Anesthesiology ADMISSION CRITERIA TO ICU

ADMISSION CRITERIA TO ICU


The Intensive Care Unit is an expensive resource area and should be reserved for patients with reversible medical conditions with a reasonable prospect of substantial recovery.
Patients with the following conditions are candidates for admission to the General Intensive Care Unit. The following conditions include, but are not limited to


A- Respiratory
1- Acute respiratory failure requiring ventilatory support
2- Acute pulmonary embolism with haemodynamic instability
3- Massive haemoptysis
4- Upper airway obstruction

B- Cardiovascular
1- Shock states ( ex. Cardiogenic shock )
2- Life-threatening dysrhythmias
3- Dissecting aortic aneurysms
4- Hypertensive emergencies
5- Need for continuous invasive monitoring of cardiovascular system
( arterial pressure, central venous pressure, cardiac output)
6- Acute myocardial infarction with complications
7-
Unstable angina, particularly with dysrhythmias, hemodynamic instability, or persistent chest pain
8- Acute congestive heart failure with respiratory failure and/or requiring hemodynamic support
9-
Cardiac tamponade or constriction with hemodynamic instability

C- Neurological
1- Severe head trauma
2- Status epilepticus
3- Meningitis with altered mental status or respiratory compromise
4- Acutely altered sensorium with the potential for airway compromise
5- Progressive neuromuscular dysfunction requiring respiratory support and / or cardiovascular monitoring (myasthenia gravis, Gullain-Barre syndrome)
6- Brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status
7- Coma: metabolic, toxic, or anoxic
8- Intracranial hemorrhage with potential for herniation
9- Acute subarachnoid hemorrhage


D- Renal
1- Requirement for acute renal replacement therapies in an unstable patient
2- Acute rhabdomyolysis with renal insufficiency

E- Endocrine
1- Diabetic ketoacidosis complicated by haemodynamic instability, altered mental status
2- Severe metabolic acidotic states
3- Thyroid storm or myxedema coma with haemodynamic instability
4- Hyperosmolar state with coma and/or haemodynamic instability
5- Adrenal crises with haemodynamic instability
6- Other severe electrolyte abnormalities, such as:
- Hypo or hyperkalemia with dysrhythmias or muscular weakness
- Severe hypo or hypernatremia with seizures, altered mental status
- Severe hypercalcemia with altered mental status, requiring haemodynamic monitoring
-
Hypo or hypermagnesemia with hemodynamic compromise or dysrhythmias
-
Hypophosphatemia with muscular weakness

F- Gastrointestinal
1- Life threatening gastrointestinal bleeding including hypotension, angina or continued bleeding
2- Acute hepatic failure leading to coma, haemodynamic instability (Fulminant hepatic failure)
3- Severe acute pancreatitis
4- Esophageal perforation with or without mediastinitis


G- Haematology
1- Severe coagulopathy and/or bleeding diasthesis
2- Severe anemia resulting in haemodynamic and/or respiratory compromise
3- Severe complications of sickle cell crisis
4- Haematological malignancies with multi-organ failure

H-Obstetric
1- Medical conditions complicating pregnancy
2- Severe pregnancy induced hypertension/eclampsia
3- Obstetric haemorrhage
4- Amniotic fluid embolism

I- Multi-system
1- Severe sepsis or septic shock
2- Multi-organ dysfunction syndrome
3- Polytrauma
4- Dengue haemorrhagic fever/dengue shock syndrome
5- Drug overdose with potential acute decompensation of major organ systems
( Hemodynamically unstable drug ingestion, Seizures following drug ingestion, Drug ingestion with significantly altered mental status with inadequate airway protection )
6- Environmental injuries (lightning, near drowning, hypo/hyperthermia)
7- Severe burns

J- Surgical
1- High risk patients in the peri-operative period
2- Post-operative patients requiring continuous haemodynamic monitoring/ ventilatory support, usually following:
- vascular surgery
- thoracic surgery
- airway surgery
- craniofacial surgery
- major orthopaedic and spine surgery
- general surgery with major blood loss/ fluid shift
- neurosurgical procedures

Objective Parameters

Vital Signs
* Pulse < 40 or > 150 beats/minute
* Systolic arterial pressure < 80 mm Hg or 20 mm Hg below the patient's usual pressure
* Mean arterial pressure < 60 mm Hg
* Diastolic arterial pressure > 120 mm Hg
* Respiratory rate > 35 breaths/minute
* SaO2< 88% with O2 supply

Laboratory Values (newly discovered)
* Serum sodium < 110 mEq/L or > 160 mEq/L
* Serum potassium < 2.5 mEq/L or > 7.0 mEq/L
* PaO2 < 50 mm Hg
* pH < 7.1 or > 7.7
* Serum glucose > 600 mg/dl
* Serum calcium > 15 mg/dl
* Toxic level of drug or other chemical substance in a hemodynamically or neurologically compromised patient

Radiography/Ultrasonography/Tomography (newly discovered)
* Cerebral vascular hemorrhage, contusion or subarachnoid hemorrhage with altered mental status or focal neurological signs
* Ruptured viscera, bladder, liver, esophageal varices or uterus with hemodynamic instability
* Dissecting aortic aneurysm

Electrocardiogram
* Myocardial infarction with complex arrhythmias, hemodynamic instability or congestive heart failure
* Sustained ventricular tachycardia or ventricular fibrillation
* Complete heart block with hemodynamic instability

Physical Findings (acute onset)
* Unequal pupils in an unconscious patient
* Burns covering > 10% BSA
* Anuria
* Airway obstruction
* Coma
* Continuous seizures
* Cyanosis
* Cardiac tamponade
 

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