title: Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine.
abstract: Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted. To provide general guidance for intensivists in ICU triage decisions, a task force of the World Federation of Societies of Intensive and Critical Care Medicine addressed 4 basic questions regarding this process. The team made recommendations and concluded that triage should be led by intensivists considering input from nurses, emergency medicine professionals, hospitalists, surgeons, and allied professionals. Triage algorithms and protocols can be useful but can never supplant the role of skilled intensivists basing their decisions on input from multidisciplinary teams. Infrastructures need to be organized efficiently both within individual hospitals and at the regional level. When resources are critically limited, patients may be refused ICU admission if others may benefit more on the basis of the principle of distributive justice.
authors.affiliation: Universitat Autònoma de Barcelona, CIBERes, Parc Taulí Hospital, Sabadell, Spain. Electronic address: lblanch@tauli.cat.
authors.forename: Lluís
authors.initials: L
authors.lastname: Blanch
authors.affiliation: Lebanese American University, Beirut, Lebanon.
authors.forename: Fayez François
authors.initials: FF
authors.lastname: Abillama
authors.affiliation: Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Pravin
authors.initials: P
authors.lastname: Amin
authors.affiliation: Mount Sinai Hospital & University Health Network, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Christian
authors.affiliation: The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
authors.forename: Gavin M
authors.initials: GM
authors.lastname: Joynt
authors.affiliation: University of New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.affiliation: Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Charles
authors.initials: C
authors.lastname: Sprung
authors.affiliation: Hacettepe University, Ankara, Turkey.
authors.forename: Arzu
authors.initials: A
authors.lastname: Topeli
authors.affiliation: Université Libre de Bruxelles, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Ohio State University, Columbus, OH, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Yeager
authors.affiliation: Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Zimmerman
mesh_terms: D026683:Advisory Committees; D000066491:Clinical Decision-Making; D003422:Critical Care; D006295:Health Resources; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D010820:Physicians; D012955:Societies, Medical; D014218:Triage
keywords: Allocation of resources; Health care delivery; Intensive care; Triage