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Perspective: The Toughest Triage — Allocating Ventilators in a Pandemic

By Currents Editor posted 04-06-2020 09:48


New England Journal of Medicine (03/23/20) doi: 10.1056/NEJMp2005689

Truog, Robert D.; Mitchell, Christine; and Daley, George Q.


As the COVID-19 epidemic leads to serious shortages of some medical products and devices in the United States, mechanical ventilation is the “most problematic,” say experts. Based on estimates from the Centers for Disease Control and Prevention and data from the experience in Italy, “the number of patients needing ventilation could range between 1.4 and 31 patients per ventilator,” write Robert D. Truog, MD, of Harvard Medical School in Boston, and colleagues. To help protect clinicians from the emotional turmoil they may experience when asked to decide which patients get ventilators during a potential shortage, the authors suggest forming triage committees made up of volunteers, such as respected clinicians and leaders in the medical community. A triage committee removes the burden of such decisions from any one individual, and it also “allows the physicians and nurses caring for the patients to maintain their traditional roles as fiduciary advocates, including the opportunity to appeal the initial decision of the committee when appropriate,” write Truog et al. The committee would also be responsible for communicating its decision to the patient’s family, which could eliminate confusion and misunderstandings. “In the weeks ahead, physicians in the United States may be asked to make decisions that they have never before had to face, and for which many of them will not be prepared,” write the authors. “Though some people may denounce triage committees as ‘death panels,’ in fact they would be just the opposite — their goal would be to save the most lives possible in a time of unprecedented crisis.”


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