SCCM Resource Library-Pro/Con Debate: Dual Fellowship Training Is Needed to Care for the Pregnant ICU Patient

Video Transcription

So, good afternoon. This is the PROCON debate. Is dual obstetric critical care fellowship training necessary to take care of the pregnant ICU patient? I'm Ed Bittner.  I'm the moderator for the session. This is going to be, I think, a very interesting, energetic session.  And you have a considerable amount of experience up here who are going to be debating these two sides.  I'm not going to go through the usual spiel about turning off your cell phones or quietly exiting if you need to during the session. But I hope you will enjoy.  Our first speaker is Dr. Richard Pino, who is the division chief for critical care at the Massachusetts General Hospital.  And he is going to be arguing the pro side for dual fellowship training. Thanks, Ed. And please don't leave. As you can see, the room is packed. Okay.  So, I've been tasked with talking about the advantages of dual fellowship. All right? So, just as a background of my experience, all right?  During my residency as a CA3, I wound up doing six months of labor and delivery. So, it was sort of a mini OB fellowship. I was staff in labor and delivery for about 15 years.  I'm the medical director of the SICU. And the high-risk OB patients at Mass General are admitted to our SICU. That's the unit. So, what is a high-risk pregnancy?  First of all, if you look, geriatric pregnancy, whoever the obstetrician was who coined that term probably should be shot.  Because geriatric pregnancy, people over 35 years old, that's considered geriatric pregnancy. And older women are getting, they have multiple risk factors.  They're delaying pregnancy. And with delaying pregnancy come all the other risk factors of being older, but now that  you're pregnant, you know, such as hypertension, whether it be chronic or eclampsia. Congenital cardiac conditions are high-risk pregnancy.  And I say either fixed or unfixed, all right? Because as the population is getting older of patients who have had successful pediatric  cardiac surgery, they're now getting pregnant, all right? Spontaneous coronary artery dissection is lethal and can happen to almost anybody.  And of course, pulmonary artery hypertension. So these are some of the critical care issues that an intensivist may face at pregnancy.  And if you look at coronary artery dissection, all right, it can happen pre-partum, in the peripartum period.  In this study, this was from University of Southern California, and it was a study of about 150 patients who had had cardiac disease.  And you can see, you know, five of those patients died, all right? Some of them, and this is in the, there were a number of patients where this was actually  pre-partum that they had this happen. One of the patients had it when she was undergoing spinal for a cesarean section, all right?  So I guess that's why you don't have the junior residents doing spinals when you do these cesarean sections. But you can see that a lot of them were on mechanical support.  So this is not your garden variety obstetrics, all right? And if you look at pregnancy and coronary artery disease, in this study showed 50 pregnancies with coronary artery disease.  The mean age was 35 years old, which is fairly young, all right? The most common risk factor is smoking. So 60% of these women were smoking.  The most common diagnosis was atherosclerosis in the older patients, and this is usually  multi-vessel disease, and intracoronary thrombus of younger patients who never had any symptoms of any coronary disease, okay?  And so this is pretty critical for some of our patients. Pulmonary artery hypertension is definitely something important, a critical care factor in pregnancy.  It affects women of childbearing age. It's defined as a mean pulmonary artery pressure greater than 25 millimeters of mercury with a right heart cath.  But I can tell you right now, I've taken care of patients with pulmonary artery hypertension whose RVSP is sometimes close to 70, if not a little bit higher, all right?  It's long regarded as a very, very high risk. And it's kind of interesting, when you look at it, you know, the papers say overall diminished life expectancy, all right?  And in one of the papers, it was actually written by a pulmonologist who came from our institution, says the current guidelines avoid pregnancy and termination when pregnancy  occurs, all right? That's the guidelines. Of course, if you terminate pregnancy, I wouldn't be up here giving this lecture, right?  The patient winds up in your ICU, she has pulmonary hypertension, and she's pregnant. And you can see the prevalence is extremely high for pulmonary hypertension.  Early pulmonary hypertension, about 60% of those with pregnancy. So we're talking about dual fellowships.  So what are the pathways of dual fellowships to take care of the pregnant patient? Well, for one, you have obstetric anesthesia, surgical critical care, and cardiac anesthesia.  And those are acceptable ways of doing critical care for these patients, combining surgical critical care with either obstetrics or with cardiac.  And indeed, at University of Cincinnati, there is an anesthesiologist who's done dual fellowships of OB and cardiac. She lectured last year at one of the courses.  And one of the reasons behind that is that many of her patients have corrected congenital cardiac disease and are pregnant. So that's a good fellowship to have.  