Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review
February 16, 2021
Tyrrell CSB, Mytton OT, Gentry S V., et al.
Tyrrell et al. conducted a systematic review of different intensive care unit (ICU) triage protocols used in hospitals during the pandemic to develop informed recommendations for a new, standardized ICU triage system. Nine unique guidelines were identified from 1902 records; one international, six national/transnational, one state-level, and one military- specific. For each guideline, nine themes were identified and evaluated. Scores for each theme were created using the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation Instrument Recommendation EXcellence (AGREE REX). Guidelines scored poorly for applicability (median score 8, IQR 4-10) and developmental rigor (9, 4-14). Only one guideline scored greater than 50% for clinical applicability. In general, guidelines held higher scores for clarity of presentation (58, 47-64) and description of scope and purpose (78, 67-83). Guidelines also stressed the importance of using ethical frameworks when designing triage protocols. The authors added that the expert panels used to develop these guidelines must be transparent about the data they use to inform their decisions, as well as their own qualifications.
Tyrrell CSB, Mytton OT, Gentry S V., et al. Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: A systematic review. Thorax. 2020; 76: 302–12.