In the recent guidelines on ICU admissions, the Union Health Ministry has said that the hospitals cannot admit critically ill patients in the intensive care unit in case of refusal by them and their relatives. According to the guidelines prepared by a group of 24 experts, it is recommended that there is no point in keeping a patient in the intensive care unit if there is no accessible or viable treatment for their disease.
It is also mentioned that if the patient is terminally sick and continuing therapy would not improve their prognosis, particularly their chance of survival, then keeping them in the ICU is futile care. Further, anyone with a living will or advanced directive against ICU care should not be admitted to ICU.
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In addition, low-priority factors should be considered when deciding whether to keep a patient in the ICU during a pandemic or other emergency when resources are limited. A patient should be admitted to the ICU if they have organ failure and require organ support, or if they anticipate their medical condition getting worse, the guidelines said.
"The following critically ill patients should not be admitted to ICU -- patient's or next of ? kin's informed refusal to be admitted in ICU, any disease with a treatment limitation plan, anyone with a living will or advanced directive against ICU care, terminally ill patients with a medical judgement of futility and low priority criteria in case of a pandemic or disaster situation where there is resource limitation (e.g. bed, workforce, equipment)," the guidelines stated, news agency PTI reported.
Criteria for ICU admission include altered level of consciousness of recent onset, hemodynamic instability, need for respiratory support, patients with acute illness requiring intensive monitoring or organ support, and any disease or medical condition with potential for worsening.
Patients who have undergone major surgery or encountered any significant intraoperative complications, such as cardiovascular or respiratory instability, also meet the requirements.
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, the guidelines said.
(With Inputs From Agency)
