[Between intensive care and palliative care at the time of CoViD-19.]
[Between intensive care and palliative care at the time of CoViD-19.]
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DOI：
10.1701/3347.33185
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发表时间：
2020-04-01
影响因子：
--
通讯作者：
Romano, Massimo
中科院分区：
文献类型：
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作者：
Romano, Massimo
由SARS-CoV-2病毒引起的大流行感染决定了重症监护的需求和实际供应之间的严重失衡。重症监护病房（ICU）病床和呼吸机的短缺，严重呼吸衰竭患者的治疗产生焦虑的临床医生/重症监护医生谁必须决定哪些患者入住ICU和在哪些患者实施姑息治疗。在紧急情况下，他们必须适用特定的临床和伦理标准。在公共卫生伦理的指导下，将比例性和适当性标准与公平、平等、效用标准相结合，将分配正义的概念从病人接受所有治疗的权利扩展到资源短缺时的合理分配。临床标准应包括疾病的严重程度、合并症的数量和严重程度、虚弱程度、器官衰竭及其阶段、患者的年龄、功能自主性和认知状态。因此，不应适用先到先得的ICU入院规则。对因临床原因和晚期疾病而未入住ICU的患者应给予高质量的姑息治疗，以获得良好的症状控制（主要是呼吸困难、焦虑和谵妄），并在生命结束时实施姑息镇静。最后，应特别注意家属/照顾者的丧亲管理，以及参与pandemia的卫生工作者的心理问题和创伤后应激障碍的正确方法。
The pandemic infection caused by the virus SARS-CoV-2 has determined a severe imbalance between demand and actual supply of intensive care. The shortage of intensive care units (ICU) beds and ventilators for the treatment of patients with severe respiratory failure produced angst in the clinicians/intensivists who have to decide which patients admit to ICU and in which patients to implement palliative care. They have to apply specific clinical and ethical criteria, in emergency conditions. Proportionality and appropriateness criteria should be integrated with equity, equality, utility criteria, widening the distributive justice concept from the right of the patient to receive all available therapies to a right resources allocation during shortage, guided by public health ethic. The clinical criteria should include the disease severity, the number and severity of comorbidities, frailty, the organ failures and their stage, the patient's age, the functional autonomy and cognitive status. Consequently the first come-first served rule to ICU admission should not be applied. The patients not admitted to ICU due to clinical reasons and advanced stage diseases should receive a high quality palliative care, to obtain a good symptoms control (mainly dyspnea, anxiety and delirium) and to implement palliative sedation at the end of life. Finally particular attention should be paid to the bereavement management of the family/caregivers and in the right approach of psychological problems and Post-Traumatic Stress Disorder of health workers involved in the pandemia.