Abstract
Purpose: To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage. Methods: Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical care triage. Results: Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resources; (2) developing fair and equitable policies may require restricting ICU services to patients most likely to benefit; (3) usual treatments and standards of practice may be impossible to deliver; (4) ICU care and treatments may have to be withheld from patients likely to die even with ICU care and withdrawn after a trial in patients who do not improve or deteriorate; (5) triage criteria should be objective, ethical, transparent, applied equitably and be publically disclosed; (6) trigger triage protocols for pandemic influenza only when critical care resources across a broad geographic area are or will be overwhelmed despite all reasonable efforts to extend resources or obtain additional resources; (7) triage of patients for ICU should be based on those who are likely to benefit most or a 'first come, first served' basis; (8) a triage officer should apply inclusion and exclusion criteria to determine patient qualification for ICU admission. Conclusions: Judicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic.
Original language | English (US) |
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Pages (from-to) | S55-S64 |
Journal | Intensive Care Medicine |
Volume | 36 |
Issue number | SUPPL. 1 |
DOIs | |
State | Published - Apr 2010 |
Keywords
- Critical care triage
- Disaster
- H1N1
- Hospital
- Infection control
- Influenza epidemic
- Intensive care unit
- Pandemic
- Recommendations
- Staff protection
- Standard operating procedures
- Triage