COVID-19: Instruments for the Allocation of Mechanical Ventilators

A Narrative Review

Marcelo José dos Santos; Maristela Santini Martins; Fabiana Lopes Pereira Santana; Maria Carolina Silvano Pacheco Corrêa Furtado; Fabiana Cristina Bazana Remédio Miname; Rafael Rodrigo da Silva Pimentel; Ágata Nunes Brito; Patrick Schneider; Edson Silva dos Santos; Luciane Hupalo da Silva

Disclosures

Crit Care. 2020;24(582) 

In This Article

Abstract and Introduction

Abstract

After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.

Introduction

SARS-CoV-2 is a highly transmissible virus that causes COVID-19, a disease that can evolve to a severe clinical state due to a chronic systemic inflammatory response which can lead to acute respiratory distress syndrome.[1–3]

After the World Health Organization declared COVID-19 to be a pandemic,[4] new public health policies aimed at protecting the population became essential. However, the adoption of ineffective public policies may have contributed to the increase in the number of cases and the consequent overload of the health system.[5,6]

Studies show that 17 to 35% of patients affected by this disease require hospitalization in intensive care units[7,8] and that from 9 to 19% need invasive mechanical ventilation (IMV),[7,9] during a period which can vary from 2 to 4 weeks.[10] Estimates indicate that countries such as the USA[11,12] and Brazil[13] may not have enough invasive mechanical ventilators to attend all of the patients who need this resource for COVID-19 treatment. This was the situation in Italy, where doctors had to decide which patient would receive IMV.[14] Decision making in the allocation of scarce resources in pandemics, in addition to directly impacting people's lives, can lead the professional to a situation of moral suffering.[15]

Given this scenario, it is urgent to build managerial and ethical strategies in order to ration scarce resources.[16] Thus, this study aims to identify instruments, analyze their structures, and present the main criteria used in the screening protocols in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the face of the COVID-19 pandemic.

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