Critical Care Subspeciality

General guidelines:

ADMISSION CRITERIA
FOR ICU (INTENSIVE CARE UNIT)

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​A. Patient will be transferred from Casualty, Wards, Rooms and OPDs for ICU admission for following diagnoses.

 

1. CARDIOVASCULAR
 

• Unstable Blood Pressure (hypotension or hypertension) 

• Large volume resuscitation, massive blood loss 

• Any type of shock requiring of inotropic/vasoactive infusions 

• Requirement of IV antihypertensives with intraarterial blood pressure monitoring 

• Uncontrolled/life threatening cardiac arrhythmias 

• Persistent Ischemic chest pain 

• Ischemia/infarction on ECG

2. RESPIRATORY
 

• Acute respiratory distress with hypoxia: respiratory rate >30 or <6/min 

• PaO2<60mmHg or SPO2<90 or P/F ratio<300 

• Require invasive mechanical ventilation or aggressive non-invasive ventilation 

• PCO2 ≥50 mmHg
   

3. METABOLIC/RENAL
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• Life threatening Electrolyte abnormalities requiring close monitoring and therapy.  

• Metabolic acidosis requiring close monitoring and therapy 

• Rhythm changes secondary to electrolyte abnormalities  

• Fluid overload requiring hemodialysis.

4. INFECTIONS
 

• Suspected Sepsis 

• Septic Shock of any etiology

5. NEUROLOGICAL

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• Traumatic brain injury  

• Intracranial Hemorrhage suspected or noted by CT scan, MRI, with drop in GCS 

• Stroke requiring monitoring or mechanical ventilation

• Irregular respiratory patterns. Uncontrolled Seizures.

6. PRE/POST-OPERTATIVE

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• Requiring invasive monitoring in view of comorbidities,

• Prolonged surgery

• Delayed awakening 

• Hypothermia 

• Surgical procedural complications 

• Intra op Complicated/difficult airway 

• Pre-operative stabilization prior to surgery 
   

7. HAEMATOLOGICAL

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• Coagulopathy needing frequent monitoring and correction. 

• Massive transfusion Hb monitoring in trauma

ADMISSION CRITERIA
FOR HDU (HIGH DEPENDENCY UNIT)

B. Patient will be transferred from Casualty, Wards, Rooms and OPDs for HDU or Step-down ICU admission for following diagnoses.

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HDU is not appropriate for patients with more than one organ system compromised

 

1. CARDIOVASCULAR

 

• Unstable Blood Pressure (BP); labile BP, SBP, <90, DBP >120 

• Large volume resuscitation, massive blood loss 

• Any type of shock requiring of inotropic/vasoactive infusions 

• Requirement of IV antihypertensives with intraarterial blood pressure monitoring 

• Uncontrolled/life threatening cardiac arrhythmias 

• Persistent Ischemic chest pain. 

• Ischemia/infarction on ECG 

 

2. RESPIRATORY

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• Acute respiratory distress with hypoxia requiring only NIV 

• Weaning on NIV or BiPAP or CPAP 

• PCO2 ≥50 mmHg requiring only NIV If patients need invasive ventilation

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3. METABOLIC/RENAL

 

• Life threatening Electrolyte abnormalities requiring close monitoring and therapy. 

• Metabolic acidosis requiring close monitoring and therapy 

• Rhythm changes secondary to electrolyte abnormalities  

• Fluid overload requiring hemodialysis. 

 

4. INFECTIONS

​

• Suspected Sepsis

• Septic Shock of any etiology 

 

5. NEUROLOGICAL

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• Traumatic brain injury not requiring intubation 

• Intracranial Hemorrhage suspected or noted by CT scan or MRI with drop in GCS  

• Alterations in consciousness: increasing restlessness, confusion, irritability, and disorientation, increasing drowsiness, lethargy.  

• Cerebrovascular accidents requiring monitoring

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6. PRE/POST-OPERATIVE

​

• Requiring invasive monitoring in view of co morbidities,

• Prolonged surgery 

• Delayed awakening 

• Hypothermia 

• Surgical procedural complications 

• Intra op Complicated/difficult airway 

• Pre-operative stabilization prior to surgery  

• For optimizing analgesia in postoperative and trauma patients  

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7. HAEMATOLOGICAL

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• Coagulopathy needing frequent monitoring and correction.

• Massive transfusion HB monitoring in trauma patients