
    10. 10. 0 2 4 6 8 10 12 14 0 2 4 6 8 10 12 14 ICU LOS for low intensity staffing ICULOSforhighintensitystaffing 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.
    11. 11. Leapfrog GroupLeapfrog Group Recognized the importance of having trainedRecognized the importance of having trained intensivists in ICUs to provide care forintensivists in ICUs to provide care for critically ill patients.critically ill patients. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    12. 12. Management of the critically ill patient is aManagement of the critically ill patient is a challenge.challenge. Anesthesiologists possess the skills necessaryAnesthesiologists possess the skills necessary to meet this challenge.to meet this challenge. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    13. 13. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    14. 14. • Anesthesiologists have historically been leadersAnesthesiologists have historically been leaders in providing critical care services.in providing critical care services. • The first “Respiratory Care Units” wereThe first “Respiratory Care Units” were established by anesthesiologists in the 1950s.established by anesthesiologists in the 1950s. • Anesthesiologists have played a pivotal role inAnesthesiologists have played a pivotal role in the development of monitoring, life support andthe development of monitoring, life support and resuscitation.resuscitation. • Anesthesiologists are leaders in the science ofAnesthesiologists are leaders in the science of safe systems in health care.safe systems in health care. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    15. 15. Anesthesiologists have made significantAnesthesiologists have made significant contributions to the understanding of criticalcontributions to the understanding of critical illnesses and in the development of effectiveillnesses and in the development of effective treatment methods.treatment methods. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    16. 16. RISK OF ANESTHESIARISK OF ANESTHESIA Anesthetic Mortality 17.9 2.2 0.040.7 0 2 4 6 8 10 12 14 16 18 20 1950 1975 1980 1989 Deathsper10,000 anesthetics Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    17. 17. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    18. 18. Severinghaus Pontoppidan Downs Kirby Bendixen Safar Anesthesiologist Contributions to ICU CareAnesthesiologist Contributions to ICU Care Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    19. 19. Recent Advances in Critical Care MedicineRecent Advances in Critical Care Medicine • 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.
    20. 20. Recent Advances in Critical Care MedicineRecent Advances in Critical Care Medicine • Development of strategies to reduce the incidence ofDevelopment of strategies to reduce the incidence of ventilator-associated pneumoniaventilator-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 abnormalitiesTreatment of cardiac dysfunction and rhythm abnormalities Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    21. 21. Anesthesiologists have particular expertise in:Anesthesiologists have particular expertise in: • Physiology of all organ systemsPhysiology of all organ systems – Normal physiologyNormal physiology – Physiology related to disease, illness, surgery, traumaPhysiology related to disease, illness, surgery, trauma – ResuscitationResuscitation • PharmacologyPharmacology – SedativesSedatives – AnalgesicsAnalgesics – Muscle relaxantsMuscle relaxants – Resuscitation medicationsResuscitation medications Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    22. 22. Anesthesiologists have particular expertise in:Anesthesiologists have particular 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.
    23. 23. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    24. 24. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    25. 25. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    26. 26. The American Board of Anesthesiology wasThe American Board of Anesthesiology was the first specialty board to offer a specialthe first specialty board to offer a special qualification examination process inqualification examination process in Critical Care Medicine.Critical Care Medicine. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    27. 27. THE ANESTHESIOLOGISTTHE ANESTHESIOLOGIST PHYSICIANPHYSICIAN / 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 in3 years residency training in anesthesiologyanesthesiology • 6 months critical care medicine6 months critical care medicine • 1 year subspecialty fellowship1 year subspecialty fellowship training in Critical Care Medicinetraining in Critical Care Medicine Copyright © 2003 American Society of Anesthesiologists. All rights reserved.
    28. 28. THE ANESTHESIOLOGISTTHE ANESTHESIOLOGIST PHYSICIAN / 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.
    29. 29. THE ANESTHESIOLOGISTTHE ANESTHESIOLOGIST NOT JUST IN THE OPERATING ROOMNOT JUST IN THE OPERATING ROOM • Operating roomOperating room hospitalhospital 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.
    30. 30. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.

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