Multidisciplinary obstetric critical care delivery: The concept of the “virtual” intensive care unit

Leovic, Michael Phillip; Robbins, Hailey N.; Starikov, Roman; Foley, Michael R.

doi:10.1053/j.semperi.2017.11.002

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…Several factors contribute to this: specific profile of the obstetric care tertiary center, easy access to ICU, hospital ICU admissions of women after birth elsewhere and lack of high dependency unit [10,11]. The percentage of obstetric ICU admissions corresponds with severe maternal morbidity of 1-3% of all deliveries [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy related and postpartum admissions to intensive care unit in the obstetric tertiary care center — an 8-year retrospective study

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Pregnancy related and postpartum admissions to intensive care unit in the obstetric tertiary care center — an 8-year retrospective study

et al. 2021

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“… 34 In this model, the ICU no longer refers to a fixed physical location on the labor and delivery wards. 35 Instead, it reflects a mobile, multispecialty team capable of providing individualized, patient-centered care, regardless of setting. 34 , 35 This model of caring for the critically ill obstetric patient in a setting other than the traditional ICU is especially favorable during the COVID-19 pandemic where ICUs are burdened with the care of COVID-19 patients.…”

Section: Intrapartum Carementioning

confidence: 99%

“… 35 Instead, it reflects a mobile, multispecialty team capable of providing individualized, patient-centered care, regardless of setting. 34 , 35 This model of caring for the critically ill obstetric patient in a setting other than the traditional ICU is especially favorable during the COVID-19 pandemic where ICUs are burdened with the care of COVID-19 patients. 36 Separating critically ill obstetric mothers from ICUs caring for COVID patients is essential since emerging evidence from the CDC suggests that pregnant patients with COVID-19 may be at increased risk for ICU admission, mechanical ventilation receipt, and severe illness compared to non-pregnant COVID-19-positive patients.…”

Section: Intrapartum Carementioning

confidence: 99%

Optimizing mother–baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine

Markwei

Goje

2021

Womens Health (Lond Engl)

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Background: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby. Objective: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy. Methods: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic. Results: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic. Conclusion: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

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“…76 The ''virtual" obstetrics intensive care unit Leovic et al have proposed an innovative model of care in which a virtual intensive care unit team, composed of pre-selected specialists from multiple disciplines (maternal-fetal medicine, intensivists, cardiologists, pulmonologists, anaesthesiologists, obstetric and critical care nurses, respiratory therapists, and clinical pharmacologists) participate in the provision of individualised care that is readily adapted to the specific patient's clinical needs, regardless of the setting. 77,78 With the help of telemedicine this concept can be applied in RLS, allowing timely assessment and support for primary care health workers. 79 Although this is a proven success in countries such as Australia, it must be remembered that the initial financial outlay for appropriate hardware and internet connections is considerable.…”

Section: Innovation and Development Of New Technologies Designed For mentioning

confidence: 99%

Maternal critical care in resource-limited settings. Narrative review

Vasco

Pandya²,

Dyk

et al. 2019

International Journal of Obstetric Anesthesia

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Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low-and middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in highincome countries, and from 2% to 43.6% in low-and middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries. Bedside assessment tools, such as early warning scores, may help to identify critically ill patients and those at risk of deterioration. There is a lack of uniformity in definitions, identification and treatment of critically ill pregnant patients, especially in resourcelimited settings. Our aims were to (i) propose a more practical definition of maternal critical care, (ii) discuss maternal mortality in the setting of limited accessibility of critical care units, (iii) provide some accessible tools to improve identification of obstetric patients who may become critically ill, and (iv) confront challenges in providing maternal critical care in resource-limited settings. To improve maternal critical care, training programmes should embrace modern technological educational aids and incorporate new tools and technologies that assist prediction of critical illness in the pregnant patient. The goal must be improved outcomes following early interventions, early initiation of resuscitation, and early transfer to an appropriate level of care, whenever possible.

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Multidisciplinary obstetric critical care delivery: The concept of the “virtual” intensive care unit

Cited by 13 publications

References 29 publications

Pregnancy related and postpartum admissions to intensive care unit in the obstetric tertiary care center — an 8-year retrospective study

Pregnancy related and postpartum admissions to intensive care unit in the obstetric tertiary care center — an 8-year retrospective study

Optimizing mother–baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine

Maternal critical care in resource-limited settings. Narrative review

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