Society of Critical Care Medicine Guidelines for the Allocation of Critical Care Resources to Adults During Crisis-Level Shortages
Recommended Citation
Nates JL, Jayaprakash N, Carayannopoulos KL, Honarmand K, Anesi GL, Bartlett Davis L, Brunson ME, Chen LL, Christian MD, Fuentes M, Gallagher JJ, Harrod CG, Gutmann Koch V, Miles WS, Mitarai T, Narva AM, Sprung CL, Stempek S, Zimmerman JL, Boling B, Sicoutris C. Society of Critical Care Medicine Guidelines for the Allocation of Critical Care Resources to Adults During Crisis-Level Shortages. Crit Care Med. 2026;54(3):619-629.
Document Type
Article
Publication Date
3-1-2026
Publication Title
Critical care medicine
Keywords
Humans, Critical Care, Triage, Intensive Care Units, Health Care Rationing, Adult, Resource Allocation, Critical Illness, United States
Abstract
RATIONALE: Efficient distribution of scarce critical care resources is essential to save the most lives in times of crisis. Evidence-based practices and processes enhance clinical decision-making.
OBJECTIVES: The objective of these guidelines was to develop evidence-based, rather than expert-based, recommendations for triaging critically ill patients eligible for ICU admission during times of crisis-level shortages in ICU capacity.
DESIGN: The American College of Critical Care Medicine Board convened a 21-member multidisciplinary panel, comprising doctors in medicine, nursing, and law; advanced practice providers; respiratory therapists; ethicists; and patient/family representatives. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guidelines development including task force selection and voting.
METHODS: The panel members identified and formulated five fundamental Patient, Intervention, Comparator, and Outcomes questions. The panel conducted a systematic review for each question to identify the best available evidence, analyzed the evidence, and assessed the certainty of the evidence using the GRADE methodology. The GRADE evidence-to-decision framework was used to formulate the recommendations. Good practice statements were included to provide additional guidance.
RESULTS: The panel generated one conditional recommendation and five no recommendation statements.
CONCLUSIONS: Crisis-level shortages significantly disrupt patient care. Despite the role of triage in minimizing adverse outcomes, there is a lack of evidence, as opposed to expert opinion, to guide practice recommendations in the critical clinical scenarios considered by the panel.
Medical Subject Headings
Humans; Critical Care; Triage; Intensive Care Units; Health Care Rationing; Adult; Resource Allocation; Critical Illness; United States
PubMed ID
41773927
Volume
54
Issue
3
First Page
619
Last Page
629
