Clinics (Sao Paulo). 2020;75:e2023.

Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis

Maria José Carvalho Carmona , Vinícius Caldeira Quintão , Brigite Feiner de Melo, Rodrigo Gherson André, Rafael Priante Kayano, Luiz Marcelo Sá Malbouisson , José Otávio Costa Auler-Júnior

DOI: 10.6061/clinics/2020/e2023

With the prospect of an increasing number of COVID-19 cases and with the city of Sao Paulo being the epicenter of the COVID-19 pandemic in Brazil, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de Sao Paulo (HCFMUSP) initiated an action plan to designate the largest of its eight institutes to the treatment of the disease. With the progressive increase in the number of attended cases, at the end of March 2020, the 900 beds of HCFMUSP Instituto Central (ICHC) were exclusively allocated to patients with COVID-19. A further 200 intensive care (ICU) beds were added in the following month, including those adapted inside operating rooms. The final plan accounted for more than 300 ICU beds and included 34 operating rooms in the four blocks of the main ICHC surgical theater that were adapted to attend to one to four patients each. This resulted in a complex of four ICUs with up to 76 beds. The rearrangement and specialized review of medical gas, electricity, air conditioning, and data network installations were essential procedures to ensure the safe use of these areas for this new purpose.

Following the cancellation, postponement, or transfer of surgical schedules at other institutes of the HCFMUSP complex and Hospital Universitario, the ICHC team of 117 physician anesthesiologists was divided into those remaining at the ICHC or conducting specific procedures at the destination sites, with emphasis on trauma, surgical emergencies, transplants, and high-risk obstetrics. According to the lessons learned from countries that have already gone through the peak of the pandemic, such as China and Italy, the 60 physician anesthesiologists who stayed in the ICHC were intensely retrained regarding the correct use of personal protective equipment and techniques of donning and doffing to minimize the occupational risk of COVID-19.

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