Development and evaluation of an influenza pandemic intensive care unit triage protocol.
Identifieur interne : 000449 ( Main/Exploration ); précédent : 000448; suivant : 000450Development and evaluation of an influenza pandemic intensive care unit triage protocol.
Auteurs : Winston Cheung [Australie] ; John Myburgh ; Ian M. Seppelt ; Michael J. Parr ; Nikki Blackwell ; Shannon Demonte ; Kalpesh Gandhi ; Larissa Hoyling ; Priya Nair ; Melissa Passer ; Claire Reynolds ; Nicholas M. Saunders ; Manoj K. Saxena ; Govindasamy ThanakrishnanSource :
- Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine [ 1441-2772 ] ; 2012.
Descripteurs français
- KwdFr :
- MESH :
- mortalité : Grippe humaine.
- épidémiologie : Grippe humaine.
- Humains, Nouvelle-Galles du Sud, Ontario, Pandémies, Protocoles cliniques, Triage, Unités de soins intensifs.
English descriptors
- KwdEn :
- MESH :
- geographic : New South Wales, Ontario.
- epidemiology : Influenza, Human.
- mortality : Influenza, Human.
- Clinical Protocols, Humans, Intensive Care Units, Pandemics, Triage.
Abstract
OBJECTIVES
To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result.
DESIGN AND SETTING
Post-hoc analysis of a study evaluating two triage protocols, designed to determine which patients should be excluded from access to ICU resources during an influenza pandemic. ICU mortality rates were determined for the individual triage criteria in the protocols and included criteria based on the Sequential Organ Failure Assessment (SOFA) score. Criteria resulting in mortality rates outside the 25th and 75th percentiles were used as exclusion criteria in a new iPIT-1 protocol. The SOFA threshold component was modified further and reported as iPIT-2 and iPIT-3.
MAIN OUTCOME MEASURE
Increase in ICU bed availability.
RESULTS
The 25th and 75th percentiles for ICU mortality were 8.3% and 35.2%, respectively. Applying the iPIT-1 protocol resulted in an increase in ICU bed availability at admission of 71.7% ± 0.6%. Decreasing the lower SOFA score exclusion criteria to ≤6 (iPIT-2) and ≤4 (iPIT-3) resulted in an increase in ICU bed availability at admission of 66.9% ± 0.6% and 59.4 ± 0.7%, respectively (P < 0.001).
CONCLUSION
The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.
PubMed: 22963212
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Seppelt</name></author><author><name sortKey="Parr, Michael J" sort="Parr, Michael J" uniqKey="Parr M" first="Michael J" last="Parr">Michael J. Parr</name></author><author><name sortKey="Blackwell, Nikki" sort="Blackwell, Nikki" uniqKey="Blackwell N" first="Nikki" last="Blackwell">Nikki Blackwell</name></author><author><name sortKey="Demonte, Shannon" sort="Demonte, Shannon" uniqKey="Demonte S" first="Shannon" last="Demonte">Shannon Demonte</name></author><author><name sortKey="Gandhi, Kalpesh" sort="Gandhi, Kalpesh" uniqKey="Gandhi K" first="Kalpesh" last="Gandhi">Kalpesh Gandhi</name></author><author><name sortKey="Hoyling, Larissa" sort="Hoyling, Larissa" uniqKey="Hoyling L" first="Larissa" last="Hoyling">Larissa Hoyling</name></author><author><name sortKey="Nair, Priya" sort="Nair, Priya" uniqKey="Nair P" first="Priya" last="Nair">Priya Nair</name></author><author><name sortKey="Passer, Melissa" sort="Passer, Melissa" uniqKey="Passer M" first="Melissa" last="Passer">Melissa Passer</name></author><author><name sortKey="Reynolds, Claire" sort="Reynolds, Claire" uniqKey="Reynolds C" first="Claire" last="Reynolds">Claire Reynolds</name></author><author><name sortKey="Saunders, Nicholas M" sort="Saunders, Nicholas M" uniqKey="Saunders N" first="Nicholas M" last="Saunders">Nicholas M. Saunders</name></author><author><name sortKey="Saxena, Manoj K" sort="Saxena, Manoj K" uniqKey="Saxena M" first="Manoj K" last="Saxena">Manoj K. Saxena</name></author><author><name sortKey="Thanakrishnan, Govindasamy" sort="Thanakrishnan, Govindasamy" uniqKey="Thanakrishnan G" first="Govindasamy" last="Thanakrishnan">Govindasamy Thanakrishnan</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2012">2012</date><idno type="RBID">pubmed:22963212</idno><idno type="pmid">22963212</idno><idno type="wicri:Area/Main/Corpus">000414</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000414</idno><idno type="wicri:Area/Main/Curation">000414</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000414</idno><idno type="wicri:Area/Main/Exploration">000414</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Development and evaluation of an influenza pandemic intensive care unit triage protocol.