Surge Capacity Principles Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement
Surge Capacity Principles Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement
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DOI：
10.1378/chest.14-0733
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发表时间：
2014-10-01
期刊：
影响因子：
9.6
通讯作者：
Christian, Michael D.
中科院分区：
文献类型：
--
作者：
Hick, John L.;Einav, Sharon;Christian, Michael D.
背景：本文为灾害或流行病中扩大重症监护应急能力和扩展重症监护服务能力提供共识建议。它侧重于发达国家扩大医院重症监护服务的原则和框架。另一篇配套文章讨论了激增后勤，即在灾难事件中提供大规模重症护理能力的要素。本文中的建议对所有参与大规模灾害或流行病中受伤或危重患者的人都很重要，包括一线临床医生、医院管理人员、公共卫生或政府官员。方法：激增能力专题小组针对以下领域提出了23个关键问题：系统问题；设备、用品和药品；人员配备;和信息。进行文献检索以确定作为关键建议基础的证据。大多数报告都是小规模的，是观察性的，或者使用了有缺陷的模型；因此，作为建议基础的证据水平很低，不允许制定基于证据的建议。因此，专家组使用改进的德尔菲过程制定了基于专家意见的建议。前一个工作队提出的建议也包括在内，供专家小组确认。结果：本文提出了10项建议，这些建议涉及指导大规模重症监护的激增能力和能力规划的原则，包括重症监护在灾害规划中的作用；浪涌连续体；浪涌响应目标；态势感知和信息共享；减轻对重症监护的影响；照顾特殊人群的规划；服务降级/停止（也被认为是工程故障）。结论：未来关于重症监护激增的报告应强调基于人群的结果以及后勤细节。规划应根据具体情况造成的危重病人或受伤病人的预计人数。这应包括考虑ICU患者的长期护理需求，并且必须考虑可能限制提供护理能力的资源限制。应制定标准的ICU管理表格和患者数据表格，以评估ICU激增能力的影响，并在灾害事件中使用。胸部2014;146 (4_supppl): e1S-e16S
BACKGROUND: This article provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disasters or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion article addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with injured or critically ill multiple patients, including front-line clinicians, hospital administrators, and public health or government officials.METHODS: The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel.RESULTS: This article presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care, including the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service deescalation/cessation (also considered as engineered failure).CONCLUSIONS: Future reports on critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include a consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and used in disaster events. CHEST 2014; 146 (4_Suppl): e1S-e16S