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Letter to the Editor
Reply to “Considerations on ICU triage ethics during the COVID-19 pandemic”
Respuesta a «Algunas consideraciones sobre la ética del triaje en UCI durante la pandemia COVID-19»
O. Rubioa,
Corresponding author
orubio@althaia.cat

Corresponding author.
, L. Cabréb, A. Estellac, R. Ferrerd
a Hospital Sant Joan de Déu de Manresa, Manresa, Spain
b Hospital de Barcelona, Barcelona, Spain
c Hospital de Jerez de la Frontera, Jerez de la Frontera, Spain
d Hospital Universitario de Valle Hebrón, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the comments made to the article&#58; &#171;Considerations on ICU triage ethics during the COVID-19 pandemic&#187;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We should mention the historic framework within which these recommendations were made&#44; of great difficulty and without any similar historic precedents&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are 2 basic premises surrounding emergency care or care provided during a crisis situation&#58; in the first place&#44; health authorities have a moral duty to reduce the morbidity and mortality of an emerging disaster and&#44; secondly&#44; ethical principles based on distributive justice and a criterion of proportionality should prevail&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; in case of mismatch between the clinical needs and the effective availability of resources&#44; a triage system should be implemented for the sake of common good&#46; Since triage is implemented by other specialists before ICU admission&#44; we thought this was the proper triage system due to its practicality&#46; Afterwards&#44; other triage algorithms have come up like the one from Sprung et al&#46; including aspects associated with the patients&#44; the severity of the clinical process&#44; and the prediction of survival&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our recommendations are not trying to cause any discriminations away from the intensivists&#8217; best clinical judgement&#44; the patient&#8217;s clinical situation or the expectations of survival as the Spanish Ministry of Health recommends&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Instead&#44; we wish to encourage thinking among the healthcare workers by offering them objective criteria agreed by our scientific medical society&#46; As a matter of fact&#44; this is no different from what is normally done in our intensive care units where&#44; upon admission&#44; decisions are made on what supports are indicated&#44; which will eventually be useless&#44; and why their use is justified&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding age&#44; it is well known that it is a factor associated with mortality in patients with ARDS due to COVID-19<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and&#44; although it is true that age should not be considered as the only factor&#44; it has a high specific weight in the main prognostic indices&#46; As a matter of fact&#44; we should remember that an ICU admission is not synonymous of survival&#44; an expectation that may have been triggered by the availability of more ventilators or their indiscriminate use without a reflection on the benefits&#44; indications&#44; and risks involved&#44; which may lead to situations of therapeutic obstinacy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; we should state clear that these recommendations are flexible&#44; adapted to the current pandemic situations&#44; and should be reassessed on a dynamic basis and based on the epidemiological situation and availability of resources&#46; Above all&#44; the clinical criterion should always prevail as well as the patients&#8217; will and preferences to always observe attitudes of respect and dignity&#46;</p></span>"
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Article information
ISSN: 21735727
Original language: English
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