Management of transgender patients in critical care

Abstract

As clinicians working in critical care, it is our duty to provide all of our patients with the high-quality care they deserve, regardless of their gender identity. The transgender community continues to suffer discrimination from the media, politicians and general public. As healthcare workers we often pride ourselves on our ability to safely care for all patients. However, there remains a distinct lack of understanding surrounding the care of critically ill transgender patients. This is likely in part because the specific care of transgender patients is not included in the Faculty of Intensive Care Medicine’s, Royal College of Anaesthetists’, Royal College of Physician’s, or Royal College of Emergency Medicine’s curriculum. There are several important considerations relevant for transgender patients in critical care including anatomical changes to the airway, alterations to respiratory and cardiovascular physiology and management of hormone therapy. Alongside this, there are simple but important social factors that exist, such as the use of patient pronouns and ensuring admittance to correctly gendered wards. In this review we will address the key points relevant to the care of transgender patients in critical care and provide suggestions on how education on the subject may be improved.

A guide to caring for patients who identify as transgender and gender diverse in the emergency department

“…however, advocating for cessation can often create more harm, as TA B L E 7 Common gender-affirming surgery procedures and complications. 13,15,16,61,[84][85][86][87][88][89][90][91] Feminizing procedure Description Complications "Bottom surgery"…”

“…Social gender affirmation practices can impede certain examinations and procedures and may require a patient‐centered discussion about removing their compression garments or prostheses. 57 , 61 Following the principles of trauma‐informed care (TIC) can help prevent traumatization and minimize re‐traumatization of T/GD. 59 , 60 Reinforcing concepts of patient self‐autonomy and providing appropriate alternative options for patients for whom certain examinations may cause significant harm.…”

“…In addition to genital, rectal, and chest examinations, checking for pelvic stability, auscultating the heart and lung, and performing point of care ultrasound may be upsetting for T/GD. Social gender affirmation practices can impede certain examinations and procedures and may require a patient‐centered discussion about removing their compression garments or prostheses 57,61 . Following the principles of trauma‐informed care (TIC) can help prevent traumatization and minimize re‐traumatization of T/GD 59,60 .…”

The care of transgender patients in critical care: A call to action

“…4 Our recent survey on UK anaesthetists suggested it may be even more than this, with the median confidence regarding the perioperative care of transgender patients being 3/10. 5 As discussed in our recent review article in the journal, 6 many of the specific considerations for transgender patients are relevant to critical care (alterations to airway anatomy, cardiovascular and respiratory changes, the management of hormone therapy etc. ), and it would therefore be logical to extrapolate that a similar knowledge gap exists in this domain.…”