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Critical appraisal of: Triaging pediatric critical care resources during a pandemic: Ethical and medical considerations*

Objective: To identify the ethical norms that should govern the allocation of pediatric critical care resources during a pandemic. Design: Narrative review. Methods: Review the literature on triage and pandemics. Findings: When care that is functionally equivalent to usual patient care practices can no longer be maintained, resources should be allocated primarily on the basis of medical need and/or benefit. Unequal treatment may be justified to increase the supply of available resources and thereby save more lives. When ethically relevant distinctions can no longer be made between patients, resources should be distributed by chance. Allocation on the basis of quality of life, general contributions to society, or age are potentially problematic. Existing triage protocols inconsistently articulate the relationship between these ethical norms and their specific recommendations. In addition, they have limited applicability in pediatrics principally because of the lack of a simple validated global scoring system, which predicts mortality and/or resource utilization. Conclusions: Although research to develop such scoring systems is ongoing, clinicians will need to rely more heavily on individual diagnoses of acute illnesses with high mortality rates and underlying conditions with short life expectancies and on random allocation methods.