Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians

被引：182

作者：

Maves, Ryan C. ^{[1
]}

Downar, James ^{[2
]}

Dichter, Jeffrey R. ^{[3
]}

Hick, John L. ^{[4
]}

Devereaux, Asha ^{[5
]}

Geiling, James A. ^{[6
]}

Kissoon, Niranjan ^{[7
]}

Hupert, Nathaniel ^{[8
]}

Niven, Alexander S. ^{[9
]}

King, Mary A. ^{[10
]}

Rubinson, Lewis L. ^{[11
]}

Hanfling, Dan ^{[12
]}

Hodge, James G., Jr. ^{[13
]}

Marshall, Mary Faith ^{[14
]}

Fischkoff, Katherine ^{[15
]}

Evans, Laura E. ^{[10
]}

Tonelli, Mark R. ^{[10
]}

Wax, Randy S. ^{[16
]}

Seda, Gilbert ^{[1
]}

Parrish, John S. ^{[1
]}

Truog, Robert D. ^{[17
]}

Sprung, Charles L. ^{[18
]}

Christian, Michael D. ^{[19
]}

机构：

[1] Naval Med Ctr, San Diego, CA USA

[2] Univ Ottawa, Ottawa, ON, Canada

[3] Univ Minnesota, Minneapolis, MN USA

[4] Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA

[5] Sharp Coronado Hosp, Coronado, CA USA

[6] Dartmouth Coll, Geisel Sch Med, Hanover, NH 03755 USA

[7] Univ British Columbia, Vancouver, BC, Canada

[8] Weill Cornell Med Coll, New York, NY USA

[9] Mayo Clin, Rochester, MN USA

[10] Univ Washington, Seattle, WA 98195 USA

[11] Morristown Med Ctr, Morristown, NJ USA

[12] Inova Fairfax Hosp, Falls Church, VA USA

[13] Arizona State Univ, Tempe, AZ USA

[14] Univ Virginia, Charlottesville, VA USA

[15] Columbia Univ, New York, NY USA

[16] Queens Univ, Kingston, ON, Canada

[17] Harvard Med Sch, Boston, MA 02115 USA

[18] Hebrew Univ Jerusalem, Hadassah Med Ctr, Fac Med, Jerusalem, Israel

[19] Barts NHS Hlth Trust, Royal London Hosp, Londons Air Ambulance, London, England

来源：

CHEST | 2020年 / 158卷 / 01期

关键词：

COVID-19; pandemic; disaster preparedness; scarcity of resources; surge capacity; triage; ASSOCIATIONS; HEALTH;

D O I：

10.1016/j.chest.2020.03.063

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.

引用

页码：212 / 225

页数：14

共 35 条

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