A question common in the minds of those working in the hospital as well as those outside is which type of patient should be treated in the ICU.
The selection of patients appropriate for intensive care not only depends upon purely medical and organisational factors but also on financial, legal, ethical and moral issues.
The following are the main considerations for admission of a patient in ICU:
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1. Physiologically unstable patients who require constant reaction to change in their condition and rapidly redefining therapy.
2. Patients may also be considered only for monitoring and observation for early detection and rapid response to impending complications.
3. It is questionable to devote ICU resources to a patient whose prognosis has resolved to one of a “point of no return”.
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In view of expectations of what medicine can achieve, intensive care must be provided for the first two categories. However, these distinctions are not always possible, and not necessarily desirable.
It cannot be said with certainly that if a particular patient was not admitted to ICU he would have died, or if a particular patient was admitted he would have survived or recovered.
Infective conditions will not be treated in the ICU; neither is it intended as a halting place for terminal care of moribund patients. Random occurrence of catastrophic events or unpredictable clinical crises is a characteristic of most patients in ICU. Death may occur unexpectedly. Initial therapeutic success may not be sustained.
Sometimes it is sad to see intensive care units cluttered with patients who could unquestionably be better looked after in the ward or at home. However, some patients requiring only monitoring and observation, even if they are physiologically stable may be considered as appropriate cases, for the purpose of early detection of changing symptoms and rapid response to serious complications.