Introduction: Surgical-trauma ICUs (STICU) during the pandemic era face unique challenges due to significant changes in resource availability, allocation, and COVID driven operational constraints. Our hypothesis is that continued anal. of these challenges is required to maintain quality trauma ICU care. Methods: Detailed factors unique to surgical-trauma critical care were analyzed at a Level 1 trauma center that is also the regional treatment center for the COVID-19 pandemic. Specific objective clin., economic and organizational factors were assessed over a 30-mo period prior to and including the current pandemic era (Jan 2019-Jun 2021). Results: A 30-mo comparative data anal. was completed that included 2 COVID surge periods and 3 STICU geog. moves. COVID hospital/ICU pts surged between 3/20-5/20 and 12/20-2/21 (peak COVID hospital/ICU-422/52 pts); STICU census decreased 80% during surge 1, 20% during surge 2; Acute Care Surgery division wRVU production varied during surge periods (surge 1, surge 2); Trauma (-12%,-17%), Surg Crit Care (-8%,-8%), Emerg Gen Surgery (-40%,+16%). wRVUs now normalized. Trauma Cat 1/Cat 2 activations decreased 33%/23% during surge 1; 23%/52% during surge 2. 58,192 total medical center operative cases during period, 1939/mo; surge 1 cases minus 38%/mo (lowest month: minus 58%), surge 2 minus 0.7%/mo. CAUTI, CLABSI, pressure wounds all increased in new STICU during pandemic; only pressure wounds correlated with surges. Addnl. STICU challenges identified during the anal. period leading to care delivery challenges include ICU design deficiencies, communication/daily goal tool utilization (< 50% goal), RN-MD communication/collaboration (workgroups established), RN trauma specific training deficits and RN management challenges (new 0.5 mi office separation, new STICU specific RN leader need). Conclusion: The COVID-19 pandemic presents unique multidisciplinary critical care challenges. The STICU at our Level 1 trauma center continues to maintain quality care and successfully address challenges from significant changes in clin., economic, and organizational factors. Subjective anal. and intervention is ongoing to address trauma training, multidisciplinary team morale, critical care RN-MD collaboration and ICU design improvements.