EDITORIAL VIEWS ALN Editorial Views Contribution of the Pitié-Salpêtrière Hospital to French Editorial Views Anesthesiology 6 Editorial Note: This issue includes 13 articles and 3 Editorials from or about work from the Department of Anesthesiol- ogy and Critical Care in Pitié-Salpêtrière in Paris, which celebrated its 400-yr anniversary this year. All articles underwent rigorous peer review with no special consideration and we are pleased to highlight the recent and past contributions of this outstanding department and institution. Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/117/6/1147/258772/0000542-201212000-00005.pdf by guest on 30 September 2021 10.1097/ALN.0b013e31827558af December HE Pitié-Salpêtrière hospital, Working in a hospital that is T founded in 1612 as a home celebrating its 400th anniversary for the poor and then as a hospice, implies constantly projecting has been progressively transformed medical practice into the future. In over the years to become a center France, the anesthesiology–critical of excellence in the field of health care specialty, driven by the impetus (fig. 1) The 2,000 conventional hos- provided by Pierre Viars, M.D. pital beds have been decreased to (Professor, University Pierre et Marie allow the construction of modern Curie, Paris, France (1930–1998), technical units, which have allowed head of the Pitié-Salpêtrière hospital both the development of major sur- “In France, the anesthesi- Department of Anesthesiology gery and the management of out- and Critical Care from 1972 to patient surgery patients. Today, the ology-critical care special- 1995, has largely contributed to Pitié-Salpêtrière hospital is one of the modernization of both our Europe’s oldest, largest (1,500 beds, ty, driven by the impetus specialty and, as a consequence, to 47 operating rooms, and 140 surgi- provid ed by Pierre Viars, surgical care. Professor Pierre Viars cal and multidisciplinary critical care was the real founder of the Pitié- unit beds, including the 80 surgical M.D. … [and further devel- Salpêtrière hospital Department of and multidisciplinary critical care Anesthesiology and Critical Care, unit beds managed by the Depart- oped by Pierre Coriat, M.D.] by forming a team that enabled him ment of Anesthesiology and Critical has largely contributed to to ensure clinical care, teaching, Care) and best renowned hospitals and research in the fields of both with a long-standing affiliation with the mod ernization of both anesthesiology and critical care, as the University of Paris, now Univer- clearly illustrated by the numerous sity Pierre et Marie Curie-Paris 6. our spe cialty and, as a con- articles published in this issue The Pitié-Salpêtrière hospital’s repu- sequence, to surgical care.” concerning studies performed in the tation dates back to the middle of department that he founded. the 19th century with the discover- It is relatively simple to describe ies of Charcot. In the second half of the 20th century, the the past and predict the future, but it is much more diffi- hospital’s surgical activity, particularly major surgery and cult to be clear-sighted in everyday practice. This particular transplantations, developed with the support of the Depart- quality enabled Pierre Viars to make French anesthesiology– ment of Anesthesiology and Critical Care. It was at the Pitié- critical care a full-fledged medical specialty. Observing that Salpêtrière, that Christian Cabrol, in 1968, performed the anesthesiology was not considered to be a real medical spe- first successful heart transplantation in Europe, allowing the cialty, but rather a “necessary evil,” all his life’s work was development of very active research on the care of brain- devoted to recognition of our specialty by the hospital com- dead organ donors in our department.1 munity, based on the principle that anesthesiology–critical care physicians play a central role in surgical practice, and are Photo: Submitted by the author. therefore essential. When recruiting physicians, he therefore Accepted for publication September 14, 2012. The author is required a high level of medical and scientific training, as not supported by, nor maintains any financial interest in, any he was convinced that only constant reference to medical commercial activity that may be associated with the topic of this article. progress would enable them to be recognized and consid- Copyright © 2012, the American Society of Anesthesiologists, Inc. Lippincott ered by physicians of other specialties. He was the first to Williams & Wilkins. Anesthesiology 2012; 117:1147-50 understand that basic and clinical research was essential for Anesthesiology, V 117 • No 6 1147 December 2012 Editorial Views Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/117/6/1147/258772/0000542-201212000-00005.pdf by guest on 30 September 2021 Fig. 1. Image of the hospital at the 17th century (with permission of the assistance Publique Hopitaux de Paris). French anesthesiology to ensure recognition of our specialty our department presented more abstracts than any country by other medical specialties and to ensure a leading role in in the world, except for the United States. These first steps in medical progress. clinical research for our residents probably play a crucial role He clearly understood that medical progress in anesthesiol- in encouraging them to conduct research. ogy and critical care, as in any field of medicine, had to be Management of the department also ensures that physi- driven by science and research and that transfer of discoveries cians have sufficient time for clinical research, by providing in the fields of physiology or pharmacology to medical prac- them with a salary equivalent to that received by physicians tice would allow significant progress in the management of with a full-time clinical activity. high-risk patients requiring anesthesia, as well as critically ill In our department, analysis of postoperative outcome is patients. Basic cardiovascular physiology and molecular biology performed prospectively in all high-risk patients, particularly and description of the structure of ion channels that are critical those undergoing cardiac and vascular surgery. Studies pub- for central nervous system functions are just a few examples of lished in this issue on the harmful effects of β-blockers2 and on how basic science can be transposed to clinical practice. the relevance of intubation criteria3 demonstrate that the large Today, in the footsteps of Professor Viars, the department’s number of operated patients managed in our hospital allow philosophy is based on identifying residents interested in powerful statistical analyses addressing clinical questions. research and convincing them to select a topic before the end Pierre Viars was encouraged and helped by Bruno Riou, of their residency as the subject of their research work once M.D., Ph.D., to form an experimental research laboratory in they have been recruited as a young member of staff, regard- the Pierre et Marie Curie School of Medicine specialized in less of the clinical sector to which they are allocated. The best the pathophysiological mechanisms of our specialty. This lab- residents were encouraged to obtain a master’s degree and/ oratory has enabled a large number of anesthesiologists from or Ph.D. in experimental research in various fields related all over France to conduct experimental research in our field. to anesthesia, critical care, or pain. Our objective has been Over recent years, we have also asked young anesthesiologists clearly to ensure each resident presents at least one abstract at in our department to obtain international experience for at our national meeting, many of them present an abstract at an least 1 yr. The international cooperation that we have devel- international meeting, and a significant proportion of them oped with many centers (Charlottesville, Milwaukee, and San will be able to finally publish an article. Presentation at the Francisco in the United States, London and Oxford in the American Society of Anesthesiology meetings was consid- United Kingdom) is a further step designed to improve both ered to be a must before the creation of the European Society the level of our research and the appeal of our department. of Anesthesiology in 1992. I remember that, in 1988, at the Pierre Viars was also one of the first to understand that San Francisco American Society of Anesthesiology meeting, critical care medicine requires dedicated anesthesiologists Anesthesiology 2012; 117:1147-50 1148 Pierre Coriat EDITORIAL VIEWS specifically trained in critical care medicine, working full- The French law of 1994 therefore overcame the reticence time in the critical care unit and ensuring global manage- expressed by various hospital communities to enforce certain ment of the patient. rules ensuring better patient safety and confirming anesthe- The articles published in this issue of ANESTHESIOLOGY siology as a full-fledged medical specialty. show that our department has continued its basic research A survey of anesthesia-related mortality in France illus- and clinical research activities in both anesthesiology and crit- trates the active role played by French anesthesiology in the ical care, and that this research has been facilitated by progress field of patient safety.8 This very large-scale, nationwide study in other fields, such as pharmacology, cardiovascular and neu- confirmed a 10-fold decrease in anesthesia-related mortality rological pathophysiology, and biotechnological