COVID-19 pandemic: triage for intensive-care treatment under resource scarcity

Abstract

Guidance on the application of Section 9.3 of the SAMS Guidelines "Intensive-care interventions" (2013) This document is available in English, French, German and Italian, cf. sams.ch/en/coronavirus. The German text is the authentic version.

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

“…The development of instruments to allocate scarce resources increases in periods of pandemics, as occurred with influenza [17][18][19][20][21][22][23][24], with severe respiratory distress syndrome (SARS) [18,23] and nowadays with COVID-19 [25][26][27].…”

“…After the SARS outbreak in 2003 [28], a pioneering guideline for triage in intensive care in pandemics [29] was developed and published, and this became a reference for the development of new instruments [17][18][19][20][21][22][23][24][25][26][27][30][31][32]]. An additional file shows a summary of each instrument identified in this investigation in more detail (see Additional file 2).…”

“…Some of the instruments found in this study [17,[20][21][22][23][24][25][26][27][29][30][31], direct screening for access to intensive care (intensive care beds, hemodynamic and respiratory support, antibiotic therapy, renal replacement therapy), while others [18,19,32] deal specifically with the allocation of invasive mechanical ventilators.…”

“…In general, the structure of the instruments includes clinical, non-clinical, and tiebreaker criteria, which are permeated by ethical aspects for decision making in the allocation of scarce resources [17][18][19][20][21][22][23][24][25][26][27][29][30][31][32] (Table 2).…”

Good rules for ICU admission allow a fair allocation of resources, even in a pandemic

“…Within less than 3 weeks after the first detection of COVID-19 infections in Switzerland, the Swiss Society of Intensive Care Medicine (SSIM) together with the Swiss Academy of Medical Sciences (SAMS) has elaborated detailed and coherent guidelines defining the criteria for admission to the ICU in situations of bed shortage, as are to be expected in the present pandemic [3,4]. As well as their rapid conception and publication, these texts have the merit of establishing a uniform national framework for patient care in a time where shortages of these resources could be particularly painful, and not only for the patients concerned.…”