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Union Health Ministry Issues Fresh Guidelines for ICU Admissions

Written by : Jayati Dubey

January 3, 2024

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These guidelines aim to provide a methodical approach to ICU admissions, prioritising judicious utilisation of critical care resources based on medical needs.

In a recent development, the Union Health Ministry has issued guidelines on Intensive Care Unit (ICU) admissions, highlighting that hospitals cannot admit critically ill patients to the ICU if there is a refusal from the patients or their relatives.

The guidelines, compiled by a team of 24 experts, also stress the importance of avoiding ICU admission for individuals with a living will or advanced directive against such care.

According to the guidelines, in cases where no further treatment is possible or available for a terminally ill patient and the continuation of therapy is unlikely to impact the outcome, particularly survival, keeping such patients in the ICU is deemed as "futile care."

The guidelines further outline criteria for admitting patients to the ICU based on organ failure, the need for organ support, or anticipation of deterioration in medical condition.

How & When To Get An ICU Admission?

Key criteria for ICU admission include altered level of consciousness, hemodynamic instability, the need for respiratory support, patients with acute illnesses requiring intensive monitoring and organ support, and individuals who have undergone major surgery or experienced intraoperative complications.

However, the guidelines specify that patients with informed refusal or advanced directives against ICU care, terminally ill patients judged as futile, and those falling under low-priority criteria during a pandemic or disaster situation with resource limitations should not be admitted to the ICU.

In situations where resource limitations are a factor, low-priority criteria during a pandemic or disaster should be considered for ICU admission decisions. The guidelines underscore the importance of monitoring various parameters, such as blood pressure, pulse rate, respiratory rate, heart rate, breathing pattern, oxygen saturation, urine output, and neurological status, in patients awaiting an ICU bed.

Moreover, the discharge criteria for ICU include the return of physiological aberrations to near-normal or baseline status, reasonable resolution and stability of the acute illness that necessitated ICU admission, and agreement from the patient/family for ICU discharge based on a treatment-limiting decision or palliative care.

These guidelines aim to provide a structured approach to ICU admissions, ensuring that critical care resources are utilised judiciously and prioritised based on medical needs. The emphasis on respecting the wishes of patients with advanced directives and considering the futility of care in specific situations reflects a patient-centric approach in critical care decision-making.


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