For obstetrics and gynecology, you can do maternal fetal medicine and surgical critical care. And they both are comparable.  The ACOG, American College of Obstetrics and Gynecology, allows surgical critical care either through anesthesia, usually through anesthesia or surgery, the same thing.  Now when you look at maternal fetal medicine, they have a whole list of things that need to be covered in their fellowship.  And if you look down on section 12, a little bit on medical surgical complications, and a little bit on anesthesia and analgesia.  And if you delve into this further, it's actually pretty superficial. It's like, yeah, you have to know these things, but it's not great.  So you need somebody who really knows this in more details. If you look at anesthesia fellowships, and this is for 2017 I think it was, if you look  that, of course, most people do pain fellowships or cardiothoracic fellowships, surgical critical care, as well as obstetric. And these are applicants for positions offered.  So you can see there's not many people who do obstetrician and critical care. It's a good little niche specialty to do for those individuals who want to do another fellowship.  And the American Board of Anesthesiology says it's actually, it's more opportunity for critical care anesthesiologists, very much so.  Because a lot of practices will actually, especially some private practices, may take a person who's specialized in both for use in the labor and delivery suite, but then  have that expertise that can work in critical care. So what are the hospital considerations for dual fellows? For one, academic institution, of course.  Large number of complex patients and research to advance the specialty. If you have an ICU unit that's an ICU at an open unit, you can have consultation with  multiple clinicians coming in and advising the intensivists. And having somebody who has knowledge of the big picture, you know, someone who's dual  boarded in either obstetric anesthesia and critical care or fetal maternal medicine and critical care, it helps you do this.  If it's a closed unit, it can create even more problems, because maybe the intensivist in that unit may not have an idea exactly pregnancy, what the physiology of pregnancy is.  And I'll show you a slide in a second. There's limitation of anesthesia attendings, often outside of labor and delivery.  A lot of attendings don't go to labor and delivery, haven't been to labor and delivery for years.  And conversely, you know, in labor and delivery and the ICU may be foreign territories for the respective staff, all right?  You know, they come in, you have an obstetric anesthesiologist come into the ICU and, you know, their eyes are open wide. They sort of are not familiar with that.  You know, and if you look at ICUs, they're managed by specialists, often with little obstetric experience, right?  So the only experience that most people have is usually their third year of medical school, okay? Third year of medical school. And here is an example of two programs, right?  This one is for, I can tell you, it's from Harvard. You can look at it. You know, and it exposes OBGYN to specialty, one week in the ambulatory, two weeks in labor  delivery, and two weeks in gynecologic operating. Two weeks in labor and delivery at Harvard Medical School, okay? I didn't go to Harvard Medical School. I went to the cheap school.  This is my alma mater, LSU. And we spent a lot more time in labor and delivery. And when I was a resident, albeit years ago, a medical student, I delivered myself 33 babies.  We got very, very used to labor and delivery. So but can you imagine someone running the ICU with this experience and someone with very little other experience?  Dual fellowships can advance obstetric critical care. That's the key. Research for obstetrics is not very intensive, all right?  I mean, if you look at the anesthesia literature, a lot of the research for obstetric anesthesia was what size needle should I use for a spinal?  It wasn't, it's not very extensive, all right? And the treatment data is largely driven by case reports, all right? Yeah, I did this technique. It works.  No one publishes, I did this and the patient didn't do well, okay? Pregnancy is an exclusion from most studies.  So if you have critical care intensivists who are dual board certified in critical care as well as obstetrics or obstetric anesthesia or maternal fetal medicine, they can then  design studies that are really good for the obstetric population. And many of these studies are drug studies that can't be done because of the possible effects of the fetus.  So it's important to drive this specialty even further. For obstetrics, for the high risk OB patient, there's an interdisciplinary team.  And as you can see, it's the intensivist, cardiologist, pulmonologist, depending upon,  the obstetrician, the neonatologist, the anesthesiologist, an ECMO specialist, you know, and the nursing team, both the ICU and OB teams.  So there's a lot of coordination here for the high risk OB patient, all right? And some people consider it very foreign territory, all right?  I know that when an OB nurse comes to my SICU, they have eyes wide open. They have no idea.  And when we have to go to the labor and delivery suite for an emergency or something, they look at us like we're trespassing, okay?  And so, you know, if you have people who are dual certified who make that communication, it makes patient care much, much easier.  