</title><author><name sortKey="Cheung, Winston" sort="Cheung, Winston" uniqKey="Cheung W" first="Winston" last="Cheung">Winston Cheung</name><affiliation wicri:level="1"><nlm:affiliation>Concord Repatriation General Hospital, Sydney, NSW, Australia. winston.cheung@sswahs.nsw.gov.au.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Concord Repatriation General Hospital, Sydney, NSW</wicri:regionArea><wicri:noRegion>NSW</wicri:noRegion></affiliation></author><author><name sortKey="Myburgh, John" sort="Myburgh, John" uniqKey="Myburgh J" first="John" last="Myburgh">John Myburgh</name></author><author><name sortKey="Seppelt, Ian M" sort="Seppelt, Ian M" uniqKey="Seppelt I" first="Ian M" last="Seppelt">Ian M. Seppelt</name></author><author><name sortKey="Parr, Michael J" sort="Parr, Michael J" uniqKey="Parr M" first="Michael J" last="Parr">Michael J. Parr</name></author><author><name sortKey="Blackwell, Nikki" sort="Blackwell, Nikki" uniqKey="Blackwell N" first="Nikki" last="Blackwell">Nikki Blackwell</name></author><author><name sortKey="Demonte, Shannon" sort="Demonte, Shannon" uniqKey="Demonte S" first="Shannon" last="Demonte">Shannon Demonte</name></author><author><name sortKey="Gandhi, Kalpesh" sort="Gandhi, Kalpesh" uniqKey="Gandhi K" first="Kalpesh" last="Gandhi">Kalpesh Gandhi</name></author><author><name sortKey="Hoyling, Larissa" sort="Hoyling, Larissa" uniqKey="Hoyling L" first="Larissa" last="Hoyling">Larissa Hoyling</name></author><author><name sortKey="Nair, Priya" sort="Nair, Priya" uniqKey="Nair P" first="Priya" last="Nair">Priya Nair</name></author><author><name sortKey="Passer, Melissa" sort="Passer, Melissa" uniqKey="Passer M" first="Melissa" last="Passer">Melissa Passer</name></author><author><name sortKey="Reynolds, Claire" sort="Reynolds, Claire" uniqKey="Reynolds C" first="Claire" last="Reynolds">Claire Reynolds</name></author><author><name sortKey="Saunders, Nicholas M" sort="Saunders, Nicholas M" uniqKey="Saunders N" first="Nicholas M" last="Saunders">Nicholas M. Saunders</name></author><author><name sortKey="Saxena, Manoj K" sort="Saxena, Manoj K" uniqKey="Saxena M" first="Manoj K" last="Saxena">Manoj K. Saxena</name></author><author><name sortKey="Thanakrishnan, Govindasamy" sort="Thanakrishnan, Govindasamy" uniqKey="Thanakrishnan G" first="Govindasamy" last="Thanakrishnan">Govindasamy Thanakrishnan</name></author></analytic><series><title level="j">Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine</title><idno type="ISSN">1441-2772</idno><imprint><date when="2012" type="published">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Clinical Protocols</term><term>Humans</term><term>Influenza, Human (epidemiology)</term><term>Influenza, Human (mortality)</term><term>Intensive Care Units</term><term>New South Wales</term><term>Ontario</term><term>Pandemics</term><term>Triage</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Grippe humaine (mortalité)</term><term>Grippe humaine (épidémiologie)</term><term>Humains</term><term>Nouvelle-Galles du Sud</term><term>Ontario</term><term>Pandémies</term><term>Protocoles cliniques</term><term>Triage</term><term>Unités de soins intensifs</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>New South Wales</term><term>Ontario</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Clinical Protocols</term><term>Humans</term><term>Intensive Care