COVID-19 大流行期间高级生命支持分诊委员会的运作。
Operation of a triage committee for advanced life support during the COVID-19 pandemic.
机构信息
Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain.
Francisco Vallés Institute of Clinical Ethics, European University, Madrid, Spain.
出版信息
Philos Ethics Humanit Med. 2022 Mar 16;17(1):5. doi: 10.1186/s13010-022-00117-1.
BACKGROUND
During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC.
METHODS
Retrospective observational study of all patients assessed by the AFUH TC.
RESULTS
There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; p < 0.001), had less comorbidity (Charlson 4 vs 3; p < 0.001) and had a better previous functional situation. A median of 5 physicians participated in each meeting and, after being assessed by the TC, 13.6% received ALS: 29.3% of those considered candidates for ALS and 2% of the non-candidates.
CONCLUSIONS
The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them.
背景
2020 年 3 月的前几周，西班牙严重呼吸衰竭的病例逐渐增多，导致高级生命支持（ALS）措施的临床需求与 ALS 资源的有效供应之间出现失衡。为了解决这个问题，提出了建立分诊委员会（TC）的建议，其主要功能是选择接受 ALS 的最佳候选人。我们的主要研究目的是描述在 SARS CoV-2 第一波期间，Alcorcón 基金会大学医院（AFUH）TC 评估的患者的临床特征。其他目的是确定考虑 ALS 候选人和非候选患者之间是否存在差异，并分析 TC 的功能。
方法
回顾性观察性研究所有接受 AFUH TC 评估的患者。
结果
共进行了 19 次会议，评估了 181 名患者，其中 65.4%为男性，平均年龄为 70.1 岁。31%有一定程度的功能依赖，Barthel 中位数为 100，Charlson 为 4.5。当时，85.8%的患者不被认为是 ALS 的候选者。被认为有资格接受 ALS 的患者更年轻（72 岁比 66 岁；p<0.001），合并症较少（Charlson 4 比 3；p<0.001），先前的功能状况更好。每次会议平均有 5 名医生参加，在 TC 评估后，13.6%的患者接受 ALS：29.3%的候选患者和 2%的非候选患者。
结论
TC 评估的患者平均年龄为 70 岁，合并症较高，近三分之一有一定程度的功能依赖。当时超过一半的患者不被认为是 ALS 的候选者，这些患者年龄较大，合并症较多，先前的功能状况较差。基于客观临床标准的 TC 决策几乎总是得到尊重。公共机构必须参与分诊程序，我们认为分诊程序应该并且必须包括在卫生中心建立 TC。实施预期决策（ADP）计划将有助于使受分诊决策影响的患者能够参与其中。
Zotero 插件