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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, April 4, 2016

Algorithm for intensive care unit admission

Resultado de imagen de critical care 2016 biomed
Joao Gabriel Rosa Ramos J. et al. Critical Care 2016; 20:81
DOI: 10.1186/s13054-016-1262-0
Intensive care unit (ICU) admission triage is performed routinely and is often based solely on clinical judgment, which could mask biases. A computerized algorithm to aid ICU triage decisions was developed to classify patients into the Society of Critical Care Medicine’s prioritization system. In this study, we sought to evaluate the reliability and validity of this algorithm.
This ICU admission triage algorithm demonstrated good reliability and validity. However, more studies are needed to evaluate a difference in benefit of ICU admission justifying the admission of one priority stratum over the others.
  • Question 1 asked whether the ICU request was for active intervention or monitoring. Intervention was defined as the need for vasoactive drugs, mechanical ventilation (invasive or noninvasive), or urgent hemodialysis in unstable patients.Monitoring was defined as the need for active monitoring with possibility of active intervention (e.g., high-risk surgical patients, acute coronary syndromes, postthrombolysis stroke patients).
  • Question 2 asked about patients’ comorbidities. Comorbidities were classified into four strata: (1) no comorbidities, (2) compensated comorbidities, (3) decompensated comorbidities (frequent hospital admissions in the last few months, unintended weight loss or loss of functionality), and (4) advanced disease with a probable life expectancy of months (metastatic cancer or locally invasive cancer, (advanced heart failure – i.e., American College of Cardiology/American Heart Association stage “D”) chronic obstructive pulmonary disease with hypoxemia and dyspnea at rest without relief with bronchodilators, National Kidney Foundation Kidney Disease Outcomes Quality Initiative chronic kidney disease stage 5 with contraindications to hemodialysis, Child-Pugh class C cirrhosis with contraindications to liver transplant, dementia with total loss of functionality and/or frailty syndrome and/or immobility syndrome, pressure ulcers, malnutrition, loss of sphincter control). These definitions were adapted from hospice indications published by the National Academy of Palliative Care.
  • Question 3 asked about patient’s previous functionality, as defined by activities of daily living (ADL) according to Katz and colleagues. Patients were classified as functionally independent, partially dependent, or severely dependent (capable of performing a maximum of two ADLs).
  • Question 4 asked about the requesting physician’s most probable intuitive prognosis. Patients were classified as probable survivors without severe disabilities, probable survivors with severe disabilities, or probable nonsurvivors.