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      Training non‐intensivist doctors to work with COVID‐19 patients in intensive care units

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          Abstract

          Background

          Due to an expected surge of COVID‐19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID‐19 patients. A training course and a theoretical test for non‐intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course.

          Methods

          The 1‐day course was comprised of theoretical sessions and hands‐on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test).

          Results

          Fifty‐four non‐intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass–fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest.

          Conclusion

          Non‐intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1‐day evidence‐based course. This knowledge was largely retained as shown by a multiple‐choice test supported by validity evidence. The test is available in appendix and online.

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          Most cited references32

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          Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

          To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".
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            Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

            Background The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. Methods We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. Results The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy. Conclusion The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new recommendations in further releases of these guidelines. Electronic supplementary material The online version of this article (10.1007/s00134-020-06022-5) contains supplementary material, which is available to authorized users.
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              Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations

              Summary As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.
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                Author and article information

                Contributors
                lene.russell@regionh.dk
                Journal
                Acta Anaesthesiol Scand
                Acta Anaesthesiol Scand
                10.1111/(ISSN)1399-6576
                AAS
                Acta Anaesthesiologica Scandinavica
                John Wiley and Sons Inc. (Hoboken )
                0001-5172
                1399-6576
                03 March 2021
                : 10.1111/aas.13789
                Affiliations
                [ 1 ] Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
                [ 2 ] Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
                [ 3 ] Department of Intensive Care University of Copenhagen Copenhagen Denmark
                [ 4 ] Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
                [ 5 ] Department of Cardiothoracic Anaesthesiology University of Copenhagen Copenhagen Denmark
                Author notes
                [*] [* ] Correspondence

                Lene Russell, Department of Intensive Care, Rigshospitalet/Copenhagen University Hospital, Inge Lehmannsvej 14, DK‐2100 Copenhagen Ø, Denmark.

                Email: lene.russell@ 123456regionh.dk

                Author information
                https://orcid.org/0000-0002-5241-7268
                https://orcid.org/0000-0003-3058-1072
                https://orcid.org/0000-0002-8176-404X
                https://orcid.org/0000-0001-7352-8728
                Article
                AAS13789
                10.1111/aas.13789
                8013477
                33529356
                a54d50fd-ca21-4ec7-96f3-53ce0cad2a78
                © 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 12 January 2021
                : 21 October 2020
                : 14 January 2021
                Page count
                Figures: 3, Tables: 3, Pages: 10, Words: 13347
                Categories
                Original Article
                Original Article
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                Anesthesiology & Pain management
                assessment,covid‐19,curriculum,education,icu,pandemic response,skills preparation,test,training,viral outbreak

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