COVID-19 pandemic in ICU. Limited resources for many patients: approaches and criteria for triaging
COVID-19 pandemic in ICU. Limited resources for many patients: approaches and criteria for triaging
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DOI：
10.23736/s0375-9393.21.15736-0
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发表时间：
2021-12-01
影响因子：
3.2
通讯作者：
Piccinni, Mariassunta
中科院分区：
文献类型：
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作者：
Gristina, Giuseppe R.;Piccinni, Mariassunta
COVID-19疫情打破了人们的错觉，即需要配给的医疗资源短缺问题仅限于中低收入国家。在疫情激增期间，许多高收入国家面临前所未有的医疗保健系统需求，大大超出了可用资源。医院的能力不堪重负，在重症监护室工作的医生经常被迫拒绝收治急需重症监护的病人。为了支持这些困难的决定，许多科学协会和政府机构已经制定了需要机械通气和其他生命支持治疗的患者分类指南。这些准则所依据的伦理方法是基于平等或功利原则。然而，迄今为止，就所采用的方法，尤其是所采取的解决办法达成的共识有限，导致意见冲突，使保健专业人员对病人需求作出最佳反应的能力进一步复杂化。随着COVID-19危机走向一些人所称的“流行病常态”阶段，辩论在分配ICU资源方面所做的个别决定的利弊的必要性似乎不那么紧迫了。相反，作者的目的是：1）批判性地回顾用于将患者分诊入ICU的方法和标准; 2）澄清宏观和微观分配选择如何在其相互依赖性中影响有关个体患者护理的决策过程; 3）反思在ICU工作的决策者和专业人员需要保持适当程度的“诚实”在资源短缺的原因和决策过程方面，需要向公民和病人提供更多的信息，这些信息在日常和危机时期以不同的方式涉及需要在这两个层面做出“悲剧性的选择”。
The COVID-19 pandemic has shattered the illusion that healthcare resource shortages that require rationing are problems restricted to low-and middle-income countries. During the pandemic surges, many high-income countries have been confronted with unprecedented demands for healthcare systems that dramatically exceeded available resources. Hospitals capacities were overwhelmed, and physicians working in intensive care units (ICUs) were often forced to deny admissions to patients in desperate need of intensive care. To support these difficult decisions, many scientific societies and governmental bodies have developed guidelines on the triage of patients in need of mechanical ventilation and other life-support treatments. The ethical approaches underlying these guidelines were grounded on egalitarian or utilitarian principles. Thus far, however, consensus on the approaches used, and, above all, on the solutions adopted have been limited, giving rise to a clash of opinions that has further complicated health professionals' ability to respond optimally to their patients' needs. As the COVID-19 crisis moves toward a phase of what some have called "pandemic normalcy," the need to debate the merits and demerits of the individual decisions made in the allocation of ICU resources seems less pressing. Instead, the aims of the authors are: 1) to critically review the approaches and criteria used for triaging patients to be admitted in ICU; 2) to clarify how macro-and micro-allocation choices, in their interdependance, can condition decision-making processes regarding the care of individual patients; 3) to reflect on the need for decision-makers and professionals working in ICUs to maintain a proper degree of "honesty" towards citizens and patients regarding the causes of the resource shortages and the decision-making processes, which, in different ways routinely and in crisis times, involve the need to make "tragic choices" at both levels.