And this is my bias, is that dual fellowship trained intensivists, and especially the anesthesiologist, is the quarterback of care for the pregnant patient in the ICU, all right?  The person provides coordinated care for the patient. And it establishes the game plan for this patient.  You know, is the patient, you know, discussing with everybody, is the patient going to have a cesarean section, or is the patient going to have a vaginal delivery?  And if they have a cesarean section, where are you going to do the cesarean section, right?  It's pretty easy to say, you know, I participated in a patient who had pulmonary artery hypertension,  and the pulmonologist said, and even the obstetrician, well, we're going to schedule this, you know,  when the patient is 36 weeks and beta complete, and we're going to schedule it during the daytime to have a cesarean section.  And I raised the question, great, 2 o'clock in the morning, the baby decides to come out, the baby's running the show, where are you going to do the c-section?  And it was like blank stares, all right? It's even more blank stares when you tell somebody in the unit, well, in an emergency,  we're either going to deliver the baby in the unit, all right? And that's like, oh, my God. Or even better, we're going to do a stat c-section at the bedside in the unit, okay?  And you almost have to be prepared to do that. But there's got to be a driving factor there. It has to be somebody to take control and say, look, most babies come out easily, but,  you know, you need to plan A, B, C, and D. Is there a possible possibility for ECMO, all right?  So if there's a possibility for ECMO, is this patient going to be delivered in maybe a suite in the main operating room where cannula are placed, and there's a well-organized plan  that if the person needs to go on ECMO, the c-section can be done and the patient placed on ECMO.  Same thing, placenta creta, you know, baby's out, is there interventional radiology needed?  And again, this is something that dual fellowship trained people who know what's going on can  say, we need to do this in a hybrid room so when the baby's born, if you need embolization of the placenta, of the uterus, it can be done.  And finally, I think knowledge of the team and simulation, very, very important to have cooperation between the ICU and obstetrics, okay?  And people with dual fellowships can navigate this really easily and can facilitate that. So if there's, for those of you who've been on labor and delivery, you know when there  is a disaster, the wheels generally fall off the cart, okay? They're not used to disasters that way.  But if you have somebody who's in the ICU who knows that disasters happen often, to make this jump and work with people in labor and delivery as a colleague.  So one day this person may be labor and delivery, the next person may be in the ICU, et cetera,  you know, then it facilitates that interaction and allows for better care of the high-risk patient. Thank you. Thank you, Dr. Pino.  Next we have Dr. Frank O'Connell from Atlantic Care Regional Medical Center, who is going to be arguing the CON position. Thanks for coming today, everybody. It's great to be here.  I got drafted by some people at the last minute and said, can you do the CON section, please? Like, okay, I'm going to go talk to two people from Mass General who are both MD, PhDs.  No, I'm not intimidated. Anyway, a little bit about me and a little bit about my background because it sort of influences what I'm about to say.  I did internal medicine, then critical care, then anesthesiology. That was eight years of training.  I wound up going to UMass Medical Center where I worked in a surgical ICU for about eight years.  There, most of the obstetrics was handled by Memorial Hospital, which was across town. So I really hadn't seen an obstetric patient in eight years.  As you go on through life, you know, things happen. You get married, you start having children, and all of a sudden my wife taps me on the  shoulder and says, oh, by the way, you're doing private practice now. I'm like, okay, dear, you're not an NIH researcher, move on. So I did that.  And by doing that, when I first got to private practice and dealing with obstetric patients, I was terrified. I was like, oh my God, what are we going to do?  By the way, with those slides and what you did, Richard, were excellent, and I agree with a lot of what you said. But I'm going to give you the con here.  How are you doing for that? Thanks. I don't have any, I have no financial disclosures. As Dr. Pino alluded to, there's multiple issues with the pregnant patient, multiple  physiologic derangements. Their cardiovascular status, their respiratory, hematologic, gastrointestinal, everything's different.  And so what you think you know for a normal patient is very different. I was also, I should mention this, I was very blessed to be, to have the opportunity to  participate in an inaugural education opportunity, which has been offered by the Society of Critical Care Medicine.  And we have one of the pioneers sitting over on the side right now, that wonderful young lady with the blue blouse. Yes, it's you, Marie.  Marie Pavini was a, Baldessari was a visionary in terms of putting this course together, and I can tell you it was very, very important to do the FCCS obstetrics.  