© 2021 Elisa Estenssoro
Unusually for a critical care specialist, Elisa Estenssoro always wanted to work in this field. “It was the early 1980s, and critical care was just beginning”, Estenssoro tells The Lancet Respiratory Medicine. “I heard about it, I read about it—and I knew it was for me.”
She was born in, grew up in, and has spent her life and career in La Plata, part of the Buenos Aires region in Argentina. Several female role models in her family worked in the sciences, and after initially thinking of chemistry, she decided instead to study medicine, obtaining her medical degree in 1980 from the University of La Plata, and completing her residency in internal medicine in 1983 at the hospital she has called home for her entire career: Hospital Interzonal de Agudos San Martin de La Plata.
“In critical care, you see the most serious cases of all specialties. You have to think quickly in every situation, and that suits me, because I am a very impatient person!” explains Estenssoro. After visiting La Plata's own intensive care unit (ICU) during her training, she knew it was her destiny, and became board-certified in intensive care medicine in 1990. Later, in 1998, she became medical director of the ICU at La Plata.
Critical care is the discipline in which death is always just one step away. “Death is not something you ever get used to”, she says. “Especially when the victims are young people, injured in road accidents or violence. Every time, the emotional strain of dealing with the families is so intense.” After Estenssoro had two daughters of her own, she was able to empathise with these families even more.
A turning point in her career was meeting her mentor, Sonia Buist, in 2002 through MECOR (Methods in Epidemiologic, Clinical and Operations Research, of the American Thoracic Society for Latin America). “After this, I began to focus on incidence, risk factors, and outcomes”, says Estenssoro. “We needed more data on prolonged mechanical ventilation in the ICU, chronic critical illness, and survivors of critical care.” She has since led on many studies of critical care in Argentina and South America. One of her first, on the epidemiology of acute respiratory distress syndrome (ARDS), found that Argentina had higher mortality than did high-income countries, despite similar risk factors and younger patients. “In many cases, the patient's problems have become established long before they ever reach the ICU—poverty, poor health, lack of access to health care among them”, she explains.
She also set out to fix Argentina's lack of sepsis data, and her studies revealed that patients in public hospitals were younger, sicker, and had more comorbidities and higher mortality than did older patients in the private system, and also took longer to be admitted. The studies made clear that disease perceptions and outcomes are very connected to the patient's socioeconomic and educational level.
During her tenure as the first female president of the Argentine Society of Intensive Care (Sociedad Argentina de Terapia Intensiva or SATI; 2008–10), Estenssoro led on the study of pandemic H1N1 influenza in her country, showing higher mortality than in high-income countries, and finding that some patients were not realising the seriousness of their flu, remaining at home for up to 6 days before hospital admission—much longer than in other countries. “Dealing with severe H1N1 flu, especially in pregnant women, was terrible. We thought this would be the worst incident in our careers. But then, 10 years later, COVID arrived.”
And when COVID-19 did arrive, the first wave came later to Argentina because early lockdown kept the case numbers down. But disaster hit in August and September, 2020, when cases increased rapidly then plateaued through to November. “One major issue is that patients who enter the ICU stay a median of 16 days, whether they survive or not, placing hospitals under huge strain”, explains Estenssoro. And as the public tired of strict restrictions in April and May, 2021, the second wave truly hit Argentina, and at the time of writing—June, 2021—Estenssoro fears that the health system is close to collapse, with 100% ICU bed occupancy, doctors and nurses exhausted, and the vaccine rollout yet to gain momentum. Her study of COVID-19 ICU outcomes in Argentina, published in The Lancet Respiratory Medicine, found high mortality and confirmed that age, comorbidities, and deep physiological derangements predict a worse outcome.
In March, 2021, she stepped down from her ICU duties at La Plata to become senior consultant of the Ministry of Health of the Province of Buenos Aires, and now devotes all her time to research. A long-term follow-up of her COVID-19 study, plus other studies on vaccination and new treatments, are in progress. “I feel I have done all I can in my hands-on work in the ICU and passed that knowledge onto others, although I miss it terribly.” She is also looking forward to spending more time with husband Arnaldo Dubin, also an intensivist, and her daughters and grandson.
“It is difficult to describe what Elisa represents for the global intensive care community: she is one of our foremost leaders. She has been the perfect ambassador for Latin America's intensive care medicine research around the world, and has contributed immensely to our speciality”, says Maurizio Cecconi, president of the European Society of Intensive Care Medicine. “Elisa also has a unique skill: being able to capture everyone's attention without ever raising her voice, whatever the topic!”