The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic
Abstract Background In 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 SI...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-06-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-021-00888-4 |
| _version_ | 1818456537081839616 |
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| author | Luigi Riccioni Francesca Ingravallo Giacomo Grasselli Davide Mazzon Emiliano Cingolani Gabrio Forti Vladimiro Zagrebelsky Riccardo Zoja Flavia Petrini |
| author_facet | Luigi Riccioni Francesca Ingravallo Giacomo Grasselli Davide Mazzon Emiliano Cingolani Gabrio Forti Vladimiro Zagrebelsky Riccardo Zoja Flavia Petrini |
| author_sort | Luigi Riccioni |
| collection | DOAJ |
| description | Abstract Background In 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. Methods Following 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. Results Eight 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. Conclusions Lacking 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. |
| first_indexed | 2024-12-14T22:28:14Z |
| format | Article |
| id | doaj.art-89dae1f37d3d4536b7eb5ba83ab2338e |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-14T22:28:14Z |
| publishDate | 2021-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-89dae1f37d3d4536b7eb5ba83ab2338e2022-12-21T22:45:18ZengSpringerOpenAnnals of Intensive Care2110-58202021-06-011111810.1186/s13613-021-00888-4The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemicLuigi Riccioni0Francesca Ingravallo1Giacomo Grasselli2Davide Mazzon3Emiliano Cingolani4Gabrio Forti5Vladimiro Zagrebelsky6Riccardo Zoja7Flavia Petrini8Anesthesia and Intensive Care, San Camillo–Forlanini HospitalLegal Medicine, Department of Medical and Surgical Sciences, University of BolognaDepartment of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUOC Anesthesia and Intensive Care, Belluno HospitalAnesthesia and Intensive Care, San Camillo–Forlanini HospitalCriminal Law, Università Cattolica del Sacro CuoreLaboratorio dei Diritti Fondamentali, Collegio Carlo AlbertoInstitute of Legal Medicine, Department of Biomedical Sciences of Health, University of Milan, President of SIMLAPresident of SIAARTIAbstract Background In 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. Methods Following 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. Results Eight 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. Conclusions Lacking 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.https://doi.org/10.1186/s13613-021-00888-4COVID-19PandemicResource allocationTriage |
| spellingShingle | Luigi Riccioni Francesca Ingravallo Giacomo Grasselli Davide Mazzon Emiliano Cingolani Gabrio Forti Vladimiro Zagrebelsky Riccardo Zoja Flavia Petrini 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 COVID-19 Pandemic Resource allocation Triage |
| title | The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic |
| title_full | The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic |
| title_fullStr | The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic |
| title_full_unstemmed | The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic |
| title_short | The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic |
| title_sort | italian document decisions for intensive care when there is an imbalance between care needs and resources during the covid 19 pandemic |
| topic | COVID-19 Pandemic Resource allocation Triage |
| url | https://doi.org/10.1186/s13613-021-00888-4 |
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