GUWAHATI: The Government of India has recently issued comprehensive regulations for hospitals, specifically addressing ICU admissions according to which hospitals are now required to obtain the consent of critically ill patients and their families before admitting them to the Intensive Care Unit (ICU), as per reports.
Formulated by a panel of 24 experts, the guidelines reportedly talk about the importance of aligning ICU admissions with the wishes and decisions of patients and their families. The recommendations highlight situations where continued therapy in the ICU may be deemed futile, especially when no further treatment is available for diseased or terminally ill patients, and its impact on the outcome, particularly survival, is limited.
The guidelines state that patients with a living will or advanced directive against ICU care should not be admitted to the ICU. Furthermore, during a pandemic or disaster scenario where resources are limited, low-priority criteria should be considered for ICU admissions. The criteria for admitting a patient to the ICU are detailed, emphasising organ failure, the need for organ support, or anticipation of deterioration in the medical condition.
Among the listed criteria for ICU admission are altered levels of consciousness, hemodynamic instability, the need for respiratory support, acute illness requiring intensive monitoring, and any medical condition with an expected deterioration. Patients experiencing major intraoperative complications or those who have undergone significant surgery are also considered within the criteria.
As per reports, the guidelines explicitly mention that critically ill patients refusing ICU admission, those with a treatment limitation plan, those with a living will or advanced directive against ICU care, terminally ill patients judged as futile, and those falling under low-priority criteria in resource-limited situations should not be admitted to the ICU.
When it comes to ICU discharge, the guidelines also reportedly emphasise the return of physiological aberrations to near normal or baseline status, reasonable resolution and stability of the acute illness that necessitated ICU admission, agreement from the patient or family for ICU discharge for a treatment-limiting decision, or opting for palliative care.
Additionally, the guidelines prescribe the continuous monitoring of various parameters, including blood pressure, pulse rate, respiratory rate, breathing pattern, heart rate, oxygen saturation, urine output, and neurological status, for patients awaiting an ICU bed.
