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Having to choose which patients to admit to the care of intensive care and which ones to leave out. It was the drama experienced by doctors and anesthetists, who had to make a decision in March, during the first wave of the Covid-19 pandemic. For this, a document was prepared, prepared by SIAARTI, the Italian Society of Anesthesia, Analgesia, Intensive Care and Intensive Care, which provided criteria and recommendations for “admission to intensive treatment and its suspension, in exceptional conditions of imbalance between needs and available resources“.
And now, it seems that the drama could repeat itself, caused by the exponential growth in demand for intensive care, which has led to a “sproportion between the request for attention and the responsiveness of the systemFor this reason, as SIAARTI announced on October 30, a working group has been set up that also includes FNOMCeO, “with the aim of jointly initiating a reflection sharing the reasoning within the framework of medical ethics and evaluating the opportunity to foresee changes in the Code of Medical Ethics“. The new document specifies that, “despite the measures taken to guarantee adequate treatment for all“thanks to the increase in beds”,in the most affected areas it was necessary to allocate resources through triage criteria based on the ethical principle of distributive justice“. I access criteria intensive and sub-intensive treatments, established in the text, are based on the adequacy and proportionality of the treatments, “in relation to the cost / benefit balance of each clinical practice, in accordance with the foreseeable health outcomes“.
In case of lack of resources, the text says “priority is given for access to intensive treatments to those who will be able to obtain a concrete, acceptable and lasting benefit thanks to them“To understand this, clinicians must apply i criteria “rigorous, explicit, concurrent and integrated, always evaluated case by case“, Which “Severity of clinical picture, comorbidities, previous functional status, impact on the person of potential side effects intensive care, knowledge of previous expressions of will, as well as the same biological age, which can never assume a predominant character“Patients who do not receive intensive treatment, says the document,”in any case, they take over by providing them with the appropriate and proportionate care that is available“The use of the above criteria should be applied.”exclusively in the state of absolute necessity“. Finally, the text specifies that”The following are guaranteed as selection criteria from the ethical and professional point of view: respect, protection of the dignity and health of the person, proportionality and adequacy of care, equity of access, criteria of beneficence, age and / or other vulnerable situations“.
After the March drama, it seems anesthesiologists may still have to choose who to admit to intensive care “:The scenario in which we find ourselves in March, unfortunately, is current again: declared the president SIAARTI– with an intensity and duration not yet quantifiable. The pressure on the health system is already high and could soon generate new situations of imbalance “.