Units</term><term>Pandemics</term><term>Triage</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Humains</term><term>Nouvelle-Galles du Sud</term><term>Ontario</term><term>Pandémies</term><term>Protocoles cliniques</term><term>Triage</term><term>Unités de soins intensifs</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN AND SETTING</b></p><p>Post-hoc analysis of a study evaluating two triage protocols, designed to determine which patients should be excluded from access to ICU resources during an influenza pandemic. ICU mortality rates were determined for the individual triage criteria in the protocols and included criteria based on the Sequential Organ Failure Assessment (SOFA) score. Criteria resulting in mortality rates outside the 25th and 75th percentiles were used as exclusion criteria in a new iPIT-1 protocol. The SOFA threshold component was modified further and reported as iPIT-2 and iPIT-3.</p></div><div type="abstract" xml:lang="en"><p><b>MAIN OUTCOME MEASURE</b></p><p>Increase in ICU bed availability.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The 25th and 75th percentiles for ICU mortality were 8.3% and 35.2%, respectively. Applying the iPIT-1 protocol resulted in an increase in ICU bed availability at admission of 71.7% ± 0.6%. Decreasing the lower SOFA score exclusion criteria to ≤6 (iPIT-2) and ≤4 (iPIT-3) resulted in an increase in ICU bed availability at admission of 66.9% ± 0.6% and 59.4 ± 0.7%, respectively (P < 0.001).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">22963212</PMID><DateCompleted><Year>2012</Year><Month>11</Month><Day>01</Day></DateCompleted><DateRevised><Year>2012</Year><Month>09</Month><Day>11</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1441-2772</ISSN><JournalIssue CitedMedium="Print"><Volume>14</Volume><Issue>3</Issue><PubDate><Year>2012</Year><Month>Sep</Month></PubDate></JournalIssue><Title>Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine</Title><ISOAbbreviation>Crit Care Resusc</ISOAbbreviation></Journal><ArticleTitle>Development and evaluation of an influenza pandemic intensive care unit triage protocol.</ArticleTitle><Pagination><MedlinePgn>185-90</MedlinePgn></Pagination><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result.</AbstractText><AbstractText Label="DESIGN AND SETTING" NlmCategory="METHODS">Post-hoc analysis of a study evaluating two triage protocols, designed to determine which patients should be excluded from access to ICU resources during an influenza pandemic. ICU mortality rates were determined for the individual triage criteria in the protocols and included criteria based on the Sequential Organ Failure Assessment (SOFA) score. Criteria resulting in mortality rates outside the 25th and 75th percentiles were used as exclusion criteria in a new iPIT-1 protocol. The SOFA threshold component was modified further and reported as iPIT-2 and iPIT-3.</AbstractText><AbstractText Label="MAIN OUTCOME MEASURE" NlmCategory="METHODS">Increase in ICU bed availability.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The 25th and 75th percentiles for ICU mortality were 8.3% and 35.2%, respectively. Applying the iPIT-1 protocol resulted in an increase in ICU bed availability at admission of 71.7% ± 0.6%. Decreasing the lower SOFA score exclusion criteria to ≤6 (iPIT-2) and ≤4 (iPIT-3) resulted in an increase in ICU bed availability at admission of 66.9% ± 0.6% and 59.4 ± 0.7%, respectively (P < 0.001).</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cheung</LastName><ForeName>Winston</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Concord Repatriation General Hospital, Sydney, NSW, Australia. winston.cheung@sswahs.nsw.gov.au.