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      Intensive care medicine in Europe: perspectives from the European Society of Anaesthesiology and Intensive Care

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          Abstract

          BACKGROUND

          Anaesthesiology represents a rapidly evolving medical specialty in global healthcare, currently covering advanced peri-operative, pre-hospital and in-hospital critical emergency management (CREM), intensive care medicine (ICM) and pain management. The aim of the European Society of Anaesthesiology and Intensive Care (ESAIC) is to develop and promote a coordinated interdisciplinary and multidisciplinary European network of Anaesthesiology and Intensive Care Medicine (AICM) societies for improvement of patient safety and outcome, and to enhance political and public awareness of the role of anaesthesiologists all over Europe. The ESAIC promotes coordinated interdisciplinary and multidisciplinary care for severely compromised patients, based on the European training requirements (ETR) within the European Union of Medical Specialists (UEMS).

          METHODS

          To define the current situation of AICM in Europe, a survey was sent in April 2019 to the ESAIC Council and the ESAIC National Anaesthesiologists Societies Committee (NASC) members. The survey posed questions regarding the year of foundation, the inclusion of ICM in the society name, and if, and to what extent, various kinds (postoperative, general, specific, mixed) of national ICUs are being run by differing medical specialties. The study data were compiled and analysed by the ESAIC Board, Council and NASC in December 2019.

          RESULTS AND CONCLUSION

          Amongst the 42 European national societies surveyed (41 members of ESAIC-NASC plus Luxembourg), nineteen (45%) also include terms related to critical care medicine or ICM in their names, seven (17%) include terms related to reanimation and three (7%) to resuscitation. In recent years, several national societies revised their names to better reflect their gradual embrace of peri-operative medicine, ICM, CREM and pain management. Approximately 70% of ICU beds in Europe, and 100% in Scandinavia, are being run by anaesthesiologists, the remaining 30% being managed by physicians from other surgical or medical specialties. To emphasise future needs and resources of European AICM, the ESAIC drafted an ICM roadmap in terms of clinical practice, organisation of healthcare, interprofessional and interdisciplinary collaboration, patient safety, outcome and empowerment, professional working conditions, and changes in research, teaching and training required to meet future challenges and expectations.

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          Most cited references4

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          The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology.

          John West (2005)
          The 1952 Copenhagen poliomyelitis epidemic provided extraordinary challenges in applied physiology. Over 300 patients developed respiratory paralysis within a few weeks, and the ventilator facilities at the infectious disease hospital were completely overwhelmed. The heroic solution was to call upon 200 medical students to provide round-the-clock manual ventilation using a rubber bag attached to a tracheostomy tube. Some patients were ventilated in this way for several weeks. A second challenge was to understand the gas exchange and acid-base status of these patients. At the onset of the epidemic, the only measurement routinely available in the hospital was the carbon dioxide concentration in the blood, and the high values were initially misinterpreted as a mysterious "alkalosis." However, pH measurements were quickly instituted, the Pco(2) was shown to be high, and modern clinical respiratory acid-base physiology was born. Taking a broader view, the problems highlighted by the epidemic underscored the gap between recent advances made by physiologists and their application to the clinical environment. However, the 1950s ushered in a renaissance in clinical respiratory physiology. In 1950 the coverage of respiratory physiology in textbooks was often woefully inadequate, but the decade saw major advances in topics such as mechanics and gas exchange. An important development was the translation of the new knowledge from departments of physiology to the clinical setting. In many respects, this period was therefore the beginning of modern clinical respiratory physiology.
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            The birth of intensive care medicine: Björn Ibsen's records.

            The birth of intensive care medicine was a process that took place in Copenhagen, Denmark, during and after the poliomyelitis epidemic in 1952/1953. The events that led to the creation of the first intensive care unit in the world in December 1953 are well described. It is generally agreed upon that the start of the process was the fact that an anaesthesiologist (Björn Ibsen) was brought out of the operating theatre and asked to use his skills on a 12-year-old girl suffering from polio. The medical record of the girl contains a minute-by-minute description of the historical event. A translation of this part of the record is published as an Online Resource to the article. The role played by the epidemiologist Mogens Björneboe is further analysed. He was the catalyst of the process, being the one with the idea that the skills of an anaesthesiologist could be used for other purposes than surgery. When first Ibsen realised what could be done with his skills, he proved to be one of the most progressive and inventive doctors seen in modern medicine. An interview with Prof. Ibsen in 2006 is published as an Online Resource to the article.
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              The monopolisation of emergency medicine in Europe

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                Author and article information

                Journal
                Eur J Anaesthesiol
                Eur J Anaesthesiol
                EJANET
                European Journal of Anaesthesiology
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0265-0215
                1365-2346
                October 2022
                29 June 2022
                : 39
                : 10
                : 795-800
                Affiliations
                From the Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy; University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany (KZ), University of Medicine and Pharmacy Carol Davila Bucharest & Department of Cardiac Anaesthesia and Intensive Care II, Emergency Institute for Cardiovascular Disease ‘Prof. Dr CC Iliescu’, Bukarest, Romania (DF), Department of Surgical Sciences and Integrated Diagnostics – University of Genoa, & Anaesthesiology and Critical Care – San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy (PP), Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University and Skåne University Hospital, Malmö, Sweden (JÅ), Emergency Institute for Cardiovascular Disease ‘Prof. Dr CC Iliescu’, Bukarest, Romania (SB), ‘G. Giglio Foundation, Cefalù’ & Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). University of Palermo, Italy (CG), Department of Anaesthesiology, Operative Intensive Care Medicine & Pain Therapy; University Hospital Gießen, UKGM GmbH, Germany (MS), Division of Anaesthesia, Analgesia, and Intensive Care – Department of Medicine and Surgery – University of Perugia, Italy (EdR)
                Author notes
                Correspondence to Kai Zacharowski, Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany. E-mail: kai.zacharowski@ 123456kgu.de .
                Article
                EJA-D-22-00333
                10.1097/EJA.0000000000001706
                9594131
                35766247
                62e9d9af-4d17-452d-a013-a9bfba921f53
                Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

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                Intensive Care Medicine
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