Resumo
Objetivo: apresentar um panorama sobre o processo de tomada de decisões ético-profissionais em situações de excepcionalidade no início da pandemia da Covid-19. Método: trata-se de uma revisão de escopo, incluindo documentos publicados entre dezembro/2019 a julho/2020 nas seguintes bases de dados: Google Acadêmico, PubMed, Scopus, Scielo, CINAHL e BVS. Adotou-se o PRISMA-ScR Checklist para apresentação da revisão. Resultados: foram selecionados 28 documentos, organizados em cinco categorias: Requisito Técnico-Médico-Científico, Justiça e Equidade, Histórico de Saúde, Comissão para Tomada de Decisão Compartilhada e Quadro Respiratório Grave. Conclusão: os critérios indicados para priorizar o processo de atenção direcionado a pacientes graves com Covid-19 foram: parâmetros técnico-médico-científico, gravidade do quadro clínico, maior idade, ser profissional da saúde, presença de doenças de base incurável, realização de sorteio e pacientes com maior probabilidade de sobrevivência.
Referências
Gallasch CH, Cunha LM, Pereira ALS, Silva-Junior JS. Prevention related to the occupational exposure of health professionals workers in the Covid-19 scenario. Rev Enferm Uerj [Internet]. 2020 [cited 2020 June 13];28(1):1-6. Available from: https://doi.org/10.12957/reuerj.2020.49596
Alessi G. O que já se sabe até agora sobre o novo coronavírus no Brasil [Internet]. São Paulo: El País; 2020 [cited 2020 Apr 14]. Available from: https://brasil.elpais.com/brasil/2020-04-02/o-que-ja-se-sabe-ate-agora-sobre-o-novo-coronavirus-no-brasil.html
Jucá B. Margareth Dalcolmo: o isolamento social severo e o SUS são as grandes armas do Brasil contra a pandemia [Internet]. São Paulo: El País; 2020 [cited 2020 Apr 14]. Available from: https://brasil.elpais.com/brasil/2020-04-12/margareth-dalcolmo-o-isolamento-social-severo-e-o-sus-sao-as-grandes-armas-do-brasil-contra-a-pandemia.html
Sarti TD, Lazarini WS, Fontenelle LF, Almeida APSC. What is the role of Primary Health Care in the Covid-19 pandemic? Epidemiol Serv Saúde. 2020;29(2):e2020166. PMid:32348404.
Janke AT, Mei H, Rothenberg C, Becher RD, Lin Z, Venkatesh AK. Analysis of hospital resource avail- ability and Covid-19 mortality across the United States. J Hosp Med. 2021;16(4):211-4.http://dx.doi.org/10.12788/jhm.3539. PMid:33496664.
Conselho Nacional de Secretarias Municipais de Saúde (CONASEMS). Reconhecer a Importância do SUS é o primeiro passo contra a pandemia [Internet]. Brasília (DF): CONASEMS; 2020 [cited 2020 Apr 14]. Available from: https://www.conasems.org.br/reconhecer-a-importancia-do-sus-e-o-primeiro-passo-contra-a-pandemia-defendaosus/
Guilhem D, Diniz D. O que é ética em pesquisa. São Paulo: Brasiliense; 2017.
Pacheco JMC Jr, Gomes R. Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals. Cien Saude Colet. 2016;21(8):2485-96. PMid:27557021.
Joanna Briggs Institute (JBI). JBI reviewers’ manual [Internet]. Austrália: Joanna Briggs Institute; 2020 [cited 2020 Apr 13]. Available from: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/ReviewersManual.pdf
Arksey H, O’malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. http://dx.doi.org/10.1080/1364557032000119616.
Ring N, Ritchie K, Mandava L, Jepson R. A guide to synthesising qualitative research for researchers undertaking health technology assessments and systematic reviews [Internet]. Glasgow: Quality Improvement Scotland (NHS QIS); 2010 [cited 2020 Apr 13]. Available from: https://dspace.stir.ac.uk/bitstream/1893/3205/1/HTA_MethodsofSynthesisingQualitativeLiterature_DEC101.pdf
Levac D, Colquhoun H, O’brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5(1):69. http://dx.doi.org/10.1186/1748-5908-5-69. PMid:20854677.