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Myburgh</LastName><ForeName>John</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Seppelt</LastName><ForeName>Ian M</ForeName><Initials>IM</Initials></Author><Author ValidYN="Y"><LastName>Parr</LastName><ForeName>Michael J</ForeName><Initials>MJ</Initials></Author><Author ValidYN="Y"><LastName>Blackwell</LastName><ForeName>Nikki</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Demonte</LastName><ForeName>Shannon</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Gandhi</LastName><ForeName>Kalpesh</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Hoyling</LastName><ForeName>Larissa</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Nair</LastName><ForeName>Priya</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Passer</LastName><ForeName>Melissa</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Reynolds</LastName><ForeName>Claire</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Saunders</LastName><ForeName>Nicholas M</ForeName><Initials>NM</Initials></Author><Author ValidYN="Y"><LastName>Saxena</LastName><ForeName>Manoj K</ForeName><Initials>MK</Initials></Author><Author ValidYN="Y"><LastName>Thanakrishnan</LastName><ForeName>Govindasamy</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><CollectiveName>Influenza Pandemic ICU Triage (iPIT) Study Investigators</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Australia</Country><MedlineTA>Crit Care Resusc</MedlineTA><NlmUniqueID>100888170</NlmUniqueID><ISSNLinking>1441-2772</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D002985" MajorTopicYN="N">Clinical Protocols</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009517" MajorTopicYN="N" Type="Geographic">New South Wales</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009864" MajorTopicYN="N" Type="Geographic">Ontario</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014218" MajorTopicYN="Y">Triage</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2012</Year><Month>9</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2012</Year><Month>9</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2012</Year><Month>11</Month><Day>2</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">22963212</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Australie</li></country></list><tree><noCountry><name sortKey="Blackwell, Nikki" sort="Blackwell, Nikki" uniqKey="Blackwell N" first="Nikki" last="Blackwell">Nikki Blackwell</name><name sortKey="Demonte, Shannon" sort="Demonte, Shannon" uniqKey="Demonte S" first="Shannon" last="Demonte">Shannon Demonte</name><name sortKey="Gandhi, Kalpesh" sort="Gandhi, Kalpesh" uniqKey="Gandhi K" first="Kalpesh" last="Gandhi">Kalpesh Gandhi</name><name sortKey="Hoyling, Larissa" sort="Hoyling, Larissa" uniqKey="Hoyling L" first="Larissa" last="Hoyling">Larissa Hoyling</name><name sortKey="Myburgh, John" sort="Myburgh, John" uniqKey="Myburgh J" first="John" last="Myburgh">John Myburgh</name><name sortKey="Nair, Priya" sort="Nair, Priya" uniqKey="Nair P" first="Priya" last="Nair">Priya Nair</name><name sortKey="Parr, Michael J" sort="Parr, Michael J" uniqKey="Parr M" first="Michael J" last="Parr">Michael J. Parr</name><name sortKey="Passer, Melissa" sort="Passer, Melissa" uniqKey="Passer M" first="Melissa" last="Passer">Melissa Passer</name><name sortKey="Reynolds, Claire" sort="Reynolds, Claire" uniqKey="Reynolds C" first="Claire" last="Reynolds">Claire Reynolds</name><name sortKey="Saunders, Nicholas M" sort="Saunders, Nicholas M" uniqKey="Saunders N" first="Nicholas M" last="Saunders">Nicholas M. Saunders</name><name sortKey="Saxena, Manoj K" sort="Saxena, Manoj K" uniqKey="Saxena M" first="Manoj K" last="Saxena">Manoj K. Saxena</name><name sortKey="Seppelt, Ian M" sort="Seppelt, Ian M" uniqKey="Seppelt I" first="Ian M" last="Seppelt">Ian M. Seppelt</name><name sortKey="Thanakrishnan, Govindasamy" sort="Thanakrishnan, Govindasamy" uniqKey="Thanakrishnan G" first="Govindasamy" last="Thanakrishnan">Govindasamy Thanakrishnan</name></noCountry><country name="Australie"><noRegion><name sortKey="Cheung, Winston" sort="Cheung, Winston" uniqKey="Cheung W" first="Winston" last="Cheung">Winston Cheung</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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