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在2020年春季COVID-19激增期间,模拟纽约市的通风机分配指南
B Corbett Walsh1,2,3, Jianan Zhu4, Yang Feng4
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York.
JAMA network open
|October 5, 2023
概括
纽约州呼吸器分配指南 (NYVAG) 在COVID-19激增期间将呼吸器从可能存活的患者转移到不太可能存活的患者. 改善分级分类可以提高通风机分配效率.
科学领域:
- 关键护理医学 关键护理医学
- 公共卫生政策 公共卫生政策
- 医疗保健服务研究 医疗服务研究
背景情况:
- 2020年春季COVID-19流行病的最初激增严重压迫了纽约市的呼吸机资源.
- 由于呼吸器短缺,医院考虑实施危机护理标准和纽约州呼吸器分配指南 (NYVAG).
- 关于NYVAG在此类危机期间的表现的证据有限.
研究的目的:
- 为了评估NYVAG在患者外科手术期间管理呼吸机分配的有效性.
- 评估NYVAG在配给时间,死亡率和健康差异方面的潜在改进.
- 在模拟的危机期间分析呼吸机选决策.
主要方法:
- 一项对纽约市卫生系统中被直管患者的队列研究 (2020年3月至7月).
- 进行了2万次呼吸机选模拟 (1万次使用现有NYVAG,1万次使用提议的改进NYVAG).
- 模拟集中在一个危机时期,以95%的流行前呼吸机利用率定义.
主要成果:
- 根据NYVAG的模拟配给影响了15天内163.9名患者;生存率为最初分配的44.4%,重新分配的呼吸机的34.8%.
- 大多数配给 (94.8%) 发生在时间试验后,其中43.1%的患者具有良好的SOFA分数,但没有改善.
- 一个改进的NYVAG协议可以减少分配效率低下,那些被选为配给的人的生存率为25.3%.
- NYVAG的配给并没有加剧现有的健康差距.
结论:
- 正如在模拟中实施的那样,NYVAG将呼吸机从具有更高生存机会的患者转移到具有更低生存机会的患者.
- 改善分拣分类和定量决定的时间 (时间试验后) 对于解决分拣效率低下至关重要.
- 需要进一步研究和完善分配准则,以优化公共卫生紧急情况期间的资源利用.
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