The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic

Annals of Intensive Care

Emiliano Cingolani¹  Luigi Riccioni¹  Gabrio Forti²  Giacomo Grasselli³  Riccardo Zoja⁴  Vladimiro Zagrebelsky⁵  Francesca Ingravallo⁶  Flavia Petrini⁷  Davide Mazzon⁸ 

[1] Anesthesia and Intensive Care, San Camillo–Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy;Criminal Law, Università Cattolica del Sacro Cuore, Milan, Italy;Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;Institute of Legal Medicine, Department of Biomedical Sciences of Health, University of Milan, President of SIMLA, Milan, Italy;Laboratorio dei Diritti Fondamentali, Collegio Carlo Alberto, Turin, Italy;Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy;President of SIAARTI, Chieti, Italy;UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy;

关键词: COVID-19;    Pandemic;    Resource allocation;    Triage;   

DOI  :  10.1186/s13613-021-00888-4

来源: Springer

【 摘 要 】

BackgroundIn early 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published clinical ethics recommendations for the allocation of intensive care during COVID-19 pandemic emergency. Later the Italian National Institute of Health (ISS) invited SIAARTI and the Italian Society of Legal and Insurance Medicine to prepare a draft document for the definition of triage criteria for intensive care during the emergency, to be implemented in case of complete saturation of care resources.MethodsFollowing formal methods, including two Delphi rounds, a multidisciplinary group with expertise in intensive care, legal medicine and law developed 12 statements addressing: (1) principles and responsibilities; (2) triage; (3) previously expressed wishes; (4) reassessment and shifting to palliative care; (5) collegiality and transparency of decisions. The draft of the statements, with their explanatory comments, underwent a public consultation opened to Italian scientific or technical-professional societies and other stakeholders (i.e., associations of citizens, patients and caregivers; religious communities; industry; public institutions; universities and research institutes). Individual healthcare providers, lay people, or other associations could address their comments by e-mail.ResultsEight stakeholders (including scientific societies, ethics organizations, and a religious community), and 8 individuals (including medical experts, ethicists and an association) participated to the public consultation. The stakeholders’ agreement with statements was on average very high (ranging from 4.1 to 4.9, on a scale from 1—full disagreement to 5—full agreement). The 4 statements concerning triage stated that in case of saturation of care resources, the intensive care triage had to be oriented to ensuring life-sustaining treatments to as many patients as possible who could benefit from them. The decision should follow full assessment of each patient, taking into account comorbidities, previous functional status and frailty, current clinical condition, likely impact of intensive treatment, and the patient's wishes. Age should be considered as part of the global assessment of the patient.ConclusionsLacking national guidelines, the document is the reference standard for healthcare professionals in case of imbalance between care needs and available resources during a COVID-19 pandemic in Italy, and a point of reference for the medico-legal assessment in cases of dispute.

【 授权许可】

CC BY