NEW DELHI: For the first time, the government has issued guidelines for hospitals on ICU admissions and directed them that they cannot admit critically ill patients in the intensive care unit in case of a refusal by them and their relatives.
The guidelines for ICU admission and discharge criteria further clarified that the requirements for admitting a patient to ICU should be based on organ failure and the need for organ support or in anticipation of deterioration in the medical condition.
The Union Health Ministry's new guidelines on ICU admissions, developed by 24 eminent physicians, including experts from Dubai and Canada, have also recommended that critically ill patients should not be admitted to ICU if any disease has a treatment limitation plan.
Anyone with a living will or advanced directive against ICU care should not be admitted to the ICU, according to the guidelines compiled by the experts, who include Dr. Sheila Nainan Myatra, Tata Memorial Hospital, Mumbai; Dr. RK Mani, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad; Dr. E Lenin Babu, JIPMER Puducherry; Dr. Anjan Trikha and Dr. Lokesh Kashyap -- from Delhi AIIMS -- and Dr. JV Peter, CMC Vellore.
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The seven-page guidelines list also said that terminally ill patients with a medical judgment of futility should not be admitted to the ICU.
It also said that those with low priority criteria in a pandemic or disaster situation, where there is resource limitation (e.g. bed, workforce, equipment), should not be admitted to ICU.
It also spelled out admission criteria for the ICU.
This includes the altered level of consciousness of recent onset, hemodynamic instability, need for respiratory support, patients with acute illness requiring intensive monitoring and organ support, or any medical condition or disease with anticipation of deterioration.
Patients who have experienced any major intraoperative complication like cardiovascular or respiratory instability or have undergone major surgery are the other feature among the criteria for ICU admission.
It also lists ICU discharge criteria. This includes 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.
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.
It also lists the qualifications of the Intensivist or critical care specialist.