CHEST Guidelines-Share-Patients,-Not-Ventilators

Share-Patients,-Not-Ventilators_chest

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The document discusses two critical topics: postextubation dysphagia in ICU patients and management of critical care resources during the COVID-19 pandemic.<br /><br />The first section centers on the DYnAMICS cohort study, highlighting the short median time until extubation for ICU patients with postextubation dysphagia. The study by Zuercher and Schefold emphasizes the importance of reflecting clinical reality in these patients, indicating a need for well-tailored clinical approaches in such scenarios.<br /><br />The latter section addresses challenges in managing ICU resources during the COVID-19 pandemic, particularly ventilator allocation. It documents observations from Milton S. Hershey Medical Center, where strategic expansions and resource allocation allowed them to handle COVID-19 admissions with a lower fatality rate compared to other centers like St. Joseph’s Medical Center and Northwell Health Hospitals. The authors propose that maintaining COVID-19 admissions below a certain threshold may reduce overall mortality rates. They advocate for regional and national policies allowing patient transfers between institutions with specialized expertise in treating acute respiratory failure, to balance burden and improve outcomes.<br /><br />Pradeep Ramachandran and colleagues emphasize the necessity of a coordinated, cross-regional response to catastrophic surges in patient numbers. They argue that while individual hospitals might manage localized increases, a broader strategy involving government-led coordination is crucial for managing resources effectively across wider regions. The authors stress the importance of transporting critical care resources to where they're needed most, supported by existing CHEST Consensus Statements, to optimize patient care during such crises.

Keywords

postextubation dysphagia

ICU patients

DYnAMICS cohort study

COVID-19 pandemic

ventilator allocation

Milton S. Hershey Medical Center

acute respiratory failure

resource management

cross-regional response

CHEST Consensus Statements