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Intensive care medicine has undergone several challenges in recent years related to its own expansion. There is lack of specialised professionals and provision of beds in the public and private sectors. In addition, there is an increase in the number of patients requiring care in Intensive Care Units (ICUs) due to an aging population seen in developed and developing countries.
The struggle for advances in ICUs is long and fascinating. In the early 1930s, eight out of ten patients who underwent brain surgery died. However experienced the surgeon was or satisfactory the intraoperative results were, death was almost inevitable. A modest and pragmatic neurosurgeon, Dr. Harvey Cushing, made a difference at a time when outcomes of medical interventions were affected by bacterial infection. His real recognition came from the meticulousness and precision in post-operative protocols. At a time when there were no ICUs, Cushing, personally, took care of surgical wounds of patients on hospital wards. His efforts were the 'anteroom' of what we now call the Intensive Care Unit.
Following World War II, postsurgical care gained momentum. As explained by Richard Hollingham, BBC Science journalist and author of several books, among them 'Blood and Guts: A History of Surgery': “Cushing's intensive therapy was for planned events (surgeries) and not for trauma, a disease critical, or an emergency event. What encouraged the creation of ICUs was the epidemics, which in the first half of the 20th century decimated thousands of lives almost every year”.
Telemedicine technologies like Tele-ICU can help by allowing continuous patient monitoring via a reduced team anywhere in the world.
Monitoring of vital signs and medical examinations in high resolution with updates in real time, as well as supervision of live visits and optimization of the multidisciplinary team, are some of the benefits of health technology that the Internet of medical things provides (IoMT). Electronic medical records are filled in automatically and can be encrypted.
Current technology and the provision of virtual health services are able to reach patients who live in remote regions or on missions carried out by the armed forces, NGOs or UN in humanitarian assistance, with limited resources and small teams of health professionals. With equipment that is connected via Wi-fi or radio frequency, patients do not have to travel to health institutions that are often considerably distant.
Telemedicine allows health care professionals to evaluate, diagnose and treat patients remotely using telecommunications technology and made possible with the increasing availability of high-speed internet and smart devices. It could also connect doctors working with a patient in one location to specialists elsewhere, in addition to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education.
Healthcare challenges in Brazil that Telehealth could address:
• The hospital market is fragmented, with many small providers.
• There are fewer hospitals with the capacity to become centers of excellence (based on size / throughput), with more hospitals as potential spoke sites.
• Most hospitals lack leveraging capabilities in order to acquire healthtech equipment and expand their capacity.
• To the exception of Brazil, all other countries in South America have a common language (with regional differences) facilitating regional interaction.
Covid-19 expanded Telemedicine like never before, but made it clear that even remotely - and with the help of intelligent machines to support clinical decisions - it is not possible to operationalise the flow in intensive care without a specialised healthcare workforce. In recent years, ICUs have been increasingly occupied by high-performance equipment, but less and less by professionals capable of handling them. In this sense, Tele-ICU helped save resources, improve care delivery, intensify intelligent use of data, and more importantly stimulate, welcome and protect ICU workforce.
The new generation of Tele-ICU incorporates instruments, controls and predictive algorithms that can, for example, identify patients most likely to need an intervention in the next 60 minutes, allowing intensivists to plan care and trigger the intramural chain in advance. Predictive analysis applications are already being incorporated in Tele-ICU stations, able to detect early signs of adverse events that may go unnoticed for long periods. On the other hand, Warning Score (an automated scoring system of early warning) allows ICU professionals to trigger appropriate, early and more assertive responses when an unforeseen situation occurs. Nurses at Ysbyty Gwynedd General Hospital (Maine, USA) conducted studies related to the use of Warning Scores, detecting a reduction in serious events and cardiac arrests (35% and 86% respectively).
In Brazil, Tele-ICU is undergoing a remodelling process where hospitals will be able to rely more and more on the allocation centers of doctors specialised in intensive care medicine, supporting colleagues in control rooms fully connected with predictive and preventive algorithms, the second opinion is no longer a trend, it is already an expanding reality.