Intensive Care Unit Admission: The Union Health Ministry in its recent guidelines on ICU admissions has said that hospitals “cannot admit critically ill patients in the Intensive Care Unit (ICU) in case of refusal by them and their relatives”.
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The guidelines further recommended that when no further treatment is possible or available in a diseased or terminally ill patient if the continuation of therapy is not going to make an impact on the outcome, especially survival, “then keeping in ICU is futile care”.
These guidelines, compiled by 24 experts, further state that anyone with a living will or advanced directive against ICU care should not be admitted to ICU.
Besides, low-priority criteria in case of a pandemic or disaster situation, where there is resource limitation, should be taken into account for keeping a patient in the ICU.
Criteria for admitting a patient to ICU should be based on organ failure and need for organ support or in anticipation of deterioration in the medical condition, say the guidelines.
Altered level of consciousness of recent onset, hemodynamic instability, need for respiratory support, patients with acute illness requiring intensive monitoring and/or organ support or any medical condition or disease with anticipation of deterioration have been listed as criteria for ICU admission.
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Patients who have experienced any major intraoperative complication like cardiovascular or respiratory instability or have undergone major surgery also feature among the criteria.
“The following critically ill patients should not be admitted to ICU — patient’s or next of kin’s informed refusal to be admitted in ICU, any disease with a treatment limitation plan, anyone with a living will or advanced directive against ICU care, terminally ill patients with a medical judgement of futility and low priority criteria in case of pandemic or disaster situation where there is resource limitation (e.g. bed, workforce, equipment),” the guidelines stated.
Return of physiological aberrations to near normal or baseline status, reasonable resolution and stability of the acute illness that necessitated ICU admission, patient/family agreeing for ICU discharge for a treatment-limiting decision or palliative care have been mentioned in the ICU discharge criteria.
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According to the guidelines, blood pressure, pulse rate, respiratory rate, breathing pattern, heart rate, oxygen saturation, urine output and neurological status among other parameters should be monitored in a patient awaiting an ICU bed.
