Anesthesiology and Intensive medicine: together against COVID-19

More than a year has passed since the start of one of the biggest health crises in our recent history. The emergence of an infectious agent such as the coronavirus that produces COVID-19¹ has drastically changed in our social relationships, our habits … in short, our life.

It goes without saying that the recent, unprecedented avalanche of patients faced by healthcare systems in Spain and worldwide has compelled hospitals to rapidly adapt their human and material resources to deal with countless cases that would not otherwise have received the care they need.

All anaesthesiologists have, in one way or another, changed their "normal" schedule to help out in resuscitation and intensive care units, and to care for patients wherever they are needed². These units have been managed either by anaesthesiologists or intensivists, depending on the hospital and its existing organizational framework – a situation that has, in some cases, led to serious conflicts.

We work in Villalba General University Hospital which, only 7 years after its inauguration, has consolidated its position as a secondary level hospital in the Community of Madrid. We have 14 critical care beds and performed more than 11,000 surgeries in 2019. Our hospital provides all surgical specialties except cardiac surgery, and critical medical and surgical patients are transferred to the intensive care unit, which is managed by intensivists. The Anaesthesiology and Resuscitation service takes care of patients who do not require mechanical ventilation or overnight surveillance anywhere other than the standard wards.

The COVID-19 outbreak was a daunting challenge for all ICU and surgical personnel. Some saw it as a tsunami they would be incapable of facing alone, and others feared they would not be up to the task of treating patients that required the type of care they are not used to providing. According to first-hand information at our disposal, hospitals in the Community of Madrid have implemented different management strategies: patients are treated by anaesthesiologists or intensivists depending on the availability of beds in the resuscitation unit or in the ICU; patients in whom intubation and cannulation was performed by an anaesthesiologist are then treated by an intensivist, etc.

Our hospital has always maximised communication between hospital management, the head of the ICU and the head of the Anaesthesiology and Resuscitation department. The heads of both departments were unanimous in agreeing to merge the intensive medicine and anaesthesiology and resuscitation departments into a single service that was renamed the critical care service. Both heads of service were responsible for organising and balancing staff rosters, removing the weak points of each service and maximising each specialist’s contribution to the group. Thus, anaesthesiologists who were less accustomed to treating critical patients and whose knowledge of critical care may be less up-to-date always worked in tandem with an intensivist who could answer any questions they might have. Likewise, intensivists needing to intubate a patient with a known or predicted difficult airway had the advantage of working together with a colleague with extensive experience in airway management, surgical tracheotomy, etc. These are just a couple of examples of the symbiosis achieved by merging the two departments.

So far, we have observed that personal and professional relationships between specialists from both departments have improved immensely. Both anaesthesiologists and intensivists empathise far more with each other’s work, and the few minor disputes that used to be resolved by imposing rules are now settled by the members of each department in a mature and constructive fashion.

The SEMICYUC and SEDAR have taken the first steps in creating communication channels to reduce the risk of conflicts and task forces to strengthen existing common areas³. This does not mean that specialists from these department will need to relinquish any of the procedures for which they are trained and qualified; rather, we believe it creates a shared critical patient management pathway in which both anaesthesiologists and intensivists support each other.

We all know that the anaesthesiology training curriculum includes critical care, and some hospitals have implemented an important postsurgical critical care unit managed by the anaesthesiology and resuscitation service, while others have not. In these hospitals, intensive care physicians are in charge of critical medical and surgical patients. One of the main objectives of the incoming SEDAR chairperson has always been to obtain recognition for the essential role played by anaesthesiologists in caring for critically ill patients with COVID-19 and other critical patients, and for the core, indispensable and complementary role they play in operating rooms or pain units⁴. May this short report show how important, and feasible, it is in Spain for anaesthesiologists and intensivists to come to an understanding and work together in harmony for the benefit of healthcare professionals and, above all, patients.