tailieunhanh - Báo cáo y học: " Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies. | Fink Critical Care 2010 14 103 http content 14 1 103 CRITICAL CARE COMMENTARY L__ Worst case rethinking tertiary triage protocols in pandemics and other health emergencies Sheri L Fink See related research by Christian etal. http content 13 5 R170 Abstract Demand for critical care resources could vastly outstrip supply in an influenza pandemic or other health emergency which has led expert groups to propose altered standards for triage and resource allocation. A pilot study by Christian and colleagues applied the Ontario Canada draft critical care triage protocol to an actual retrospective cohort of intensive care unit patients. The findings are troubling. Patients who would have been triaged to expectant and designated for withdrawal of intensive care unit care and ventilator support in fact had substantial survival rates. Triage officers often disagreed and lacked confidence in their categorization decisions. These findings suggest that rationing paradigms which include categorical exclusion criteria and withdrawal of lifesaving resources should be reconsidered and public input sought on nonclinical aspects. Several groups in Canada and the US have recently pondered disastrous scenarios where demand for hospital admission and critical care resources would vastly outstrip supply in an influenza pandemic or other health emergency. Rather than leave wrenching prioritization decisions to exhausted frontline health professionals the groups have proposed algorithms that would be used to triage patients and to allocate - and even reallocate -lifesaving resources. Questions have been raised about the ability of physicians to implement these proposals however which in some cases call for categorically excluding groups of patients from needed care and withdrawing life support regardless of the wishes of patients or their proxies. Correspondence Sfink@ Harvard Humanitarian Initiative Harvard University 14 Story Street 2nd .