• Michael D Christian, Gavin M Joynt, John L Hick, John Colvin, Marion Danis, Charles L Sprung, and European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster.
• Division of Infectious Diseases and Critical Care, Department of National Defence, Canadian Forces, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
• Intensive Care Med. 2010 Apr 1; 36 Suppl 1 (Suppl 1): S55S64S55-64.

PurposeTo provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage.MethodsBased on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical care triage.ResultsKey recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resources; (2) developing fair and equitable policies may require restricting ICU services to patients most likely to benefit; (3) usual treatments and standards of practice may be impossible to deliver; (4) ICU care and treatments may have to be withheld from patients likely to die even with ICU care and withdrawn after a trial in patients who do not improve or deteriorate; (5) triage criteria should be objective, ethical, transparent, applied equitably and be publically disclosed; (6) trigger triage protocols for pandemic influenza only when critical care resources across a broad geographic area are or will be overwhelmed despite all reasonable efforts to extend resources or obtain additional resources; (7) triage of patients for ICU should be based on those who are likely to benefit most or a 'first come, first served' basis; (8) a triage officer should apply inclusion and exclusion criteria to determine patient qualification for ICU admission.ConclusionsJudicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic.

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