Because regardless of whether you were in a tertiary care facility and you were not used to a lot of obstetric patients or you're in a community hospital, there are quite a  few people that aren't familiar with that. Marie had the foresight and vision to put this together, to get people to come together and to make this happen.  And as a result of that, and as a result of taking care of a lot of obstetric patients, I got to be a lot more comfortable and got used to taking care of some disasters.  A lot of the things that Dr. Pino said were absolutely true. Women are getting pregnant much later in life than they are earlier.  The idea of the, quote, geriatric patient, I mean, you're going up to 50, maybe even beyond at some points. A lot of these people do have congenital malformations.  They may have coronary disease. I had the privilege of taking care of a woman that came in, in extremis and pulmonary edema.  She was 47 years old, told not to get pregnant by her obstetrician. She had an AICD in place. And she and her boyfriend were busy, and she was at term, and they were busy.  That's known in some circles as a French induction. Anyway, she comes to us. She's in florid pulmonary edema.  I was going to sit her up and do the spinal, but that wasn't going to happen. She's morbidly obese. I wound up having to intubate her.  Thank God we had capnography, because the amount of fluid coming out of the endotracheal  tube, I thought for sure, I could swear I saw it go through the cords, and it was, but it was just, it was torrential fluid. So these patients can be very challenging, very scary.  I also had the joy of taking care of a patient with placenta increta. That's an abnormality where the placenta keeps growing into the myometrium.  We had an obstetrician that did not bother to look at the ultrasound, did not see the placental lakes, went in and did a C-section with torrential bleeding. It was horrible.  We resuscitated her for 12 hours, getting her body temperature up and correcting her coagulation status to the point that we could get her back to the OR and remove what remained  of her reproductive organs. The baby did fine. We were terrified. We were going to lose mom, and it's very scary.  They have hypertensive disorders, many, many manifestations of preeclampsia. They can go to eclampsia.  They can also come in with medical disorders, community-acquired pneumonia, the coronary dissection issue alluded to. They may have substance abuse issues.  So they have myriad things that can go wrong with them. I think part of what you want to look at here is regardless of whether you're a tertiary  care facility or you're a community hospital, you go by leapfrog criteria, right? So one of the things with leapfrog is volume-based competency.  Where I am in Atlantic Care, we're doing 2,200 deliveries a year, so we see a fair amount of stuff. Yeah, we may have to ship out some stuff, but we're taking care of a lot.  As you alluded to, you have that tension between the obstetric world and the critical care world.  They regard each other with suspicion, and yet you need to make it work, and you need to have those people that are known in both realms that can sit there and speak to that.  I'm lucky the corporate culture of my hospital is such that you usually have people talking to one another. They've known one another for years.  You've got maternal-fetal medicine, the intensivist, the obstetrician, and then notice at the bottom  there are a lot of your medical specialists or people that you may really rely on. If you're sitting there wondering if you've got some unusual presentation of preeclampsia  or the HELP syndrome, or whether it's actually thrombotic thrombocytic panic purpura or hemolytic  uremic syndrome, having a nephrologist who's savvy, a savvy clinician, can help tease out those two from you. So it can be kind of challenging.  It's very important to diagnose and know the difference between, am I treating a medical condition that's been exacerbated by obstetrics, or am I treating an unusual and potentially  fatal obstetric condition? Lots of times if you are dealing with a primary obstetric condition and you can safely deliver  the child, mom gets better, versus having the medical therapies where you're going to need to go, and there are specific therapies for those medical illnesses.  And you may have to take a step back and say, we'll deliver the baby when it's appropriate from an obstetric standpoint.  But here again, you're relying on multiple people coming in together, looking at one another, talking as a team.  I'm really glad that you brought up the hybrid room because we do have a facility like that at the hospital.  I work at two hospitals, but the one that's an obstetric center that we can go ahead and do a cesarean if we have to, and then go on and do interventional radiology should we  need to do that. There are some drawbacks here to this, though, and I want to bring out some practicalities.  The average medical student walking out of graduating from med school is looking at roughly  $190,000 being in debt, and they may or may not, in addition to trying to pay back those loans, they may or may not have a significant other that's going to sit there and say, hey,  where's our pot of gold at the end of the rainbow? So that's going to influence you saying, do I really want to spend one more year doing this?  And by the way, these are not my numbers. This comes from the Association of American Medical Colleges. Then you have the projected physician shortage in this country.  