University of Oxford, UK.
Bioethics. 2012 Jun;26(5):259-66. doi: 10.1111/j.1467-8519.2010.01852.x. Epub 2010 Dec 7.
Intensive care units (ICUs) are not always able to admit all patients who would benefit from intensive care. Pressure on ICU beds is likely to be particularly high during times of epidemics such as might arise in the case of swine influenza. In making choices as to which patients to admit, the key US guidelines state that significant priority should be given to the interests of patients who are already in the ICU over the interests of patients who would benefit from intensive care but who have not been admitted. We examine four reasons that in principle might justify such a prioritization rule and conclude that none is convincing. We argue that the current location of patients should not, in principle, affect their priority for intensive care. We show, however, that under some but not all circumstances, maximizing lives saved by intensive care might require continuing to treat in the ICU a patient already admitted rather than transferring that patient out of the unit in order to admit a sicker patient who would also benefit more from intensive care. We conclude that further modelling is required in order to clarify what practical policies would maximize lives saved by intensive care.
重症监护病房（ICU）并不总能收治所有从重症监护中受益的患者。在像猪流感这样的传染病流行期间，ICU 床位的压力可能特别大。在做出收治哪些患者的选择时，美国的主要指南规定，应优先考虑已经在 ICU 的患者的利益，而不是优先考虑那些从重症监护中受益但尚未入院的患者。我们考察了四个原则上可能证明这种优先排序规则合理的理由，并得出没有一个理由是令人信服的。我们认为，患者的当前位置原则上不应影响他们接受重症监护的优先级。然而，我们表明，在某些但不是所有情况下，通过重症监护来挽救更多生命可能需要继续在 ICU 治疗已经入院的患者，而不是将该患者转出 ICU，以便收治一位病情更重、从重症监护中获益更多的患者。我们得出结论，需要进一步建模，以明确通过重症监护挽救更多生命的实际政策。
