Decision making in ICU, an essential burden

Abstract

The decision-making process is of paramount importance for the critical care physician and is an integral part of his everyday life. Stress, frustration, and sometimes anger, occur when, during a pandemic, the flow of patients increases, and does not match any more the capacities of the intensive care unit (ICU), and selection of patients become unavoidable. There is a lack of knowledge on the decision-making process in this setting. Etymological analyses may help understanding the underlying mechanisms. Deciding is different from choosing and is not limited to a mathematical algorithm. Anxiety and uncertainties are part of the decision process. Recent researches in neurosciences and on cognitive biases have emphasized the profound complexity of the decision-making process in a critical care setting, including during the Covid-19 pandemic. Discussing and sharing the decision, a well-developed practice in critical care medicine, may help alleviating the committed physician’s burden. Daily decision is part of care and the advent of new technologies may alter the critical care physician’s responsibilities. It is therefore urgent to disentangle the decision-making process in the ICU before integrating these new technologies. Our goal, as caregivers, is to position ourselves as technosophes and not as technophiles or technophobes.