Peters M, Godfrey C, Khalil H, Mcinerney P, Soares C, Parker D. Chapter 11: JBI Manual for Evidence Synthesis. In: Aromataris E, Munn Z, editors. Guidance for the conduct of JBI scoping reviews [Internet]. Adelaide (AUS): University of Adelaide; 2017 [cited 2020 May 14]. p. 1-28. Available from: https://reviewersmanual.joannabriggs.org/
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097. PMid:19621072.
Gonçalves L, Dias MC. Bioethical discussions on resource allocation during the Covid-19 pandemic in Brazil. Diversitates Int J [Internet]. 2020 [cited 2020 Apr 13]; 12(1):17-36. Available from: https://www.bing.com/search?q=Bioethical+discus%02sions+on+resource+allocation+during+the+Covid-19+pandemic+in+Brazil&cvid=a8281a67e1ed4fd2824514e0fbc78c0b&aqs=edge..69i57.849j0j1&pglt=41&FORM=ANNTA1&PC=U531
Rubio O, Estella A, Cabre L, Saralegui-Reta I, Martin MC, Zapata L et al. Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the Covid-19 pandemic: a rapid review & consensus of experts. Med Intensiva [Internet]. 2020 [cited 2020 Apr 23]; 122(1):13-5. Available from: https://doi.org/10.1016/j.medine.2020.06.002
Parsons JA, Johal HK. Best interests versus resource allocation: could Covid-19 cloud decision- making for the cognitively impaired? J Med Ethics. 2020;46(7):447. http://dx.doi.org/10.1136/medethics-2020-106323. PMid:32376717.
Chase J. Caring for frail older adults during Covid-19: integrating public health ethics into clinical practice. J Am Geriatr Soc. 2020;68(8):1666-70. http://dx.doi.org/10.1111/jgs.16666. PMid:32557533.
Laventhal N, Basak R, Dell ML, Diekema D, Elster N, Geis G, et al. The ethics of creating a resource allocation strategy during the Covid-19 pandemic. Pediatrics. 2020;146(1):1-13. http://dx.doi.org/10.1542/peds.2020-1243. PMid:32366610.
Costa CMA, Pompermayer FCL, Costa AS. Protocols in times of pandemic by Covid-19 with criteria for allocating scarce resources: can you consider them (un) fair? Diversitates Int J. 2020;12(1):131- 62. http://dx.doi.org/10.53357/GZYG7716.
Torres A, Félix AAA, Oliveira PIS. Choices of Sofia and the pandemic of Covid-19 in Brazil: bioethical reflections. Rev Bioet Derecho [Internet]. 2020 [cited 2020 Aug 15];50:333-52. Available from: https://doi.org/10.1344/rbd2020.50.31811
Marinho S, Palácios M, Gomes AP, Brito L, Borges L, Narciso L, et al. Faz sentido instituir Comissão de Bioética Hospitalar (CBH) nas unidades de saúde durante a pandemia da Covid-19? [Internet]. Rio de Janeiro, RJ: Fiocruz; 2020 [cited 2020 Apr 12]. Available from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/comissao_de_bioetica_hospitalar_covid19_versao_final_29072020_observatorio.pdf
Farrell TW, Francis L, Brown T, Ferrante LE, Widera E, Rhodes R et al. Rationing limited health care resources in the Covid-19 era and beyond: ethical considerations regarding older adults. J Am Geriatr Soc [Internet]. 2020 [cited 2020 Apr 15];68(6):1143-49. Available from: https://doi.org/10.1111/jgs.16539
Haas LE, Lange DW, Van Dijk D, Van Delden JJ. Should we deny ICU admission to the elderly? Ethical considerations in times of Covid-19. Crit Care. 2020;24:321. http://dx.doi.org/10.1186/s13054-020-03050-x.
