Adult ICU Triage During the Coronavirus Disease 2019 Pandemic: Who Will Live and Who Will Die? Recommendations to Improve Survival*

Sprung, Charles L.; Joynt, Gavin M.; Christian, Michael D.; Truog, Robert D.; Rello, Jordi; Nates, Joseph L.

doi:10.1097/ccm.0000000000004410

Cited by 135 publications

(147 citation statements)

References 40 publications

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“…population characteristics, hospital practices, prevalence of pre-existing conditions) and not applicable universally. Triage of adult patients with COVID-19 remains challenging with most evidence coming from expert recommendations; evidence-based methods based on larger U.S.-based cohorts have not been reported ( Sprung et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Early prediction of level-of-care requirements in patients with COVID-19

Hao

Sotudian

Wang

et al. 2020

eLife

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This study examined records of 2,566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively.ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.

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Section: Introductionmentioning

confidence: 99%

Early prediction of level-of-care requirements in patients with COVID-19

Hao

Sotudian

Wang

et al. 2020

eLife

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“…Differences in hospital facilities, patient preferences (where limitations of care may have been in place) and indications for IMV may have also influenced CFR (12). Finally, the change in triage process considering comorbidities, age and frailty status in allocating ICU beds and ventilators during the pandemic may have contributed to a lower CFR among patients receiving IMV, where younger and less frail patients were prioritized for IMV and ICU care(105)(106)(107)(108) while older and frailer patients were less likely to receive ventilatory support.…”

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confidence: 99%

Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis

Lim

Subramaniam

Reddy

et al. 2021

Am J Respir Crit Care Med

290

239

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Author contributions:-Zheng Jie LIM: This author has conceived the project idea, conducted the systematic review, statistical analysis, assisted with data analysis, wrote the initial drafts of the manuscript, created tables and figures and finalized the manuscript.-Ashwin SUBRAMANIAM: This author has conceived the project idea, conducted the systematic review, assisted with data analysis, wrote the initial drafts of the manuscript and finalized the manuscript.-Mallikarjuna REDDY: This author has conducted the systematic review, assisted with data analysis, wrote the initial drafts of the manuscript and finalized the manuscript.-Gabriel BLECHER: This author has analyzed the data and wrote the initial drafts of the manuscript and finalized the manuscript.-Umesh KADAM: This author has conducted the systematic review, assisted with data analysis, wrote the initial drafts of the manuscript and finalized the manuscript.

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“…Consistent with recommendations in Canada and the United States, respondents supported triage protocols and multidisciplinary "triage teams" compared to a single "triage o cer" and valued the availability of a bioethicist. 1,2,15 Critical care physicians favored excluding the MRP from these teams,…”

Section: Discussionmentioning

confidence: 99%

Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

Mulla

Bigham

Frolic

et al. 2020

Preprint

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Purpose: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians towards triaging scarce critical care resources in the COVID-19 pandemic. Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes towards triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65%), as well as fears of psychological distress if required to triage scarce resources (77%). Only 49% of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 vs 2.9/5 p=0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 vs 4.0/5 p=0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medico-legal protection, additional tools for therapeutic communications, and healthcare provider psychological support. Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.

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Adult ICU Triage During the Coronavirus Disease 2019 Pandemic: Who Will Live and Who Will Die? Recommendations to Improve Survival*

Cited by 135 publications

References 40 publications

Early prediction of level-of-care requirements in patients with COVID-19

Early prediction of level-of-care requirements in patients with COVID-19

Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis

Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

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