Finally, the merit of the article by Rumpf and colleagues [1] is to remind us that clinical applications of capnography are still growing, especially amongst spontaneously breathing patients. Physicians AGI-6780? dealing with acute medicine should make every effort to become familiar with expired CO2 measurement. Inconclusive capnographic results related to tachypneic or apprehensive patients do not overcome the potential for expired CO2 to be placed inside the diagnostic algorithm of a challenging disease like PE.AbbreviationsCO2: carbon dioxide; PCO2: partial pressure of carbon dioxide; PE: pulmonary embolism.Competing interestsThe authors declare that they have no competing interests.NotesSee related research by Rumpf et al., http://ccforum.

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Several groups in Canada and the US have recently pondered disastrous scenarios where demand for hospital admission and critical care resources would vastly outstrip supply in an influenza pandemic or other health emergency. Rather than leave wrenching prioritization decisions to exhausted, frontline health professionals, the groups have proposed algorithms that would be used to triage patients and to allocate – and even reallocate – lifesaving resources.Questions have been raised about the ability of physicians to implement these proposals, however, which in some cases call for categorically excluding groups of patients from needed care and withdrawing life support regardless of the wishes of patients or their proxies. Evidence that these protocols would accurately predict which patients are likely or unlikely to survive, and to direct resources accordingly, has also been insufficient.

A pilot study by Christian and colleagues tackles some of these questions by examining the results of applying Ontario’s draft critical care triage protocol to an actual cohort of intensive care unit (ICU) patients [1]. One-half of the pilot study’s authors were original authors of the Ontario protocol [2]. In the US and in Canada, many governmental bodies, hospitals, and the US Veterans Health Administration have incorporated aspects of the Ontario protocol into pandemic planning documents.The study’s results are troubling. Patients who would have been triaged to expectant and designated for withdrawal of ICU care and ventilator support in fact had substantial survival rates.

Triage officers often disagreed and lacked confidence in their categorization decisions. The findings suggest that rationing paradigms which include categorical exclusion criteria and withdrawal of lifesaving GSK-3 resources may need to be rethought, and public input sought on nonclinical aspects.The Ontario protocol was successful by one measure. Patients who would have been excluded from ICU admission in a pandemic had significantly lower rates of survival than other patients when they received standard treatments.A full one-quarter of these patients, however, survived their hospital stays.