Microaggressions in anesthesiology and critical care: individual and institutional approaches to change.

Microaggressions are subtle verbal or nonverbal insults that convey derogatory and negative messages to and about people who belong to oppressed groups. Microaggressions reflect structurally and historically perpetuated societal values, which advantage some groups of people by considering them to be inherently more worthy than others, while simultaneously disadvantaging others. While microaggressions may seem innocuous and are often unintentional, they cause tangible harm. Microaggressions are commonly experienced by physicians and learners working in perioperative and critical care contexts and are often not adequately addressed, for a multitude of reasons, including witnesses not knowing how to respond. In this narrative review, we provide examples of microaggressions towards physicians and learners working in anesthesia and critical care, and offer individual and institutional approaches to managing such incidents. Concepts of privilege and power are introduced to ground interpersonal interventions within the larger context of systemic discrimination, and to encourage anesthesia and critical care physicians to contribute to systemic solutions.

RéSUMé: Les microagressions sont des insultes subtiles verbales ou non verbales qui transmettent des messages désobligeants et négatifs aux personnes qui appartiennent à des groupes opprimés ou à leur sujet. Les microagressions reflètent des valeurs sociétales qui se perpétuent de manière structurelle et historique, et qui profitent à certains groupes de personnes en les considérant comme intrinsèquement plus dignes que d'autres, tout en désavantageant les autres. Bien que les microagressions puissent sembler inoffensives et soient souvent involontaires, elles causent des dommages tangibles. Les microagressions sont couramment vécues par les médecins et les stagiaires travaillant dans des contextes périopératoires et de soins intensifs et ne sont souvent pas traitées adéquatement, pour une multitude de raisons, y compris le fait que les personnes qui en sont témoins ne savent pas comment réagir. Dans ce compte rendu narratif, nous fournissons des exemples de microagressions envers les médecins et les stagiaires travaillant en anesthésie et en soins intensifs, et proposons des approches individuelles et institutionnelles pour gérer de tels incidents. Les concepts de privilège et de pouvoir sont introduits pour ancrer les interventions interpersonnelles dans le contexte plus large de la discrimination systémique et pour encourager les anesthésiologistes et les intensivistes à contribuer à apporter des solutions systémiques.

COVID-19 critical illness in pregnancy.

Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.