A multicentre evaluation of two intensive care unit triage protocols for use in an influenza pandemic

Abstract

Both triage protocols resulted in increases in ICU bed availability, but the OHPIP protocol provided the greatest increase overall. With the NSW triage protocol, ICU bed availability increased as the protocol was escalated.

Triage

“…28,36 Following the outbreak of severe acute respiratory syndrome 50 in 2003 and the development of the first protocol 51 for ICU tertiary triage, there has been a significant amount of work to further develop such protocols. 16,18,29,[52][53][54][55][56][57][58][59][60][61] Most well-developed and evaluated ICU triage protocols 16,29,51,57,58,60,61 have used inclusion and exclusion criteria in combination with the sequential organ failure score (SOFA). In a conventional or contingency situation, when there is not an absolute shortfall of resources, the inclusion criteria for admission to ICU in most units will be patients who are at high risk of deteriorating and requiring initiation of life support or who are already receiving life support.…”

“…During the H1N1 pandemic, governments in Canada, the United Kingdom, and New Zealand established triage protocols, based on the Ontario protocol, 51 to be implemented if ICU resources were overwhelmed. 58,66…”

“…Given that any ICU triage protocol must apply to all patients being considered for ICU admission, most of the protocols have been based on physiologic prognostic scores, such as the SOFA score. 16,29,51,57,58,60,81 Although this addresses the need for a score that applies to all, there is concern about certain subjective aspects of the SOFA score (including Glasgow Coma Scale measurement and level of inotrope support), its lack of applicability for pediatric patients, 82 as well as concerns about the performance of the score. 65,67,83 However, the studies questioning SOFA performance have done so based on individual patient outcome analyses not populationlevel outcomes (overall survival), which should be the basis of triage evaluations.…”

Avaliação de um instrumento de auxílio à tomada de decisão para a priorização de vagas em unidades de terapia intensiva

“…Existe um consenso crescente na literatura sobre o fato de que diretrizes claras e objetivas para triagem para admissão na UTI poderiam melhorar os processos de tomada de decisão de alocação de recursos e pacientes 14,17,31 . No entanto, ferramentas de estratificação e triagem para admissão na UTI não vem sendo implementadas de maneira rotineira, exceto em casos excepcionais, como em situações de surtos ou catástrofes 63,140 .…”

Detección de gripe y de otros virus respiratorios durante un periodo pandémico y postpandémico de nueva variante de gripe

“…La demanda procedente de las dos áreas sanitarias de Valladolid seguida de la de Burgos obedece con elevada probabilidad a la propia configuración física y asistencial de la red sanitaria que responde a la emergencia de la Gripe pandémica. Diversos autores han realizado en nuestro país estudios descriptivos sobre el diagnóstico de gripe A H1N1 con diferentes enfoques: estudios epidemiológicos en el contexto asistencia 92 , análisis de variables clínicas asociadas al diagnóstico en distintos grupos de población 93 y descripción de marcadores pronósticos 94,95 , hallazgos circunscritos a los propios aislados víricos o incluso comparación de técnicas diagnósticas en el contexto del periodo pandémico y postpandémico 96 .El número de pacientes incluidos en dichas investigaciones es muy variable y en algunas se obtiene a expensas del análisis de series multicéntricas 94,[97][98][99][100] .No hemos encontrado trabajos que analicen de forma consecutiva los resultados de la demanda asistencial a la que se somete a un sólo centro. Es por ello, por lo que nuestro estudio tiene una relevancia mayor, ya que se analiza toda la población atendida en un centro de diagnóstico, obteniendo así una visión de conjunto de dos años consecutivos dividiendo el estudio paraalgunas variables en dos periodos diferenciados, periodo pandémico y periodo postpandémico.…”