MOHFW has released guidelines for ICU admission and discharge criteria for Hospitals and Doctors.The guidelines define ICUand the Intensivist and also lays down criteria for admissions in ICU as well as the criteria for discharging a patient from ICU.

Intensive Care Unit (ICU)

The terms Critical Care /Intensive Care/Intensive Therapy Unit are synonymous. It is a designated,specialized area for multidisciplinary, focused management of patients who have life-threatening,partially, or completely reversible organ(s) dysfunction. Such treatment requires continuous and intensive observation and interventions by a multi professional team of appropriately trainedhealthcare workers including doctors, nurses and other support staff with equipment andparaphernalia necessary for sustaining life until recovery.

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Intensivist or Critical Care specialist is a specialist who has specific training, certification and experience in managing critically ill patients in an ICU.The Intensivist should have a postgraduate qualification in Internal Medicine, Anaesthesia,Pulmonary Medicine, Emergency Medicine or General Surgery with an additional qualification in Intensive Care.

ICU Admission Criteria: As per the guidelines only following category of patients should be admitted in ICU-

01.  Altered level of consciousness of recent onset

02. Hemodynamic instability (e.g., clinical features of shock, arrythmias)

03. Need for respiratory support (e.g. escalating oxygen requirement, de–novo respiratory

failure requiring non-invasive ventilation, invasive mechanical ventilation, etc.)

04. Patients with severe acute (or acute–on–chronic) illness requiring intensive monitoring and/or organ support

05. Any medical condition or disease with anticipation of deterioration

06. Patients who have experienced any major intraoperative complication (e.g.

cardiovascular or respiratory instability)

07.Patients who have undergone major surgery, (e.g. thoracic, thoraco–abdominal, upper

abdominal operations, trauma who require intensive monitoring or at a high risk of

developing postoperative complications).

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The following Critically Ill Patients should not be admitted to ICU:

01. Patient’s or next–of–kin informed refusal to be admitted in ICU

02. Any disease with a treatment limitation plan

03. Anyone with a living will or advanced directive against ICU care

04. Terminally ill patients with a medical judgement of futility

05. Low priority criteria in case of pandemic or disaster situation where there is resource-

limitation (e.g. bed, workforce, equipment).

ICU Discharge Criteria

01.  Return of physiological aberrations to near normal or baseline status

02.  Reasonable resolution and stability of the acute illness that necessitated ICU admission

03. Patient/family agrees for ICU discharge for a treatment-limiting decision or palliative

care.

04. Based on lack of benefit from aggressive care (should be a medical decision, not

obligating family agreement and as far as possible should not be based on economic

constraints).

05.  For infection control reasons with ensuring appropriate care of the given patient in a non ICU location

06. Rationing (i.e., prioritisation in the face of a resource crunch). In this event there should be an explicit and transparent written rationing policy that should be fair, consistent and reasonable.

Acess the original guidelines through this link-

GUIDELINES FOR INTENSIVE CARE UNIT ADMISSION AND DISCHARGE CRITERIA