The good, the bad and the ugly: pandemic priority decisions and triage

Journal of Medical Ethics
Hans FlaattenDylan W deLange

Abstract

In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit bed...Continue Reading

References

Dec 15, 2010·Critical Care Medicine·William MeadowJesse Hall
Jul 11, 2012·Intensive Care Medicine·A RhodesR P Moreno
Mar 24, 2020·The New England Journal of Medicine·Ezekiel J EmanuelJames P Phillips
Apr 12, 2020·Journal of Medical Ethics·Chiara Mannelli
May 20, 2020·Journal of Medical Ethics·Benjamin HerrerosDiego Real de Asua

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Citations

Oct 3, 2020·Journal of Clinical Medicine·Pierre-Yves BoëlleOlivier Robineau
Jan 28, 2021·Annals of Intensive Care·Pieter Depuydt, Bertrand Guidet
Feb 14, 2021·Journal of Critical Care·Michael BeilHans Flaatten
Oct 20, 2020·Journal of Critical Care·Michael BeilP Vernon van Heerden
Apr 8, 2021·Critical Care Medicine·Kusum S MathewsUNKNOWN National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Networ
Sep 2, 2020·British Journal of Anaesthesia·Hans FlaattenBertrand Guidet
Nov 4, 2021·Primary Dental Journal·Harriet E Powell

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