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COVID-19 pandemic: triage for intensive-care treatment under resource scarcity (3rd, updated version)

Special article
Swiss Academy of Medical Sciences
Swiss Med Wkly. 2020;150:w20401

Given the development of the pandemic in October, the guidelines issued by the Swiss Academy of Medical Sciences (SAMS) and the Swiss Society of Intensive Care Medicine (SSICM) needed to be revised and updated in the light of the experience accumulated since March. There has been no change in the guiding principle that uniform criteria for intensive-care unit (ICU) admission and continued occupancy should be applied throughout Switzerland. The present guidelines provide the necessary basis.    

Strong second COVID-19 wave calls for a second look at ICU triage guidelines

Viewpoint
Suter P, Pargger H
Swiss Med Wkly. 2020;150:w20407

The revised Swiss guidelines bring not only a useful framework for delicate discussions and decisions at the bedside, but hopefully also progress in public awareness of some limits of the best health systems in the world, appearing much faster in a time of scarcity of resources. Based on what we learned from the crisis of this year, several aspects of our and other health systems could benefit from a revision or an update, in line with a recognised truism.

Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult

Original article
Othenin-Girard A, Regamey J, Lamoth F, Horisberger A, Glampedakis E, Epiney JB, Kuntzer T, de Leval L, Carballares M, Hurni CA, Rusca M, Pantet O, Di Bernardo S, Oddo M, Comte D, Piquilloud L
Swiss Med Wkly. 2020;150:w20387

Multisystem inflammatory syndrome associated with SARS-CoV-2 can occur in adults. The clinical presentation can include severe organ damage with features of incomplete or complete Kawasaki disease, including coronary aneurysm, as well as myocarditis-associated cardiogenic shock and also mononeuritis multiplex.

Communication challenges in end-of-life decisions

Review article: Biomedical intelligence
Becker C, Beck K, Vincent A, Hunziker S
Swiss Med Wkly. 2020;150:w20351

With the progress in healthcare over recent decades and a growing life expectancy, discussions and decisions regarding end-of-life issues have become increasingly important. Especially in intensive care and emergency medicine there is a growing need of decision making for optimised end-of-life care. Prolonging life and preventing death is considered to be the highest principle of healthcare professionals; however, in some cases alleviation of suffering is a more appropriate goal. This article discusses communication challenges in end-of-life decision making and outlines strategies from an area of growing interest and research.

Value of the TTM risk score for early prognostication of comatose patients after out-of-hospital cardiac arrest in a Swiss university hospital

Original article
Kägi E, Weck A, Iten M, Levis A, Haenggi M
Swiss Med Wkly. 2020;150:w20344

Since the TTM followed strict inclusion and exclusion criteria, the validity in a general ICU population of cardiac arrest patients is unknown. With this study, the authors aimed to confirm and assess the usefulness in a Swiss population suffering from out-of-hospital cardiac arrest outside a clinical trial.

Adequacy of stress ulcer prophylaxis prescription in the intensive care unit: an observational study

Original article
Franchitti M, Piubellini J, Sadeghipour F, Eckert P, Voirol P, Schneider AG
Swiss Med Wkly. 2020;150:w20322

The adequacy of stress ulcer prophylaxis in the ICU is low. In addition, the prescription is frequently continued after ICU and many patients are even discharged home with inadequate acid-suppressive therapy.

Good rules for ICU admission allow a fair allocation of resources, even in a pandemic

Viewpoint
Suter P
Swiss Med Wkly. 2020;150:w20230

A set of guidelines concerning ethical, medical and social aspects of triage decisions, as well as of other related problems of the COVID-19 pandemic: In all cases, decisions must be based on sound, transparent and understandable rules.

COVID-19 pandemic: triage for intensive-care treatment under resource scarcity

Special article
Swiss Academy of Medical Sciences
Swiss Med Wkly. 2020;150:w20229

If insufficient resources are available, rationing decisions will become necessary, placing considerable burdens on medical staff. This makes it all the more important that uniform criteria for ICU admission and continued occupancy should be applied throughout Switzerland.

Recommendations for the admission of patients with COVID-19 to intensive care and intermediate care units (ICUs and IMCUs)

Special article
Swiss Society of Intensive Care Medicine
Swiss Med Wkly. 2020;150:w20227

The Swiss Society of Intensive Care Medicine (SSIM) has elaborated detailed and coherent guidelines defining the criteria for admission to the ICU in situations of bed shortage.

Implementation of a multiprofessional, multicomponent delirium management guideline in two intensive care units, and its effect on patient outcomes and nurse workload: a pre-post design retrospective cohort study

Original article
Schubert M, Bettex D, Steiger P, Schürch R, Haller A, Bogdanovic J, Garcia Nuñez D, Schwarz U, Siegemund M
Swiss Med Wkly. 2020;150:w20185

Delirium is a frequent intensive care unit (ICU) complication, affecting 26% to 80% of ICU patients, often with serious consequences. For appropriate delirium management, early identification of relevant risk factors is crucial.

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