Meadow W, Lantos J D, Mokalla M, Reimshisel T
Department of Pediatrics, La Rabida Children's Hospital, University of Chicago, Illinois, USA.
Clin Perinatol. 1996 Sep;23(3):597-608.
Babies of extremely low birthweight and elderly adults both require expensive and scarce resources, and both have a relatively poor prognosis for survival if they require intensive care. Thus, proposals for rationing often target one or both of these groups. We suspected that although mortality rates might be higher in the neonatal intensive care unit (NICU) than in the adult intensive care unit (ICU), NICU care might nevertheless be more cost effective, where cost efficiency is measured along the dimension of resources targeted to survivors. We examined mortality patterns in our NICU and for adults admitted to our medical intensive care units. We found that adult ICU patients who died consumed many times more ICU resources before their death than did their NICU confreres, independent of the severity of illness or likelihood of dying. Although there may be many legitimate concerns about justice and ethics in the NICU, undue expenditure of society's resources prolonging the dying of extremely low birthweight infants is not among them. To the extent that concerns about distributive justice drive allocation decisions in ICU care, it would seem more justifiable to ration intensive care for the very old, not the very young.
极低出生体重儿和老年人都需要昂贵且稀缺的资源，并且如果他们需要重症监护，两者的生存预后相对较差。因此，配给提议通常针对这两个群体中的一个或两个。我们怀疑，尽管新生儿重症监护病房（NICU）的死亡率可能高于成人重症监护病房（ICU），但从针对幸存者的资源维度衡量成本效益的角度来看，NICU护理可能更具成本效益。我们研究了我们NICU以及入住我们医疗重症监护病房的成人的死亡率模式。我们发现，死亡的成人ICU患者在死亡前消耗的ICU资源是NICU患者的许多倍，这与疾病严重程度或死亡可能性无关。尽管在NICU中可能存在许多关于公正和伦理的合理担忧，但社会资源过度用于延长极低出生体重儿的死亡时间并不在其中。就对分配公正的担忧推动ICU护理分配决策而言，对老年人而非年轻人的重症监护进行配给似乎更合理。
