Conti, Bianca MD; Greco, Karla M. MD, MHS; McCunn, Maureen MD, MIPP, FCCM
International Anesthesiology Clinics: Summer 2017 - Volume 55 - Issue 3 - p 109–116
Resuscitation from critical illness or traumatic injury is no longer defined by massive crystalloid infusions, blood product transfusions without defined endpoints, or initiation of vasoactive medications at the physician’s discretion. Clearly defined, data-driven guidelines now exist that target specific goal-directed therapies in trauma, sepsis, and emergency general surgery, and incorporate both therapeutic and bedside diagnostic adjuncts. Ongoing research and controversy regarding resuscitation strategies in patients after trauma, for emergency surgery, or with sepsis will undoubtedly change current management paradigms. There is a need to maintain up-to-date knowledge and clinical excellence in the science of resuscitation that may suggest the need for specialization and expertise in the field of anesthesiology.
Anesthesiology has become more subspecialized, with recognized Accreditation Council for Graduate Medical Education (ACGME) fellowships offered in pediatrics, cardiac, critical care, pain management, and, most recently, obstetrics and regional anesthesia. There is currently a proposal to highlight the need for an additional American Board of Anesthesiology (ABA)/ACGME-approved fellowship—through the critical care track—targeted at trauma, acute care, and emergency care anesthesia practice: the acute care anesthesiologist. The question of whether this training should be unique to anesthesiologists, or should be combined with training in emergency medicine, has also been raised.Regardless of the structured curriculum that eventually develops, the management of resuscitation is rapidly maturing.