The Toughest Triage — Allocating Ventilators in a
Pandemic by Robert D. Truog, M.D., Christine Mitchell, R.N., and George
Q. Daley, M.D., Ph.D.
“Rationing is performed by a triage officer or a
triage committee composed of people who have no clinical responsibilities for
the care of the patient. Triage proceeds in three steps: application of
exclusion criteria, such as irreversible shock; assessment of mortality risk
using the Sequential Organ Failure Assessment (SOFA) score, to determine
priority for initiating ventilation; and repeat assessments over time, such
that patients whose condition is not improving are removed from the ventilator
to make it available for another patient. Anticipating the need to allocate
ventilators to the patients who are most likely to benefit, clinicians should
proactively engage in discussions with patients and families regarding
do-not-intubate orders for high-risk subgroups of patients before their health
deteriorates”.