Marckmann Georg, Neitzke Gerald, Schildmann Jan, Michalsen Andrej, Dutzmann Jochen, Hartog Christiane, Jöbges Susanne, Knochel Kathrin, Michels Guido, Pin Martin, Riessen Reimer, Rogge Annette, Taupitz Jochen, Janssens Uwe
Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland.
Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
Med Klin Intensivmed Notfmed. 2020 Sep;115(6):477-485. doi: 10.1007/s00063-020-00708-w.
In view of the globally evolving Coronavirus Disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary authors group with support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethico-legal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supra-individual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. Assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.
鉴于全球范围内不断演变的冠状病毒病（COVID-19）大流行，德国医院迅速扩大了其重症监护能力。然而，即便最佳利用增加的资源，这些资源也有可能不足以满足所有有需要的患者。因此，一个多学科作者团队在八个科学医学协会的支持下，制定了关于COVID-19大流行背景下重症监护资源分配的建议。资源稀缺情况下的程序和优先排序标准建议基于科学证据、伦理法律考量及实践经验。医疗决策必须始终基于个体患者的需求和治疗偏好。除了这种以患者为中心的方法外，资源稀缺情况下的优先排序还需要一个超个体的视角。在这种情况下，优先排序应基于临床成功前景的标准，以尽量减少因资源稀缺导致的可预防死亡数量，并避免基于年龄、残疾或社会因素的歧视。对临床成功前景的评估应考虑当前疾病的严重程度、严重合并症以及患者在当前疾病之前的总体健康状况。
