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通过模拟通风机分配协议来研究危机护理标准中的伦理权衡
Jonathan Herington1,2, Jessica Shand1,3, Jeanne Holden-Wiltse4
1Department of Health Humanities and Bioethics, University of Rochester, Rochester, New York, United States of America.
PloS one
|September 12, 2024
概括
基于年龄的危机护理标准 (CSC) 协议在COVID-19大流行期间挽救了最多的生命和生命年. 这些协议并没有加剧种族差异,尽管其他方法没有显示出明显的差异.
科学领域:
- 公共卫生 公共卫生
- 生物伦理学生物伦理学
- 卫生政策 卫生政策
背景情况:
- 围绕危机护理标准 (CSC) 的伦理辩论经常假设在最大限度地挽救生命,挽救生命年数和防止种族差异之间进行权衡.
- 在公共卫生紧急情况中支持这些假设的权衡的经验证据是有限的.
研究的目的:
- 通过模拟在COVID-19大流行期间为通风机配给实施五项拟议的CSC协议的实施,量化评估道德权衡.
- 为了比较不同CSC协议在不同患者群体中拯救生命和寿命的有效性.
主要方法:
- 一个蒙特卡洛模拟模型是使用3707个需要机械通风的成人入院的患者数据开发的.
- 该模拟估计了在各种短缺场景下,通过临床敏度,并发症和基于年龄的CSC协议挽救的生命和生命年数.
- 对于每位患者来说,存活到出院的时间和剩余的预期寿命都被计算出来,以确定节省的生命年数.
主要成果:
- 年龄敏感的CSC协议表现出卓越的性能,在1:2床位容量下,每千名患者约挽救了29人生命和3400个生命年.
- 不考虑年龄的协议 (纽约和马里兰州) 挽救了更少的生命 (13.2和8.5) 和生命年 (416和420).
- 虽然基于年龄的协议最大限度地提高了生命和寿命,但非基于年龄的协议显示没有显著的种族差异;然而,所有协议都显示了拯救生命和跨种族/种族群体拯救生命的不平等之间的相关性.
结论:
- 在最大限度地挽救生命和挽救生命年之间没有发现任何权衡;对年龄敏感的协议在两个指标上表现最好.
- 需要仔细考虑确保公平的生存率和最大限度地挽救特定种族/民族亚群体生命之间的权衡,以解决对分拣的种族歧视的担忧.
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