The evolution of critical care has been significantly influenced by global health challenges, particularly pandemics. From its early days during the polio epidemic of the 1950s, critical care has continually adapted to meet the demands of various health crises. These events have necessitated swift changes in standard practices, resource allocation, and care objectives.

Dr. William  Thomson, Dr. Zudin Puthucheary, and Dr. Yize Wan from Queen Mary University of London have recently explored the intricate relationship between critical care and pandemic preparedness. Their research, published in the British Journal of Anaesthesia, sheds light on the challenges and strategies essential for an effective critical care response during pandemics.

The authors trace the evolution of critical care, noting its initial response to the polio epidemic in the 1950s. They emphasize how subsequent pandemics, including COVID-19, H1N1, Ebola, and SARS, have further shaped its development. These events have not only tested healthcare systems globally but also revealed challenges related to infrastructure, organization, ethical standards, and clinical practice.

A significant point of discussion in their research is the importance of coordination at local, national, and international levels. Such coordination spans various domains, from research collaboration to the organization of critical care networks. This collaborative approach is crucial for addressing the different stages of a pandemic, including preparation, alert, surge, and recovery.

The authors also delve into the long-term outcomes of patients who have survived pandemics. They note that while survivors may not show visible signs of past illnesses like polio or smallpox, many continue to experience persistent organ dysfunction long after their initial recovery, especially in the case of critical COVID-19.

Furthermore, the research emphasizes the role of adaptability, collaboration, and continuous learning in enhancing pandemic preparedness and response. The authors highlight the efforts made before COVID-19 to streamline governance and funding structures. They discuss the introduction of ‘sleeping’ trials—dormant adaptable RCTs ready to be activated during a pandemic—to rapidly develop high-quality evidence in the early stages of an outbreak.

In conclusion, the study of Dr. Thomson and his colleagues provides valuable insights into the role of critical care during global health crises. Their findings underscore the importance of adaptability, collaboration, and a deep understanding of past pandemics to shape the future of critical care.

Reference: William R. Thomson, Zudin A. Puthucheary, Yize I. Wan, “Critical care and pandemic preparedness and response”, British Journal of Anaesthesia, 2023. DOI: [Link to DOI]