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Correspondence |

A Multidisciplinary Approach Is Key to the Development of Critical Care Medicine in Mainland ChinaKey to Critical Care Medicine in China FREE TO VIEW

Bin Du, MD; Li Weng, MD
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From the Medical Intensive Care Unit, Peking Union Medical College Hospital.

Correspondence to: Bin Du, MD, Medical Intensive Care Unit, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing 100730, China; e-mail: dubin98@gmail.com


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Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest. 2014;145(6):1433. doi:10.1378/chest.14-0186
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To the Editor:

We read the recent article in CHEST (January 2014) by Qiao et al1 with great interest. The authors asserted that there are limitations to an “integrated” ICU and proposed a system of specialty ICUs led by pulmonologists in mainland China.

In China, modern critical care medicine began with surgical ICU in the early 1980s and now presents in all tertiary hospitals and many regional hospitals, with general ICUs accounting for > 50% of critical care resources.2 The debate about general vs specialty ICU has been ongoing for decades, with conflicting results. A cohort study in the United States suggested that diagnosis-appropriate (“ideal”) specialty ICU care offered no survival benefit over general ICU care for selected common diagnoses, whereas non-ideal specialty ICU care was associated with increased risk-adjusted mortality.3 Experience in China confirmed these findings.

In fact, the critical care subspecialty has already existed for decades in China within some primary specialties, for example, pulmonology, surgery, emergency medicine, and anesthesia. Furthermore, critical care medicine has been officially recognized as a primary specialty since 2009,2 with general and specialty ICUs run by “pure” intensivists, anesthetists, emergency physicians, and/or pulmonologists. In addition, critical care systems in Australia (anesthetist-led) and Japan (emergency physician-led) are excellent examples that alternative infrastructure of critical care training and patient management can also be successful. All of the previously mentioned phenomena strongly emphasize the importance of adopting a multidisciplinary approach to improving patient outcome,4 rather than merely discussing who should be the driving force or leadership of critical care.1 This also indicates that pulmonary medicine, though very important in the practice of critical care, is only a part of all relevant critical care knowledge and skills, including sedation/analgesia, resuscitation, hemodynamics, infectious disease, renal disorders, nutrition, and even surgery.

As in the United States, failure of some previous pulmonary and critical care medicine training programs in China might be explained by the concerns of negative lifestyle perceptions.5 In addition, it might also be related to underrecognition of the value of a multidisciplinary approach. More importantly, these barriers could not be automatically resolved by reintroducing the pulmonary and critical care medicine subspecialty.

We, therefore, strongly encourage our pulmonology colleagues to develop a multidisciplinary subspecialty training program, and we also welcome them to be more involved in other well-established critical care specialty and subspecialty training programs in China. After all, the beauty of the world lies not in its identity but in its diversity.

References

Qiao R, Rosen MJ, Chen R, Wu S, Marciniuk D, Wang C; on behalf of the CTS-ACCP Pulmonary and Critical Care Medicine Workgroup. Establishing pulmonary and critical care medicine as a subspecialty in China: joint statement of the Chinese Thoracic Society and the American College of Chest Physicians. Chest. 2014;145(1):27-29.
 
Du B, Xi X, Chen D, Peng J; China Critical Care Clinical Trial Group (CCCCTG). Clinical review: critical care medicine in mainland China. Crit Care. 2010;14(1):206.
 
Lott JP, Iwashyna TJ, Christie JD, Asch DA, Kramer AA, Kahn JM. Critical illness outcomes in specialty versus general intensive care units. Am J Respir Crit Care Med. 2009;179(8):676-683.
 
Brilli RJ, Spevetz A, Branson RD, et al; American College of Critical Care Medicine Task Force on Models of Critical Care Delivery. The American College of Critical Care Medicine guidelines for the definition of an intensivist and the practice of critical care medicine. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med. 2001;29(10):2007-2019.
 
Lorin S, Heffner J, Carson S. Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training. Chest. 2005;127(2):630-636.
 

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References

Qiao R, Rosen MJ, Chen R, Wu S, Marciniuk D, Wang C; on behalf of the CTS-ACCP Pulmonary and Critical Care Medicine Workgroup. Establishing pulmonary and critical care medicine as a subspecialty in China: joint statement of the Chinese Thoracic Society and the American College of Chest Physicians. Chest. 2014;145(1):27-29.
 
Du B, Xi X, Chen D, Peng J; China Critical Care Clinical Trial Group (CCCCTG). Clinical review: critical care medicine in mainland China. Crit Care. 2010;14(1):206.
 
Lott JP, Iwashyna TJ, Christie JD, Asch DA, Kramer AA, Kahn JM. Critical illness outcomes in specialty versus general intensive care units. Am J Respir Crit Care Med. 2009;179(8):676-683.
 
Brilli RJ, Spevetz A, Branson RD, et al; American College of Critical Care Medicine Task Force on Models of Critical Care Delivery. The American College of Critical Care Medicine guidelines for the definition of an intensivist and the practice of critical care medicine. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med. 2001;29(10):2007-2019.
 
Lorin S, Heffner J, Carson S. Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training. Chest. 2005;127(2):630-636.
 
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