The Union Health Ministry has issued guidelines for hospitals on Intensive Care Unit (ICU) admissions. The guidelines included information about who should be admitted, who should not be, the discharge procedure and the minimum monitoring requirements while the patient awaits for the bed. These guidelines have been developed by 24 doctors from various parts of India, including doctors from Canada and Dubai.
ICU Admission Criteria
- If someone from your family has to be admitted to ICU then you must know the following criteria. It is crucial to particularly know this criteria beforehand rather than getting confused at the hospital where the whole procedure of filling forms and everything starts. This can cause delay in the treatment for your loved one.
- The guidelines stated that the requirement for admitting a patient in ICU should be based on organ failure and need for organ support or in anticipation of deterioration in the medical condition.
- Altered level of consciousness of recent onset Hemodynamic instability (e.g., clinical features of shock, arrhythmias)
- Need for respiratory support (e.g. escalating oxygen requirement, de–novo respiratory failure requiring non-invasive ventilation, invasive mechanical ventilation, etc.)
- Patients with severe acute (or acute–on–chronic) illness requiring intensive monitoring and/or organ support Any medical condition or disease with anticipation of deterioration
- Patients who have experienced any major intraoperative complication (e.g. cardiovascular or respiratory instability)
- Patients who have undergone major surgery, (e.g. thoracic, thoraco–abdominal, upper abdominal operations, trauma who require intensive monitoring or at a high risk of developing postoperative complications).
- The guidelines provided by the health ministry also mentioned who should not be admitted to the ICU. Below is the list of instructions put forth in the guidelines.
Who Should Not Be Admitted To ICU
The guidelines provided by the health ministry further stated the criteria of critically ill patients who should not be admitted in the ICU. Following are the points listed in the guidelines.
- Patient’s or next–of–kin 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
- Low priority criteria in case of pandemic or disaster situation where there is resource limitation (e.g. bed, workforce, equipment).
The guidelines also stated, “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.”
The experts also mentioned the discharge criteria in the guidelines which included the return of physiological aberrations to near normal or baseline status, reasonable resolution and stability of the acute illness that necessitated ICU admission, and patient/family agreeing for ICU discharge for a treatment-limiting decision or palliative care.