Objective:
The surge in critically ill patients has pressured hospitals to expand their intensive care unit capacities and critical care staff. This was difficult given the country’s shortage of intensivists. This paper describes the implementation of a multidisciplinary central line placement team and its impact in reducing the vascular access workload of ICU physicians during the height of the COVID-19 pandemic.
Methods:
Vascular surgeons, interventionalists, and anesthesiologists were redeployed to the ICU Access team to place central and arterial lines. Nurses with expertise in vascular access were recruited to the team to streamline consultation and assist with line placement.
Results:
While 51 central and arterial lines were placed per 100 ICU patients in 2019, there were 87 central and arterial lines placed per 100 COVID-19 ICU patients in the sole month of April 2020. The ICU Access Team placed 107 of the 226 vascular access devices in April 2020, reducing the procedure-related workload of ICU treating teams by 46%.
Conclusions:
The ICU Access Team was able to complete a large proportion of vascular access insertions without reported complications. Given another mass casualty event, this ICU Access Team could be reassembled to rapidly meet the increased vascular access needs of patients.
It is useful when inaugurating a new journal on Anesthesia Research and Pain management to know something about the beginnings and development of the field. Earlier doctors giving anesthetics had many problems to overcome. They had to try new drugs and develop new techniques and how best to perform them. Some of these have passed into oblivion but others are now taken for granted without the thought that someone had to work them out. It is hoped that this paper will provide some interesting insights about what has gone before. Ether and chloroform dominated the first 100 years of anesthesia, along with nitrous oxide, the analgesic properties of which Humphrey Davy suggested as early as 1799 "might be useful to relieve pain in operations where there was no great effusion of blood". The analgesic properties of these drugs were recognized during their use as party drugs when they were inhaled. From the beginning, there were a few individuals like John Snow and Joseph Clover who recorded their experience and developed appropriate equipment for their administration. John Snow's ether inhaler was remarkable because he had baffles which extended the time the ether was exposed to the air flowing over it to enhance vaporization and it had a water bath to reduce heat loss which is associated with ether vaporization. At first, the liquid drugs were administered drop by drop on to a handkerchief or cloth held over the patient's face. Then metal framed masks, such as Schimmelbusch's, were constructed to hold gauze on
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.