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10.7326/M20-1738

http://scihub22266oqcxt.onion/10.7326/M20-1738
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32330224!7207244!32330224
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suck abstract from ncbi


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pmid32330224      Ann+Intern+Med 2020 ; 173 (3): 188-194
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  • Ventilator Triage Policies During the COVID-19 Pandemic at U S Hospitals Associated With Members of the Association of Bioethics Program Directors #MMPMID32330224
  • Antommaria AHM; Gibb TS; McGuire AL; Wolpe PR; Wynia MK; Applewhite MK; Caplan A; Diekema DS; Hester DM; Lehmann LS; McLeod-Sordjan R; Schiff T; Tabor HK; Wieten SE; Eberl JT
  • Ann Intern Med 2020[Aug]; 173 (3): 188-194 PMID32330224show ga
  • BACKGROUND: The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies. OBJECTIVE: To characterize the development of ventilator triage policies and compare policy content. DESIGN: Survey and mixed-methods content analysis. SETTING: North American hospitals associated with members of the Association of Bioethics Program Directors. PARTICIPANTS: Program directors. MEASUREMENTS: Characteristics of institutions and policies, including triage criteria and triage committee membership. RESULTS: Sixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend that those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations. LIMITATION: The results may not be generalizable to institutions without academic bioethics programs. CONCLUSION: Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation. PRIMARY FUNDING SOURCE: None.
  • |Betacoronavirus[MESH]
  • |Bioethics[MESH]
  • |COVID-19[MESH]
  • |Coronavirus Infections/*therapy[MESH]
  • |Health Policy[MESH]
  • |Hospitals[MESH]
  • |Humans[MESH]
  • |Pandemics[MESH]
  • |Pneumonia, Viral/*therapy[MESH]
  • |Respiration, Artificial/*ethics/*standards[MESH]
  • |SARS-CoV-2[MESH]
  • |Surveys and Questionnaires[MESH]
  • |Triage/*ethics/*standards[MESH]
  • |United States[MESH]


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