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Table 1 Impact and potential legacy of the COVID-19 pandemic on critical care

From: The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists

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

  1. ICU intensive care unit, IRB institutional review board, RCT randomized controlled trial