Role of Critical Care Medicine Training in the Cardiovascular Intensive Care Unit: Survey Responses From Dual Certified Critical Care Cardiologists
Role of Critical Care Medicine Training in the Cardiovascular Intensive Care Unit: Survey Responses From Dual Certified Critical Care Cardiologists
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DOI：
10.1161/jaha.118.011721
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发表时间：
2019-03-19
影响因子：
5.4
通讯作者：
Solomon, Michael A.
中科院分区：
文献类型：
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作者：
Brusca, Samuel B.;Barnett, Christopher;Solomon, Michael A.
背景-心血管重症监护病房（CICU）已经从冠心病监护病房发展成为治疗原发性心脏病危重患者的独立病房，这些患者通常患有跨学科疾病。越来越多的证据表明，与具有重症监护医学（CCM）专业知识的专门CICU提供者合作，可以提高生存率。这是第一项研究，以系统地调查双认证的医生，以评估CCM培训的相关性，当代CICU care.Methods和结果，利用美国内科医学委员会的数据，通过2014年，397名合格的医生获得了初步认证，在心血管疾病和CCM。对这些医生进行了一项调查，以描述重症监护培训在CICU中的作用。在接受调查的人中，有120名医生（30%）做出了回应。双认证医生报告在CICU中频繁使用他们的CCM技能，强调呼吸机管理，多器官功能障碍管理，临终关怀和气道管理。大多数人（85%）认为这些技能是未来CICU提供者应优先考虑CCM培训的原因。很少有人（17%）同意，目前仅普通心脏病学奖学金就足以照顾现代CICU的患者。此外，有一个共识，即有一个未满足的需求，心脏病专家在CCM（70%）的培训，CICU应采用类似的创伤中心（61%）的水平系统。结论引用特定的技能CCM培训期间获得，双重认证的重症监护心脏病专家报告说，他们的额外的重症监护经验是必要的，在他们的实践中，有效地提供护理在现代CICU。
Background-Cardiovascular intensive care units (CICUs) have evolved from coronary care wards into distinct units for critically ill patients with primary cardiac diseases, often suffering from illnesses that cross multiple disciplines. Mounting evidence has demonstrated improved survival with the incorporation of dedicated CICU providers with expertise in critical care medicine (CCM). This is the first study to systematically survey dual certified physicians in order to assess the relevance of CCM training to contemporary CICU care.Methods and Results-Utilizing American Board of Internal Medicine data through 2014, 397 eligible physicians had obtained initial certification in both cardiovascular disease and CCM. A survey to delineate the role of critical care training in the CICU was provided to these physicians. Among those surveyed, 120 physicians (30%) responded. Dual certified physicians reported frequent use of their CCM skills in the CICU, highlighting ventilator management, multiorgan dysfunction management, end-of-life care, and airway management. The majority (85%) cited these skills as the reason CCM training should be prioritized by future CICU providers. Few (17%) agreed that general cardiology fellowship alone is currently sufficient to care for patients in the modern CICU. Furthermore, there was a consensus that there is an unmet need for cardiologists trained in CCM (70%) and that CICUs should adopt a level system similar to trauma centers (61%).Conclusions-Citing specific skills acquired during CCM training, dual certified critical care cardiologists reported that their additional critical care experience was necessary in their practice to effectively deliver care in the modern CICU.