Levels of care
Level 0
- Patients whose needs can be met through normal ward care in an acute
hospital
Level 1
- Patients at risk of their conditions deteriorating or those recently
relocated from higher levels of care
- Needs can be met on an acute ward with additional advice and support
from critical care team
Level 2
- Patients requiring more details observation or intervention
- Includes support for single failing organ system or postoperative
care
- Includes those 'stepping down' from higher levels of care
Level 3
- Patients requiring advances respiratory support alone or
- Basic respiratory support together with support of at least two
other organs
- Includes complex patients requiring support for multiorgan failure
Principles of ITU
Indications for admission to ITU
- Mechanical support of organ function
- Respiratory - ventilation / CPAP
- Renal - haemofiltration / haemodialysis
- Cardiac - ECG monitoring and inotropic support
- Hepatic - blood transfusion
- Neurological - intracranial pressure monitoring
- Usually has 1:1 nursing care
Indications for admission to HDU
- Close monitoring of unstable patient
- Oxygenation - respiratory rate, oxygen saturation, arterial gases
- Cardiac function - pulse, blood pressure, central venous pressure
- Renal function - urine output
- Usually has 2:1 nursing care
- Usually does not have facilities for ventilation or haemodialysis
Factors to be considered when assessing admission to ICU
- Diagnosis
- Severity of illness
- Age
- Coexisting disease
- Physiological reserve
- Prognosis
- Availability of suitable treatment
- Response of treatment to date
- Recent cardiopulmonary arrest
- Anticipated quality of life
- The patient's wishes
Criteria for ICU assessment
- Threatened airway
- Respiratory arrest
- Respiratory rate >40 or <8 breaths / min
- Oxygen saturation <90% on >50% oxygen
- Cardiac arrest
- Pulse rate <40 or >140 beats / min
- Systolic blood pressure < 90 mmHg
- Sudden fall in level of consciousness
- Repeated or prolonged seizures
- Rising arterial carbon dioxide tension with respiratory acidosis
Outreach services
- Essential component of critical care services
- Has three essential objectives
- To assess potential admissions
- To enable discharges
- To share critical care skills
- Often use early warning scoring systems to identify sick patients
- Scoring systems based on assessment of physiological dysfunction
Early warning system
| Score |
3 |
2 |
1 |
0 |
1 |
2 |
3 |
| Heart rate |
|
<40 |
41-50 |
51-100 |
101-110 |
111-130 |
>130 |
| Mean BP |
<70 |
71-80 |
81-100 |
101-199 |
|
>200 |
|
| Resp. rate |
|
<8 |
|
9-14 |
15-20 |
21-29 |
>30 |
| Temperature |
|
<35 |
35.1-36.5 |
|
36.6-37.4 |
>37.5 |
|
| Conscious level |
|
|
|
Awake |
Respond to voice |
Respond to pain |
No Response |
Bibliography
McIntosh N. Intensive care monitoring; past, present and future.
Clin Med 2002; 2: 349-355 |