In a mere five years, you're looking at anywhere from 45,000 to 90,000 physician shortage based on what they feel the health care needs of our aging population is going to be.  So again, looking at that, saying, do we really want to have somebody tied up for one more year doing that versus if we can have a health care system where we have good  collaboration between multiple specialties and multiple disciplines trying to do the best they can for both mom and the baby.  Then I want to bring up the idea that you're looking at. This is from the American Hospital Association.  You have roughly 6,400 hospitals discounting psychiatric facilities, whatever else in the United States. Of those, a mere 1,100 of those are tertiary care facilities.  So you're really looking at between 70%, 80%, 85% of the health care in this country being delivered at a non-university setting.  And you're not going to have all those people in the community hospitals or the non-academic centers that may necessarily have dual training.  Just throwing out there is practical barriers. It's very nice to do that. And I would say in an optimal world, those are optimal things to go on.  But the reality is we live in a less than perfect world. And finally, I want to share with you my dog, Lola.  I just wanted to share that even though we're talking about obstetrics and having children in roughly 30% to 40% of the households in the United States from a recent survey, the  pet is the favorite child. Thank you very much for your time, ladies and gentlemen.  So I'm an intensivist that actually sits on both the OBE and the Criminal Prepared Edition.  And recently I had the opportunity to write one thing about for a Secretary Fellowship because I do so much OBE and Dijon, and I think that that's really where the nation's moving.  But there is a significant paucity...  No, no, that's a good question, all right?  But the, you know, subspecialty certification, especially in anesthesiology, doesn't necessarily need  ABA subspecialty approval. I think the biggest thing, if you look at it, I think, was it cardiac, cardiothoracic surgery? For a long time, it's an ACGME program,  but it's not like they're boards. It's not like critical care boards or pain boards. So I think the experience that counts in a fellowship, you know, if you do a fellowship  and it's an ACGME-approved fellowship, that's something that you definitely need. But then after that, I would suspect if the American Board of Anesthesiology goes ahead  and says, oh, this is what we want, we want an exam, or like, as in the other things, I think most people are grandfathered in by experience,  as they were with cardiac anesthesia, for instance.  Thank you.  Yeah, Marie. Hi, Marie. Hello. So I think it's, one of the divisions I make is between the academic centers and, as Frank mentioned,  the vast majority of hospitals, which are non-academic centers. So those of us who are academicians, yeah, we think the dual fellowship is great  because most of us are dual trained, right? I mean, it just kind of comes with the job. But are you gonna take people like us?  and I don't want to go, I'm going to be in the big mecca. So that's a dilemma, I feel. I do think that dual training is best. More training is always better, right?  Although, if you have a great cadre of consultants, maybe that dual training is just a little bit superfluous, right? So you really need to be dual trained  if you have a great cadre of consultants that can help you out in your ICU. But where are you going to have that? You're probably going to have that  in the big academic, university affiliated hospitals. But in those small hospitals, people like us, we're not going to work there. We spent too much money and too many hours  and sweated too hard to get from Yash to go to those small places. I mean, that's the reality. Let's be real. So I think this is a dilemma, and I  don't know how it's ever going to be rectified. So Marie, I'm glad you brought that up, and I wanted to speak to that. So 19 years in private practice, I've  worked at larger and smaller hospitals, some of which were more quality driven and some of which were less. So I'm going to go back to what I had said before.  I think it's based on leapfrog. It's volume based competency. If you're in a place that does 300 carotid endarterectomies in a year versus a place that does 50,  where would you rather be a patient getting your carotid done? By the same token, I think if you're in a place that does a lot of deliveries  and has neonatal ICU and has provisions for high risk OB, has provisions where you have an OR that does have dual capability as a hybrid room  with radiologic interventional radiology, if you've got your very routine use of a stat massive transfusion protocol in your hospital,  if you've got consultant groups, an active maternal fetal medicine group that looks at patients that are currently pregnant and that have a high risk of becoming critically  ill and sort of highlighting to people beforehand, and this is an ongoing thing. If you can think two or three months ahead before they come to you with term or near term or even  midterm with some horrible thing saying, I've got something going on here, I think that's important. And if you have people that are active consultants  and that are responsive, great. If you really don't have those things, then you should not be doing high risk OB at all. And again, like you said, I think for some of the places,  there might be less geographically desirable locations where someone of your stature you really would not want to be. But then you have to ask yourself,  how much obstetrics should these patients and people really be doing? But it. You're thinking about this. You can't really say obstetrics, because it's  supposed to be a combination of that and all of that.  their hospital, they're just gonna come in.  power in the United States, many other places.  