Jafarey A. Ethical dilemmas in clinical care during Covid-19 pandemic. J Pak Med Assoc. 2020;70(5):S145- 8. http://dx.doi.org/10.5455/JPMA.35. PMid:32515398.
Boas PJFV, Albuquerque DC, Roriz J Fo, Mello RGB. Criteria for the admission of older patients in the intensive care unit: chronological age cannot be the unique factor. Soc Bras Geriatr Gerontol [Internet]. 2020 [cited 2020 Sept 23]; 14(12):138-9. Available from: https://cdn.publisher.gn1.link/ggaging.com/pdf/en_v14n2a12.pdf
Siqueira-Batista R, Gomes AP, Braga LM, Costa ADS, Thomé B, Schramm FR, et al. Covid-19 e o fim da vida: quem será admitido na Unidade de Terapia Intensiva? [Internet]. Rio de Janeiro, RJ: Fiocruz; 2020 [cited 2020 Sept 23]. Available from: https://www.arca.fiocruz.br/bitstream/icict/41469/2/COVID-19UTI.pdf
Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G, et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the Covid-19 epidemic. Crit Care. 2020;24:165. http://dx.doi.org/10.1186/s13054-020-02891-w. PMid:32321562.
Pattison N. End-of-life decisions and care in the midst of a global coronavirus (Covid-19) pandemic. Intensive Crit Care Nurs. 2020;58(1):102862. http://dx.doi.org/10.1016/j.iccn.2020.102862. PMid:32280052.
Hulsbergen AF, Eijkholt MM, Balak N, Brennum J, Bolger C, Bohrer AM, et al. Ethical triage during the Covid-19 pandemic: a toolkit for neurosurgical resource allocation. Acta Neurochir (Wien). 2020;162(7):1485. http://dx.doi.org/10.1007/s00701-020-04375-w. PMid:32405671.
Solnica A, Barski L, Jotkowitz A. Allocation of scarce resources during the Covid-19 pandemic: a Jewish ethical perspective. J Med Ethics. 2020;46(7):444. http://dx.doi.org/10.1136/medethics-2020-106242. PMid:32277021.
Herreros B, Gella P, Asua DR. Triage during the Covid-19 epidemic in Spain: better and worse ethical arguments. J Med Ethics. 2020;46(7):1-9. http://dx.doi.org/10.1136/medethics-2020-106352. PMid:32424063.
Vincent JL, Creteur J. Ethical aspects of the Covid-19 crisis: how to deal with an overwhelming shortage of acute beds. Eur Heart J: Acute Car Care [Internet]. 2020 [cited 2020 Aug 15];9(3):248- 52. Available from: https://doi.org/10.1177/2048872620922788
White DB, Lo B. A framework for rationing ventilators and critical care beds during the Covid-19 pandemic. JAMA. 2020;323(18):1773-4. http://dx.doi.org/10.1001/jama.2020.5046. PMid:32219367.
Engstrom E, Melo E, Giovanella L, Mendes A, Grabois V, Mendonça MHMD. Recomendações para a organização da Atenção Primária à Saúde no SUS no enfrentamento da Covid-19 [Internet]. Rio de Janeiro, RJ: Fiocruz; 2020 [cited 2020 July 19]. Available from: https://www.arca.fiocruz.br/bitstream/icict/41404/2/RecomendacoesAPSEnfrentamentoCovid-19.pdf
Rello J, Tejada S, Userovici C, Arvaniti K, Pugin J, Waterer G. Coronavirus disease 2019 (Covid-19): a critical care perspective beyond China. Anaesth Crit Care Pain Med. 2020;39(2):167. http://dx.doi.org/10.1016/j.accpm.2020.03.001. PMid:32142972.
Warrillow S, Austin D, Cheung WY, Close E, Holley A, Horgan B, et al. ANZICS guiding principles for complex decision making during the Covid-19 pandemic. Crit Care Resusc. 2020;22(2):98. http://dx.doi.org/10.51893/2020.2.sa1. PMid:32294810.
