PDF(Pubmed)
Abstract：
To model performance of the Sequential Organ Failure Assessment (SOFA) score-based ventilator allocation guidelines during the COVID-19 pandemic.
A retrospective cohort study design was used. Study sites included 3 New York City hospitals in a single academic medical center. We included a random sample (205) of adult patients who were intubated (1002) from March 25, 2020, till April 29, 2020. Protocol criteria adapted from the New York State\'s 2015 guidelines were applied to determine which patients would have had mechanical ventilation withheld or withdrawn.
117 (57%) patients would have been identified for ventilator withdrawal or withholding based on the triage guidelines. Of those 117 patients, 28 (24%) survived hospitalization. Overall, 65 (32%) patients survived to discharge.
Triage protocols aim to maximize survival by redirecting ventilators to those most likely to survive. Over 50% of this sample would have been identified as candidates for ventilator exclusion. Clinical judgment would therefore still be needed in ventilator reallocation, thus re-introducing bias and moral distress. This data suggests limited utility for SOFA score-based ventilator rationing. It raises the question of whether there is sufficient ethical justification to impose a life-ending decision based on a SOFA scoring method on some patients in order to offer potential benefit to a modest number of others.
A retrospective cohort study design was used. Study sites included 3 New York City hospitals in a single academic medical center. We included a random sample (205) of adult patients who were intubated (1002) from March 25, 2020, till April 29, 2020. Protocol criteria adapted from the New York State\'s 2015 guidelines were applied to determine which patients would have had mechanical ventilation withheld or withdrawn.
117 (57%) patients would have been identified for ventilator withdrawal or withholding based on the triage guidelines. Of those 117 patients, 28 (24%) survived hospitalization. Overall, 65 (32%) patients survived to discharge.
Triage protocols aim to maximize survival by redirecting ventilators to those most likely to survive. Over 50% of this sample would have been identified as candidates for ventilator exclusion. Clinical judgment would therefore still be needed in ventilator reallocation, thus re-introducing bias and moral distress. This data suggests limited utility for SOFA score-based ventilator rationing. It raises the question of whether there is sufficient ethical justification to impose a life-ending decision based on a SOFA scoring method on some patients in order to offer potential benefit to a modest number of others.
摘要：
目的：模拟基于序贯器官衰竭评估（SOFA）评分的呼吸机配置指南在COVID-19大流行期间的表现。
方法：采用回顾性队列研究设计。研究地点包括3个纽约市医院在一个学术医疗中心。我们纳入了从2020年3月25日至2020年4月29日插管的成年患者（1002）的随机样本（205）。适用于纽约州2015年指南的协议标准，以确定哪些患者将停止或撤回机械通气。
结果：根据分诊指南，117（57%）名患者会被确定为停用或扣留呼吸机。在这117名患者中，28(24%)存活住院。总的来说,65例(32%)患者存活出院。
结论：分诊方案旨在通过将呼吸机重定向到最有可能存活的患者来最大化存活。超过50%的该样品将被鉴定为呼吸机排除的候选者。因此，在呼吸机重新分配中仍然需要临床判断，从而重新引入偏见和道德困扰。该数据表明基于SOFA评分的呼吸机配给的效用有限。它提出了一个问题，即是否有足够的道德理由对某些患者施加基于SOFA评分方法的终身决定，以便为少数其他患者提供潜在的利益。
方法：采用回顾性队列研究设计。研究地点包括3个纽约市医院在一个学术医疗中心。我们纳入了从2020年3月25日至2020年4月29日插管的成年患者（1002）的随机样本（205）。适用于纽约州2015年指南的协议标准，以确定哪些患者将停止或撤回机械通气。
结果：根据分诊指南，117（57%）名患者会被确定为停用或扣留呼吸机。在这117名患者中，28(24%)存活住院。总的来说,65例(32%)患者存活出院。
结论：分诊方案旨在通过将呼吸机重定向到最有可能存活的患者来最大化存活。超过50%的该样品将被鉴定为呼吸机排除的候选者。因此，在呼吸机重新分配中仍然需要临床判断，从而重新引入偏见和道德困扰。该数据表明基于SOFA评分的呼吸机配给的效用有限。它提出了一个问题，即是否有足够的道德理由对某些患者施加基于SOFA评分方法的终身决定，以便为少数其他患者提供潜在的利益。