No, I don't think so, but I know where I'll do it.  I agree a hundred percent, and I have a little confession to make. I was assigned the pro by default, so to speak, okay?  So I had to make the argument for the pro, and I'm sure some of the ideas of the pro, you know, looking at after this, it's fine.  From my experience and Ed's experience, in our surgical ICU, you know, we often laugh at the fact that people, sorry Amanda, but that people want to do, you know, OB and critical  care fellowships, because we really feel that as surgical intensivists, as intensivists, you know, it's the critical care aspect that is the most important, you know?  And that's where, and as Marie said, you take care of the valvular problems, you take care of all the bleeding problems, you take care, those are all critical care issues.  And communication with our colleagues, and that's the key. Communicating with people, being non-confrontational, being working as a team, having them call  you, you know, before the patient has an emergency, you know, is the most important. So realistically, I personally would not encourage anybody to do OB anesthesia fellowship  and critical care fellowship, you know? If they want to do cardiac and critical care, that's the big thing that people are doing in anesthesia these days.  But I think for the obstetrics patient, you know, good critical care, because everybody said, you know, we have Maine, you know?  So we have the patients transferred from Maine who are really sick, you know, sick, pregnant sick patients, you know?  And if they don't get transferred, somebody in Maine is going to have to take care of them. Some intensivist is going to have to take care of them.  So as the society continues to train, you know, with courses on critical care obstetrics, I think that's where the money should be, so to speak.  I wanted to respond to one thing that Marie had said, and she's absolutely right about the indigent patients, and you're dead on.  In my experience where I am, there are two hospitals. One's located in Atlantic City. That's the trauma center in the Knife and Gun Club.  That also does some low-risk pediatrics, and it does neurosurgery. That caters to a much more indigent patient population.  Then we have the suburban hospital 12 miles out, which is cardiac surgery and obstetrics and lots of arthroplasties for orthopedics, and that has the more suburban.  But given the obstetric population, we do get all comers. We get the people that are indigent. We get the people with private insurance, and thank God we have a lot of resources in  order to take care of both of those, and in both places we have the ability to do thromboelastography.  When we're looking at strange coagulation disorders or where we're trying to marshal what blood products should we give to somebody with a torrential hemorrhage in an obstetric  situation, and we're also lucky that Camden with Cooper Hospital is close by, as well as Philadelphia with Jefferson and with University of Pennsylvania.  Not everybody's that lucky, and I feel, count myself, fortunate to have that situation. But you're right, people in the Midwest and the South, they may not have those resources  and it's going to be a lot tougher. You're absolutely right. Just a quick question because it was mentioned.  I'm also a program director and I also train fellows who have sometimes virtually no obstetrics experience coming into fellowship training, and for them the critically ill obstetric  patient is really fear-inducing. Frank, I think you had mentioned the obstetric FCCS, and I don't know a lot about it.  My guess is that, and I'm not clear what audience it's designed for, but it seems to me that  one of the big issues here is that overall there's a very low bar of knowledge that needs to be raised, and then there is the top subgroup of providers for which dual training would  be beneficial. But I don't know, is the obstetric FCCS sort of designed for the intensivist to give them that added expertise, or what is the goal?  So again, I was very privileged to be part of the program that Marie Baldessari gave birth to, and it was essentially an inaugural program which happened over a period of years,  but it was designed for both the obstetrician that has to deal with a critically ill pregnant  patient or any type of intensivist with medical background, anesthesia background, whatever, and we were lucky enough to have faculty that were dual board certified in both critical  care and obstetrics. These were OBGYN docs that were also intensivists, and this course really was great in terms of raising people's awareness.  Marie, do you want to say a few more words about it?  Now, having said that, there are many...  We have intensivists such as myself and others.  Does anybody else have anything to add? Any other questions? Well, I'd like to thank our speakers and for you all for your attendance and engagement  and hope you enjoy the rest of the conference.