Maves RC, Downar J, Dichter JR, Hick JL, Devereaux A, Geiling JA, et al. Triage of scarce critical care resources in Covid-19: an implementation guide for regional allocation an expert panel report of the task force for mass critical care and the american college of chest physicians. Chest. 2020;158(1):212- 225. PMid:32289312.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the Covid-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323(16):1545-6. http://dx.doi.org/10.1001/jama.2020.4031. PMid:32167538.
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region: case series. N Engl J Med. 2020;382(21):2012-22. http://dx.doi.org/10.1056/NEJMoa2004500. PMid:32227758.
Singh JA, Moodley K. Critical care triaging in the shadow of Covid-19: ethics considerations. S Afr Med J. 2020;110(5):355-9. PMid:32657716.
Zhao Z, Chen A, Hou W, Graham JM, Li H, Richman PS, et al. Prediction model and risk scores of ICU admission and mortality in Covid-19. PLoS One. 2020;15(7):e0236618. http://dx.doi.org/10.1371/journal.pone.0236618. PMid:32730358.
Associação de Medicina ntensiva Brasileira (AMIB). Recomendações da Associação de Medicina Intensiva Brasileira para a abordagem do Covid-19 em medicina intensiva [Internet]. São Paulo: AMIB; 2020 [cited 2020 Aug 15]. Available from: https://protocolocoimbradrcicerogallicoimbra.files.wordpress.com/2020/06/recomendacoes_amib04042020_10h19.pdf
Biddison ELD, Gwon HS, Schoch-Spana M, Regenberg AC, Juliano C, Faden RR, et al. Scarce resource allocation during disasters: a mixed-method community engagement study. Chest. 2018;153(1):187- 95. http://dx.doi.org/10.1016/j.chest.2017.08.001. PMid:28802695.
Conselho Federal de Medicina (BR). Resolução do CFM nº 2.156/2016. Define critérios para melhorar fluxo de atendimento médico em UTIs [Internet]. Diário Oficial da União. 19 nov. 2016 [cited 2020 Aug 15]. Available from: https://www.acm.org.br/resolucao-do-cfm-no-2-1562016/
Conselho Regional de Medicina do Rio de Janeiro (BR). Recomendação CREMERJ Nº 05/2020. Recomenda a utilização de critérios objetivos e transparentes para estabelecer prioridades na alocação dos pacientes em leitos de terapia intensiva e suas intervenções [...] [Internet]. Rio de Janeiro (RJ): CREMERJ; 2020 [cited 2020 Aug 15]. Available from: https://www.cremerj.org.br/downloads/pdf/40_recomendacao_cremerj_052020.pdf?inline=inline
Conselho Regional de Medicina de Pernambuco (BR). Recomendação CREMEPE Nº 05/2020. Recomenda a utilização do Escore Unificado para Priorização (EUP-UTI) de acesso a leitos de terapia intensiva [...] [Internet]. Recife (PE): CREMEPE; 2020 [cited 2020 Aug 15]. Available from: https://www.cremepe.org.br/2020/05/12/cremepe-publica-recomendacao-no-05-2020/
Associação de Medicina Intensiva Brasileira (AMIB). Recomendações da AMIB (Associação de Medicina Intensiva Brasileira), ABRAMEDE (Associação Brasileira de Medicina de Emergência), SBGG (Sociedade Brasileira de Geriatria e Gerontologia) e ANCP (Academia Nacional de Cuidados Paliativos) de alocação de recursos em esgotamento durante a pandemia por Covid-19 [Internet]. São Paulo: AMIB, ABRAMEDE, SBGG, ANCP; 2020 [cited 2020 Aug 15]. Available from: http://redacao.amib.org.br/noticia/nid/recomendacoes-da-amib-abramede-sbgg-e-ancp-de-alocacao-de-recursos-em-esgotamento-durante-a-pandemia-por-covid-19/
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