Article Text
Statistics from Altmetric.com
The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units (ICUs) within many health systems, including the National Health Service in the UK. The experience of Northern Italy—a couple of weeks ahead of the UK, suggests that it will simply not be possible to provide mechanical ventilation to every patient who might need it. When the crunch comes, the unpalatable question facing clinicians is which patient to save.
There are some obvious strategies to avoid or reduce the problem—through measures to increase intensive care capacity, and via society-level interventions to reduce the spread of the virus. These are vitally important, but unfortunately they are unlikely to prevent the problem of demand outstripping supply from occurring. What, then, should clinicians do? How should they allocate the scarce resource of intensive care—particularly over the coming weeks as the crisis escalates?
ICU triage
There are different values at stake in triage decisions, but at a basic level the key values are those of benefit and …
Other content recommended for you
- Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review
- Improving clinical handover: Development of a web-based intensive care unit consultation system with structured reply generation
- Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians
- Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas
- Readiness for transfer: a mixed-methods study on ICU transfers of care
- Pandemic ICU triage challenge and medical ethics
- Survival of mechanically ventilated ward patients and association with organisational factors: a multicentre prospective study
- Physicians’ perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study
- Preparedness and response to COVID-19 in a quaternary intensive care unit in Australia: perspectives and insights from frontline critical care clinicians
- Rapid response team integration at a quaternary care academic centre: new paradigm for critical care organistions