NEW DELHI: For the first time, the government has issued guidelines for hospitals on ICU admissions, directing that critically ill patients cannot be admitted to the intensive care unit if there is refusal by the patients and their relatives. The guidelines on ICU admission and discharge criteria further clarify that the requirements for admitting a patient to the ICU should be based on organ failure, 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, recommend that critically ill patients should not be admitted to the ICU if there is a treatment limitation plan for any disease.
According to the guidelines, which include contributions from Dr. Sheila Nainan Myatra of Tata Memorial Hospital, Mumbai; Dr. RK Mani of Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad; Dr. E Lenin Babu of JIPMER Puducherry; Dr. Anjan Trikha and Dr. Lokesh Kashyap from Delhi AIIMS; and Dr. JV Peter of CMC Vellore, anyone with a living will or advanced directive against ICU care should not be admitted to the ICU.
The seven-page guidelines also state that terminally ill patients with a medical judgment of futility should not be admitted to the ICU. Additionally, those with low priority criteria in a pandemic or disaster situation, where there is a limitation of resources (e.g., beds, workforce, equipment), should not be admitted to the ICU.
The guidelines spell out admission criteria for the ICU, including 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 also included in the criteria for ICU admission. The guidelines list ICU discharge criteria as well. 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 agreement for ICU discharge for a treatment-limiting decision or palliative care.