Development of a triage protocol for critical care during an influenza pandemic
Development of a triage protocol for critical care during an influenza pandemic
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DOI：
10.1503/cmaj.060911
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发表时间：
2006-11-21
影响因子：
14.6
通讯作者：
Burkle, Frederick M., Jr.
中科院分区：
文献类型：
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作者：
Christian, Michael D.;Hawryluck, Laura;Burkle, Frederick M., Jr.
背景：最近爆发的禽流感(H(5)N1)使人们重新重视为人类流感大流行做准备。在这一规划中特别关注的是资源的分配，例如呼吸机和抗病毒药物的分配，这些资源在大流行期间可能变得稀缺。方法：我们应用协作过程，使用最佳证据、专家小组、利益相关者协商和伦理原则来制定在大流行期间优先获得包括机械通气在内的危重护理资源的分诊方案。结果：分流方案使用序贯器官衰竭评估评分，包括四个主要组成部分：纳入标准、排除标准、最低生存条件和优先工具。解释：该方案旨在为在流感大流行的最初几天到几周期间，如果危重护理系统变得不堪重负时做出分流决定提供指导。尽管我们设计这个方案是为了在流感大流行期间使用，但分诊方案既适用于有流感的患者，也适用于没有流感的患者，因为所有患者必须共享一个重症监护资源池。
Background: The recent outbreaks of avian influenza (H(5)N1) have placed a renewed emphasis on preparing for an influenza pandemic in humans. Of particular concern in this planning is the allocation of resources, such as ventilators and antiviral medications, which will likely become scarce during a pandemic.Methods: We applied a collaborative process using best evidence, expert panels, stakeholder consultations and ethical principles to develop a triage protocol for prioritizing access to critical care resources, including mechanical ventilation, during a pandemic.Results: The triage protocol uses the Sequential Organ Failure Assessment score and has 4 main components: inclusion criteria, exclusion criteria, minimum qualifications for survival and a prioritization tool.Interpretation: This protocol is intended to provide guidance for making triage decisions during the initial days to weeks of an influenza pandemic if the critical care system becomes overwhelmed. Although we designed this protocol for use during an influenza pandemic, the triage protocol would apply to patients both with and without influenza, since all patients must share a single pool of critical care resources.