Video Summary

This video is a debate about whether dual obstetric critical care fellowship training is necessary to take care of pregnant ICU patients. Dr. Richard Pino argues the pro side, stating that dual fellowship training provides the necessary knowledge and skills to manage high-risk pregnancies. He highlights the various critical care issues that intensivists may face during pregnancy, including coronary artery dissection and pulmonary artery hypertension. Dr. Pino also emphasizes the importance of collaboration among different specialists in the care of high-risk obstetric patients. On the other side, Dr. Frank O'Connell argues the con side, stating that while dual fellowship training may be beneficial in academic centers with high patient volumes and specialized expertise, it may not be necessary or feasible in smaller hospitals or non-academic settings with limited resources. He also mentions the financial burden and projected physician shortage as practical barriers to implementing dual fellowship training. In conclusion, the debate raises important points about the pros and cons of dual fellowship training in the care of pregnant ICU patients, highlighting the need for collaboration and the potential challenges in implementing such training across different healthcare settings.

Asset Subtitle

Obstetrics, Professional Development and Education, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Learning Objectives

Identify the reasons for ICU admission of the pregnant patient
Explore the training related to critical care obstetrics in medicine, anesthesia, and obstetrics
Outline minimal requirements for the care of the obstetric patient admitted to the ICU

Pro: Dual Fellowship Training Is Needed to Care for the Pregnant ICU Patient

Richard M. Pino

Con: Dual Fellowship Training Is Not Needed to Care for the Pregnant ICU Patient

Frank M. O'Connell

Meta Tag

Content Type Presentation

Knowledge Area Obstetrics

Knowledge Area Professional Development and Education

Knowledge Level Intermediate

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Pregnancy

Tag Fellowship Training

Year 2020

Keywords

dual fellowship training

pregnant ICU patients

high-risk pregnancies

intensivists

collaboration among specialists

academic centers

limited resources

physician shortage

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