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August 2002
Volume 66 |
Number 8
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| Critical Care
Medicine Is the Practice of Anesthesiology! |
Michael J. Murray, M.D., Ph.D., Chair
Committee on Critical Care Medicine and Trauma Medicine
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"Our airway management skills,
familiarity with and knowledge of mechanical ventilators
and our experience with fluid resuscitation and
with the use of sedatives, analgesics, neuromuscular
blocking agents, inotropes and vasopressors are
unmatched by any other specialty."
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A few years ago, the American Medical Association (AMA) adopted
as policy that anesthesiology is the practice of medicine. Similarly,
anesthesiologists who specialize in critical care medicine believe
firmly that critical care medicine is the practice of anesthesiology.
Unfortunately, not many anesthesiologists have that same perception;
less than 1,000 anesthesiologists have certification by the American
Board of Anesthesiology (ABA) in critical care medicine. ASA's
Committee on Critical Care Medicine and Trauma Medicine (CCMTM)
focuses on improving the care that critically ill patients and
trauma victims receive. In this issue of the ASA NEWSLETTER,
we will focus on new developments in critical care medicine. The
events of September 11, 2001, have had a profound effect on all
of us, and in recent months, members of the committee have written
articles to educate anesthesiologists on disaster preparedness.
These articles have appeared in the March 2002 NEWSLETTER
and in the Anesthesia Patient Safety Foundation Newsletter (Vol.
17, No. 1, 1-20).
The committee hopes you have read these articles and that you
will maintain your education in preparation for the next act of
terrorism or the next natural catastrophe for which our expertise
will be required. The same expertise that is of benefit in disaster
response also is of great value in managing critically ill patients
outside the operating room. Our airway management skills, familiarity
with and knowledge of mechanical ventilators and our experience
with fluid resuscitation and with the use of sedatives, analgesics,
neuromuscular blocking agents, inotropes and vasopressors are
unmatched by any other specialty. We should be and need to be
more visible outside the operating room.
No physician group places more pulmonary artery catheters than
we do. It is for this reason that C. William Hanson III, M.D.,
and William H. Montgomery, M.D., have agreed to provide an update
on the pulmonary artery catheter education program (page 7). ASA
and the CCMTM committee are committed to representing anesthesiologists
as we work with other specialties and nonphysician health professionals
to ensure that any pulmonary artery catheter education project
meets our members' needs. Anesthesiologists also should be aware
that the Centers for Disease Control and Prevention has published
new "Guidelines for the Prevention of Intravascular Catheter-Related
Infections," which have been developed and endorsed by several
specialty groups, including the American Society of Critical Care
Anesthesiologists (ASCCA). The guidelines can be found at . All anesthesiologists should be familiar with the
guidelines as they recommend gowning and gloving prior to central
line placement.
Equally important to all anesthesiologists are the recommendations
being promulgated by the Leapfrog Group. Peter J. Pronovost, M.D.,
Ph.D., has co-written an article in this issue (page 10) commenting
upon these recommendations. The Leapfrog Group is a consortium
of some of the largest U.S. corporations that have hundreds of
thousands of beneficiaries (employees and their families). These
corporations have been dissatisfied with the care that their beneficiaries
currently receive; therefore, they want to "leapfrog"
out of the current medical system and refer their beneficiaries
to systems that provide improved outcomes and excellent care.
The Leapfrog Group's current focus is to: 1) refer patients to
hospitals that do a high volume of surgical procedures of the
type for which the patient is being referred, 2) refer them to
hospitals that have systems in place to improve the accuracy of
prescriptions and 3) refer their beneficiaries to hospitals that
have intensive care units (ICUs) staffed by board-certified intensivists.
No better opportunity exists for anesthesiologists to improve
their visibility outside of an operating room than facilitating
hospitals' "compliance" with these recommendations.
Finally, despite what we on the CCMTM committee perceive as outstanding
opportunities within the ICU for our expertise, over the last
10 years, the number of anesthesiology residents who choose to
do a critical care medicine fellowship and who remain in critical
care has been approximately 40 to 50 residents per year out of
a pool of approximately 1,500 residents. William E. Hurford, M.D.,
Chair of the ASCCA Committee on Manpower and Training, and colleagues
share their thoughts on how our recruitment of future anesthesia-intensivists
might be improved (page 12).
For those of you who do not work in an ICU and have no desire
to, we can respect your preferences but hope that you will support
your colleagues who do elect to improve the outcome of critically
ill patients and to enhance our visibility and public acceptance
for the care that we provide in ICUs.
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Michael
J. Murray, M.D., Ph.D., is Professor and Chair, Department
of Anesthesiology, Mayo Clinic, Jacksonville, Florida. |
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