Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine

Lluís Blanch, Fayez François Abillama, Pravin Amin, Michael Christian, Gavin M. Joynt, John Myburgh, Joseph L. Nates, Paolo Pelosi, Charles Sprung, Arzu Topeli, Jean Louis Vincent, Susan Yeager, Janice Zimmerman

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted. To provide general guidance for intensivists in ICU triage decisions, a task force of the World Federation of Societies of Intensive and Critical Care Medicine addressed 4 basic questions regarding this process. The team made recommendations and concluded that triage should be led by intensivists considering input from nurses, emergency medicine professionals, hospitalists, surgeons, and allied professionals. Triage algorithms and protocols can be useful but can never supplant the role of skilled intensivists basing their decisions on input from multidisciplinary teams. Infrastructures need to be organized efficiently both within individual hospitals and at the regional level. When resources are critically limited, patients may be refused ICU admission if others may benefit more on the basis of the principle of distributive justice.

Original languageEnglish (US)
Pages (from-to)301-305
Number of pages5
JournalJournal of Critical Care
Volume36
DOIs
StatePublished - Dec 1 2016

Keywords

  • Allocation of resources
  • Health care delivery
  • Intensive care
  • Triage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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