The Toughest Triage – Allocating Ventilators in a Pandemic

Truog, R., Mitchell, C., and Daley, G. (2020). The Toughest Triage – Allocating Ventilators in a Pandemic. The New England Journal of Medicine.
Based on the currently available number of ventilators in the US in acute care hospitals and the Strategic National Stockpile, the authors of this perspective article estimate that each ventilator may be needed for a range of 1.4 to 31 patients during the COVID-19 pandemic. To prepare for the potential need to ration ventilators, the authors suggest establishing a committee excluding clinicians providing patient care to set the triage criteria and adjust those criteria as the overall situation changes. Additionally, they recommend proactive engagement with high-risk patients and their families about “do not intubate” orders and establishing a voluntary team with palliative care and emotional support expertise to withdraw mechanical ventilation rather than those clinicians caring for patients.
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