Clinical Review ABC of intensive care

Criteria for admission

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7197.1544 (Published 05 June 1999) Cite this as: BMJ 1999;318:1544
  1. Gary Smith,
  2. Mick Nielsen

    Intensive care has been defined as “a service for patients with potentially recoverable conditions who can benefit from more detailed observation and invasive treatment than can safely be provided in general wards or high dependency areas.” It is usually reserved for patients with potential or established organ failure. The most commonly supported organ is the lung, but facilities should also exist for the diagnosis, prevention, and treatment of other organ dysfunction.

    Ward observation chart showing serious physiological deterioration

    Who to admit

    Intensive care is appropriate for patients requiring or likely to require advanced respiratory support, patients requiring support of two or more organ systems, and patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ. Early referral is particularly important. If referral is delayed until the patient's life is clearly at risk, the chances of full recovery are jeopardised.

    View this table:

    Categories of organ system monitoring and support

    Factors to be considered when assessing suitability for admission to intensive care

    • Diagnosis

    • Severity of illness

    • Age

    • Coexisting disease

    • Physiological reserve

    • Prognosis

    • Availability of suitable treatment

    • Response to treatment to date

    • Recent cardiopulmonary arrest

    • Anticipated quality of life

    • The patient's wishes

    As with any other treatment, the decision to admit a patient to an intensive care unit should be based on the concept of potential benefit. Patients who are too well to benefit or those with no hope of recovering to an acceptable quality of life should not be admitted. Age by itself should not be a barrier to admission to intensive care, but doctors should recognise that increasing age is associated with diminishing physiological reserve and an increasing chance of serious coexisting disease. It is important to respect patient autonomy, and patients should not be admitted to intensive care if they have a stated or written desire not to receive intensive care—for example, in an advanced …

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