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Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review.
Tyrrell, Carina S B; Mytton, Oliver T; Gentry, Sarah V; Thomas-Meyer, Molly; Allen, John Lee Y; Narula, Antony A; McGrath, Brendan; Lupton, Martin; Broadbent, Jo; Ahmed, Aliko; Mavrodaris, Angelique; Abdul Pari, Anees Ahmed.
  • Tyrrell CSB; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK carina.tyrrell@mrc-epid.cam.ac.uk.
  • Mytton OT; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
  • Gentry SV; Public Health England, East of England, Cambridge, UK.
  • Thomas-Meyer M; Public Health England, East of England, Cambridge, UK.
  • Allen JLY; Norwich Medical School, University of East Anglia, Norwich, UK.
  • Narula AA; Public Health England, East of England, Cambridge, UK.
  • McGrath B; Oxford University Hospitals, University of Oxford, Oxford, UK.
  • Lupton M; Global Tracheostomy Collaborative, Boston, Massachusetts, USA.
  • Broadbent J; Global Tracheostomy Collaborative, Boston, Massachusetts, USA.
  • Ahmed A; Global Tracheostomy Collaborative, Boston, Massachusetts, USA.
  • Mavrodaris A; Manchester Academic Critical Care Research Group (MACC), The University of Manchester, Manchester, UK.
  • Abdul Pari AA; Faculty of Medicine, Imperial College London, London, UK.
Thorax ; 76(3): 302-312, 2021 03.
Artículo en Inglés | MEDLINE | ID: covidwho-991868
ABSTRACT
The surge in cases of severe COVID-19 has resulted in clinicians triaging intensive care unit (ICU) admissions in places where demand has exceeded capacity. In order to assist difficult triage decisions, clinicians require clear guidelines on how to prioritise patients. Existing guidelines show significant variability in their development, interpretation, implementation and an urgent need for a robust synthesis of published guidance. To understand how to manage which patients are admitted to ICU, and receive mechanical ventilatory support, during periods of high demand during the COVID-19 pandemic, a systematic review was performed. Databases of indexed literature (Medline, Embase, Web of Science, and Global Health) and grey literature (Google.com and MedRxiv), published from 1 January until 2 April 2020, were searched. Search terms included synonyms of COVID-19, ICU, ventilation, and triage. Only formal written guidelines were included. There were no exclusion criteria based on geographical location or publication language. Quality appraisal of the guidelines was performed using the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation Instrument Recommendation EXcellence (AGREE REX) appraisal tools, and key themes related to triage were extracted using narrative synthesis. Of 1902 unique records identified, nine relevant guidelines were included. Six guidelines were national or transnational level guidance (UK, Switzerland, Belgium, Australia and New Zealand, Italy, and Sri Lanka), with one state level (Kansas, USA), one international (Extracorporeal Life Support Organization) and one specific to military hospitals (Department of Defense, USA). The guidelines covered several broad themes use of ethical frameworks, criteria for ICU admission and discharge, adaptation of criteria as demand changes, equality across health conditions and healthcare systems, decision-making processes, communication of decisions, and guideline development processes. We have synthesised the current guidelines and identified the different approaches taken globally to manage the triage of intensive care resources during the COVID-19 pandemic. There is limited consensus on how to allocate the finite resource of ICU beds and ventilators, and a lack of high-quality evidence and guidelines on resource allocation during the pandemic. We have developed a set of factors to consider when developing guidelines for managing intensive care admissions, and outlined implications for clinical leads and local implementation.
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Cuidados Críticos / COVID-19 / Hospitalización Tipo de estudio: Estudio experimental / Estudio observacional / Estudio pronóstico / Revisiones / Revisión sistemática/Meta análisis Límite: Humanos Idioma: Inglés Revista: Thorax Año: 2021 Tipo del documento: Artículo País de afiliación: Thoraxjnl-2020-215518

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Cuidados Críticos / COVID-19 / Hospitalización Tipo de estudio: Estudio experimental / Estudio observacional / Estudio pronóstico / Revisiones / Revisión sistemática/Meta análisis Límite: Humanos Idioma: Inglés Revista: Thorax Año: 2021 Tipo del documento: Artículo País de afiliación: Thoraxjnl-2020-215518