AS7.1-2 | ICU Organization, Functions and Admission-Discharge Criteria — Summary & Reflection

KEY TAKEAWAYS

The ICU is a geographically distinct, technology-rich, multidisciplinary clinical environment designed for patients with actual or threatened single or multi-organ failure. ICUs are classified into Levels I, II, and III by capability; their physical design (open-bay versus closed-cubicle) and staffing (minimum 1:1 nurse-to-patient for ventilated patients) are governed by ISCCM and international guidelines. The key ICU functions span airway and ventilatory support, invasive haemodynamic monitoring, renal replacement therapy, nutritional support, and infection prevention through care bundles (ventilator bundle reduces VAP by 50-66%; central-line bundle minimises CLABSI). Admission criteria are organised around objective physiological thresholds (SpO2, BP, HR, GCS, urine output, pH) and disease-specific indications (septic shock, post-cardiac surgery, severe TBI, fulminant hepatic failure). Discharge criteria mirror admission in reverse — respiratory stability on low-level support, haemodynamic independence from vasopressors, neurological adequacy, and metabolic stability — with the 48-hour readmission risk as the key safety signal for premature discharge.

REFLECT

A junior doctor on night duty is called to the ward for a post-appendicectomy patient whose vitals show: BP 94/60, HR 112, RR 28, SpO2 92% on room air, GCS 14 (down from baseline 15). The surgical registrar is busy in theatre and asks you to watch and wait for 30 minutes. Using what you have learned about ICU admission criteria, how would you approach this situation? What specific parameters cross the threshold? How would you communicate the urgency to the registrar and to the patient's family? What monitoring would you initiate immediately while awaiting ICU assessment? Reflect also on the ethical dimension: what obligation does a junior doctor have to escalate care when a senior defers?