Development of a triage protocol for critical care during an influenza pandemic.
BACKGROUND
The recent outbreaks of avian influenza (H5N1) have placed a renewed emphasis on preparing for an influenza pandemic in humans. Of particular concern in this planning is the allocation of resources, such as ventilators and antiviral medications, which will likely become scarce during a pandemic.


METHODS
We applied a collaborative process using best evidence, expert panels, stakeholder consultations and ethical principles to develop a triage protocol for prioritizing access to critical care resources, including mechanical ventilation, during a pandemic.


RESULTS
The triage protocol uses the Sequential Organ Failure Assessment score and has 4 main components: inclusion criteria, exclusion criteria, minimum qualifications for survival and a prioritization tool.


CONCLUSIONS
This protocol is intended to provide guidance for making triage decisions during the initial days to weeks of an influenza pandemic if the critical care system becomes overwhelmed. Although we designed this protocol for use during an influenza pandemic, the triage protocol would apply to patients both with and without influenza, since all patients must share a single pool of critical care resources.
Christian
Michael D
MD
Division of Infectious Diseases & Critical Care, Department of Postgraduate Medicine, McMaster University, Hamilton, Ont. michael.christian@utoronto.ca
Hawryluck
Laura
L
Wax
Randy S
RS
Cook
Tim
T
Lazar
Neil M
NM
Herridge
Margaret S
MS
Muller
Matthew P
MP
Gowans
Douglas R
DR
Fortier
Wendy
W
Burkle
Frederick M
FM
D002985:Clinical Protocols; D003422:Critical Care; D004196:Disease Outbreaks; D004608:Eligibility Determination; D014943:Global Health; D015276:Health Care Rationing; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D009102:Multiple Organ Failure; D011379:Prognosis; D016730:Program Development; D014218:Triage / Q000941:ethics / Q000379:methods