Allocation of intensive care beds and ventilator treatment during pandemics
Citation: Cardona M, Dobler CC, Koreshe E, et al. A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review. Journal of Critical Care. 2021;66:33-43.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: The authors reported no specific funding for this work.
What is this? In this scoping review, the authors searched for objective factors to assist policy-makers and clinicians in making consistent, objective, and ethically sound decisions about resource allocation during a pandemic. The review included the allocation of beds in intensive care units (ICUs) and ventilators. They restricted their searches to articles from Western health systems published in English after 2001. The authors searched in June 2021 and found 80 publications from 20 countries.
What was found: Consistent ethical, legal, and practical considerations that adhere to local service policies should be addressed at every step of the triage process. Transparent, objective parameters should be used to determine a patient’s risk profile and the need for immediate care. No decision should be based on a single parameter or an undesirable feature. A list of possible criteria for rationing could help to avoid prejudice in decision-making. Patients with a good prognosis had the highest priority for ventilator and ICU access.
No consensus was found to aid decision-making for contentious ethical issues, such as possible age discrimination. Triage in under-resourced situations can only aim for practicality.
Implications: The authors offered this review to stimulate discussion by clinicians and policy-makers for the allocation of intensive care and ventilator resources. The prognostic variables in the review can inform the creation of objective, locally relevant, triage guidelines.
Other considerations: The authors discussed equity of access to treatment in relation to age.
This summary was prepared by Jade di Girolamo, checked by Sydney Johnson, and finalized by William Summerskill.