Triage of mechanical ventilation for pediatric patients during a pandemic.
OBJECTIVE
The novel H1N1 influenza pandemic renewed the concern that during a severe pandemic illness, critical care and mechanical ventilation resources will be inadequate to meet the needs of patients. Several published protocols address the need to triage patients for access to ventilator resources. However, to our knowledge, none of these has addressed the pediatric populations.


METHODS
We used a systematic review of the pediatric critical care literature to evaluate pediatric critical care prognosis and multisystem organ failure scoring systems. We used multiple search engines, including MEDLINE and EMBASE, using a search for terms and key words including including multiple organ failure, multiple organ dysfunction, PELOD, PRISM III, pediatric risk of mortality score, pediatric logistic organ dysfunction, pediatric index of mortality pediatric multiple organ dysfunction score, "child+multiple organ failure + scoring system." Searches were conducted in the period January 2010-February 2010.


RESULTS
Of the 69 papers reviewed, 22 were used. Five independently derived scoring systems were evaluated for use in a respiratory pandemic ventilator triage protocol. The Pediatric Logistic Organ Dysfunction (PELOD) scoring system was the most appropriate for use in such a triage protocol.


CONCLUSIONS
We present a pediatric-specific ventilator triage protocol using the PELOD scoring system to complement the NY State adult triage protocol. Further evaluation of pediatric scoring systems is imperative to ensure appropriate triage of pediatric patients.
University of Michigan Health System, Ann Arbor, Michigan, USA. kmkim@umn.edu
Kristin M
KM
Kim
Sandro
S
Cinti
Steven
S
Gay
Susan
S
Goold
Andrew
A
Barnosky
Marie
M
Lozon
D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D020380:Needs Assessment; D058873:Pandemics; D010372:Pediatrics / Q000379:methods*; D012121:Respiration, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods*