Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic

Tambone, Vittoradolfo; Boudreau, Donald A.; Ciccozzi, Massimo; Sanders, Karen; Campanozzi, Laura Leondina; Wathuta, Jane; Violante, Luciano; Cauda, Roberto; Petrini, Carlo; Abbate, Antonio; Alloni, Rossana; Argemí, Josepmaria; Renom, Josep Argemí; Benedictis, Anna De; García-Sánchez, Emilio; Ghilardi, Giampaolo; Hafler, Janet P.; Lindén, Magdalena; Marcos, Alfredo; Muda, Andrea Onetti; Pandolfi, M.; Pelaccia, Thierry; Picozzi, Mario; Revello, Rubén Óscar; Ricci, Giovanna; Rohrbaugh, Robert M.; Rossi, Patrizio; Sirignano, Ascanio; Spagnolo, Antonio G.; Stammers, Trevor; Velázquez, Lourdes; Agazzi, Évandro; Mercurio, Mark R.

doi:10.3389/fpubh.2020.00284

Cited by 20 publications

(16 citation statements)

References 6 publications

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“…However, the results of this rapid review suggest that most protocols are not validated or do not have sufficient criterion validity to predict mortality. Validated scoring systems such as a SOFA or APACHE-II score or pneumonia scoring systems were designed for a specific population and have been demonstrated to be less accurate when used in other patient populations [97,[104][105][106][107][108]. A recent systematic review on prediction models for diagnosis and prognosis of COVID-19 reported that proposed models were poorly described, had a high risk of bias, and may be unreliable when used in situ [109].…”

Section: Discussionmentioning

confidence: 99%

Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

Fiest

Krewulak

Plotnikoff

et al. 2020

BMC Med

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Background The COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks. Methods We conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design. Results From 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason. Conclusions This review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.

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Section: Discussionmentioning

confidence: 99%

Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

Fiest

Krewulak

Plotnikoff

et al. 2020

BMC Med

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“…Analysis of emergency calls and admissions to emergency departments have recorded a pronounced increment ( 1 , 2 ). In countries heavily stricken by COVID-19, rapidly rising patient numbers continue to exceed healthcare resources ( 2 , 3 ) with dramatic consequences ( 4 ). At the same time, reports on decreasing admissions for non-COVID-19 conditions are becoming more frequent.…”

Section: Introductionmentioning

confidence: 99%

Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage

et al. 2020

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Background: The COVID-19 pandemic has seriously impacted healthcare systems worldwide. Admissions for various non-COVID-19 emergencies have significantly decreased. We sought to determine the impact of COVID-19 on admissions for intracranial hemorrhage to a German University Hospital emergency department. Methods: In a retrospective analysis of admissions to the emergency department of the University Hospital Mannheim from January to June 2020 and the corresponding time period in 2019, all patients admitted for either traumatic or non-traumatic intracranial hemorrhage were evaluated. Poisson regression was performed to analyze changes in admission rates as a function of year, epoch (COVID-19-epoch, March to April 2020 and corresponding months 2019; non-COVID-19-epoch, January to February and May to June 2019/2020) and the interaction of year and epoch (reflecting the impact of the pandemic and subsequent lockdown measures). Results: Overall, 320 patients were included in the study. During the COVID-19-epoch, admission rates for spontaneous intracranial hemorrhage decreased significantly by 42.1% (RR 0.579, p = 0.002, 95% confidence interval 0.410-0.818). Likewise, admission rates for traumatic intracranial hemorrhage decreased significantly by 53.7% [RR = 0.463, p < 0.001, 95% confidence interval (CI) 0.358-0.599]. Conclusion: The decrease of spontaneous intracranial hemorrhages may be a consequence of underutilization of the healthcare system whereas decreasing rates of traumatic intracranial hemorrhage admissions may predominantly reflect a decrease in true incidence rates due to lockdown measures with restricted mobility. Raising patient awareness to seek emergency healthcare for acute neurological deficits during lockdown measures is important to ensure appropriate emergency care for patients with intracranial hemorrhage.

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“…There have been over three hundred thirty thousand deaths, and a higher number of individuals have developed severe disease, requiring escalated medical care involving hospitalization, admission to the ICU, and the use of mechanical ventilation. During the peak phase of the pandemic in the state of Michigan (March-April 2020) [ 15 ], medical resources were used towards the maximum, raising the problem of resource allocation in situations of mass critical care demand [ [16] , [17] , [18] ]. In this scenario, tools to predict outcomes would be important to better triage patients who require more intensive support.…”

Section: Discussionmentioning

confidence: 99%

Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography – A novel translational approach using a radiation oncology contour software

Sapienza¹,

Nasra²,

Calsavara³

et al. 2021

European Journal of Radiology Open

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Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic

Cited by 20 publications

References 6 publications

Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage

Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography – A novel translational approach using a radiation oncology contour software

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