重症监护室专家对COVID-19大流行期间处理稀缺资源分配临床决策的伦理准则的认识、意见和态度

Faisal A. Al-Suwaidan, J. Aljarallah, N. Alyousefi, G. Hussein
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引用次数: 0

摘要

背景:随着新型冠状病毒病(COVID-19)大流行的升级,重症监护专家受到了与稀缺资源分配相关的伦理问题的挑战。世界各地已经出版了许多相关的指导方针。沙特重症监护协会(Saudi Critical Care Society)在其首份临床指导方针中纳入了一项当地伦理框架,该指导方针涉及COVID-19大流行期间为重症监护病房(icu)患者分配稀缺资源的临床决策。本研究旨在评估ICU专家对这些伦理准则和拟议定义的认识、意见和态度。方法:采用自填问卷进行描述性横断面研究。研究人群包括沙特阿拉伯的300名ICU医生,他们是沙特重症监护协会的成员。结果:共70人(23.3%)参与问卷调查。大多数是男性,非沙特人和穆斯林。在专业上,他们大多是有10年以上经验的重症监护医师。最一致同意的建议定义是"健康危机"、"可抢救的病人"类别和"必要性量表" (32;37岁的45.7%;52.9%, 52个;74.3%, 34%;分别为48.6%)。对于“不遗漏的降级”和“主要分类等级”的定义,意见不太一致(20;28.6%, 21%;分别为3%)。最一致同意的声明是要求医疗保健提供者接受关于传染病的培训,并呼吁在需要他们离开家园的情况下为他们提供住房(56;80%),而最不一致的说法是停止对患者进行机械通气(29;41.4%)。结论:在流行病期间,卫生保健工作者在不寻常的、具有挑战性的情况下提供服务。这样做需要社会、心理和专业领域的支持。需要一个支持文化和宗教背景以及一线临床医生的实际经验的决策框架,包括大流行期间明确的降级计划和初级分诊系统。
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Awareness, opinion, attitude of intensive care unit specialists about the ethical guidelines for dealing with clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic
Background: With the escalation of the coronavirus disease (COVID-19) pandemic, critical care specialists have been challenged by ethical issues related to the distribution of scarce resources. Many relevant guidelines have been published worldwide. The Saudi Critical Care Society included a local framework for ethics in its first clinical guidelines for clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic for COVID-19 patients in intensive care units (ICUs). This study aimed to assess the awareness, opinions, and attitudes of ICU specialists concerning these ethical guidelines and the proposed definitions. Methods: A descriptive cross-sectional study using a self-administered questionnaire was conducted. The study population included 300 ICU physicians in Saudi Arabia who were members of the Saudi Critical Care Society. Results: A total of 70 participants (23.3%) responded to the questionnaire. Most were male, non-Saudi, and Muslim. Professionally, they were mostly intensivists with 10 or more years of experience. The most agreed-upon suggested definitions were “health crisis,” “salvageable patients” category, and the “necessity scale” (32; 45.7%, 37; 52.9%, 52; 74.3%, and 34; 48.6%, respectively). Less agreement was observed for the definitions of “de-escalation without omission” and “primary triage scale” (20; 28.6%, and 21; 3%, respectively). The most agreed-upon statements were those requiring healthcare providers to receive training on contagious diseases and calling for providing them with housing if a situation requires them to leave their homes (56; 80%), while the least agreed-upon statements concerned withholding mechanical ventilation from patients (29; 41.4%). Conclusion: During epidemics, health-care workers provide services in unusual, challenging situations. Doing so necessitates support in social, psychological, and professional areas. A decision-making framework is needed that endorses the cultural and religious contexts, as well as the lived experiences of frontline clinicians, including a clear de-escalation plan and a primary triage system during the pandemic.
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