Domain | Positive | Drawbacks | Proposals |
---|---|---|---|
Flexibility of critical care | • Healthcare workers’ mobilization • Healthcare system reorganization • Pivotal role of intensive care | • Suboptimal management of COVID-19 patients • Worsened outcome in non-COVID patients | • Predetermined crisis response plan • Coordinated medical leadership • Preplanned activity continuation plan • Expandable and monitored ICU bed capacities |
Need for investment | • Massive investments • Rapid responses from politicians • Resource reallocation by industry | • Shortages of human resources and medical devices • Deficient public–private partnership • Lack of international solidarity | • Reinforced public–private partnership • Improved monitoring of equipment stocks • Wage revaluation • Increased ICU caregiver staffing resources |
Visibility of critical care | • Social recognition • Intensivists’ role in public health • Direct communication through social networks and media | • Caregivers’ harassment • Scientific controversy • Unclear boundaries between science and politics | • Media communication training • Medical and scientific education for the general population • Designated spokespersons from professional union organizations • Institutional boards including paramedical staff |
Research dynamic | • Massive scientific production • Early patient enrollment in large RCTs • Fast-track IRB and peer-review process | • Lower scientific standards • Study duplication • Negative impact on non-COVID scientific production | • Large scale intensive care registries • Improvement of clinical research coordination • Harmonized and simplified process of ethical approval • Improved transparence (open-reviews, data and analysis sharing…) |
Improving outcome | • Beneficial impact of corticosteroids • Targeted interventions • Enhanced non-specific supportive care strategies | • Few treatments for critically ill patients • Failure of bio-plausible treatments • Use of non-validated treatments | • Evaluation of non-specific supportive interventions in non-COVID-19 ARDS • Avoid treatment use before large-scale and methodologically rigorous trials • Personalized and precision medicine integrating disease time-course, clinical phenotypes, omics tools, biomarkers |
Ethical decisions | • Early concerns about admission strategies • Recognition of the ethical aspects of ICU admission • Understanding of the complexity of ethical decisions | • Inadequacy between massive influx and limited ICU bed capacities • Use of single criterion triage (notably age) • Lack of transparency in admission criteria | • Dedicated triage team • Anticipated decisions with family and referring team • Stand-by resuscitation with rapid and regular reassessment of healthcare goals • Prognostic score development based on patient-centered outcome |
Post-intensive care syndrome | • Increased recognition of post-intensive care syndrome • Research dynamics on post-ICU symptoms | • Lack of systematic post-ICU follow-up • Insufficient information on long-term outcomes • Lack of pathophysiological data | • Focused research on PICS pathophysiology • Post-ICU multidisciplinary follow-up • Expanded capacities of rehabilitation facilities |
Communication with families | • New multimedia communication tools • Early and gradual lifting of visit restrictions • Renewed demonstration of the importance of in-person visits | • Increased PTSD and depression incidences in patients and families • Increased burn-out incidence in ICU caregivers | • Open-door ICU • Additive channels of communication • Dedicated focusing research • Secured digital tool development |
Caregivers’ quality of life | • Awareness of healthcare workers' well-being • Impressive resilience by caregivers | • Altered working conditions • Increased burn-out incidence • Unsuitable interventions | • Access to well-being programs • Recognition of the difficult working conditions • Increased staffing resources • End of 24h rounds |
ICU attractivity | • Unprecedented media coverage • Social recognition • Caregiver solidarity | • Decreased staffing resources • Aggravation of the hospital crisis | • Implemented diploma and training programs dedicated to caregivers • Wage revaluation • Respectful and caring working environment |