In 2021, we will start to use ideas from the operating room in the intensive-care unit (ICU). The Covid-19 pandemic has compelled us to rethink our understanding both of the human body and of systemic medicine. We have seen that pathological inflammations in patients with the virus can appear anywhere, and patients can present disorders in any organ system, from simple fevers to major strokes. This has led to novel approaches concerning the treatments being tried in hospitals and traditional divisions between departments breaking down.
One example is how we monitor patients who are sedated. Sedation is a major part of treating an ICU patient who needs a ventilator, just as it is of treating one in an operating theatre. In the past we have taken different approaches to monitoring how sedated a patient is. In an operating theatre, anaesthesiologists generally use electroencephalogram (EEG) recordings to monitor a patient’s level of unconsciousness. In ICUs, however, clinicians typically have used clinical assessments instead.
This has changed under Covid-19. During the pandemic, we have started to see more requests for help with EEG machines in the ICU to assess patients’ levels of arousal. This is because the virus affects everything, including the brain, and an understanding of how a patient’s brain is functioning is crucial to providing the right level of sedation.
One key reason that this kind of cross-pollination occurred, in the hospital I work in at least, is that many of the staff who were redeployed during the pandemic when we were trying to keep everything running early in the year, were anesthesiologists, anaesthesia residents and anaesthesia nurses. In 2021, we will see more exchange of ideas like this between departments and other specialties. The pandemic has taught us the benefits of these new partnerships, and they will continue in the months and years to come.
Of course, these conversations have been ongoing among our communities from even before the pandemic struck – but Covid-19 has accelerated the willingness of seasoned experts to try new approaches. When it comes to using EEG monitors in ICU, there remain issues around cost and training. But these kinds of developments could herald a new age in our understanding of the systems that comprise our bodies and how we devise effective therapies, particularly when we find ourselves working in resource-limited situations that we have never been prepared for.
Emery Brown is the Warren M Zapol prof. of anesthesia at Harvard Medical School and a practising anesthesiologist at Massachusetts General Hospital