Essentials of intensive care medicine
Triage, ICU admission & prognostication
Critical care resources are often limited, requiring systematic triage, well-defined ICU admission criteria, and accurate prognostication to ensure optimal patient care. Efficient allocation of ICU resources helps prioritize those most likely to benefit while maintaining ethical and evidence-based decision-making.
This section explores ICU admission, discharge, and triage strategies, focusing on guidelines that help clinicians determine which patients require intensive care. It also covers scoring systems, such as APACHE, SAPS, and SOFA, which assist in assessing disease severity, guiding treatment decisions, and predicting patient outcomes.
Additionally, prognostication plays a vital role in managing critically ill patients, helping clinicians anticipate outcomes and facilitate discussions with patients and families. Factors such as comorbid conditions and advanced care planning further shape the trajectory of care in the ICU.
The resources compiled here provide evidence-based frameworks for effective triage, ICU admission decision-making, and prognostication, supporting critical care professionals in delivering informed, ethical, and patient-centered care.
Admission, discharge, and triage
Admission, discharge, and triage
ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research
Joseph L. Nates et al., Critical Care Medicine (2016)
What’s inside
The Society of Critical Care Medicine's guidelines provide a framework for ICU admission, discharge, and triage, aimed at improving clinical operations, guiding institutional policies, and informing future research.
Why it’s relevant
Effective ICU admission and discharge criteria are essential for optimizing patient outcomes, resource allocation, and ensuring appropriate care for critically ill patients.
Key focus
- Admission criteria to determine which patients benefit from ICU care based on illness severity and prognosis.
- Discharge strategies for safely transitioning patients to lower levels of care.
- Triage processes to prioritize ICU admissions during periods of resource constraints.
- Emphasis on quality assurance and metrics for continuous improvement in ICU performance.
Takeaway
These guidelines support better patient care by establishing clear criteria for ICU admission and discharge, ensuring resources are used efficiently, and enhancing clinical operations.
Scoring systems
Scoring systems
Clinical review: Scoring systems in the critically ill
Jean-Louis Vincent et al., Critical Care (2010)
What’s inside
This review article examines commonly used scoring systems in intensive care units (ICUs) for predicting patient outcomes, assessing disease severity, organ dysfunction, and resource utilization.
Why it’s relevant
Scoring systems like APACHE, SAPS, and SOFA are essential tools in critical care for evaluating patient conditions, guiding treatment decisions, and facilitating comparisons across ICUs.
Key focus
- Overview of general illness severity scores used to predict outcomes in ICU patients.
- Discussion on the development and evolution of these scoring systems over time.
- Analysis of the performance and application of various scoring models in clinical practice.
Takeaway
Understanding and appropriately applying these scoring systems can enhance patient management in ICUs by providing structured assessments of illness severity and prognosis.
Prognostication
Prognostication
Prognostication during Critical Illness: Moving the Field Forward
Lauren E. Ferrante, Annals of the American Thoracic Society (2017)
What’s inside
This editorial discusses the challenges and advancements in prognostication during critical illness, emphasizing the need for accurate predictions to guide clinical decision-making and improve patient outcomes.
Why it’s relevant
Accurate prognostication in critically ill patients is essential for informing treatment decisions, setting realistic goals, and facilitating communication with patients and families.
Key focus
- Limitations of current prognostic models in critical care settings.
- The role of biomarkers and advanced imaging techniques in enhancing prognostic accuracy.
- Ethical considerations in communicating prognoses to patients and families.
- Recommendations for future research to improve prognostic tools in critical care.
Takeaway
Advancing prognostication methods during critical illness is crucial for personalized patient care, enabling clinicians to make informed decisions and effectively communicate with patients and their families.
Cormorbid conditions
The impact of cormorbid conditions on critical illness
Annette M. Esper et al., Critical Care Medicine (2011)
What’s inside
This review examines the impact of common comorbidities—such as diabetes mellitus, chronic obstructive pulmonary disease, cancer, end-stage renal and liver diseases, HIV infection, and obesity—on critically ill patients in the intensive care unit (ICU).
Why it’s relevant
Understanding how chronic conditions affect ICU patients is crucial for tailoring treatment strategies, anticipating complications, and improving patient outcomes.
Key focus
- Evaluation of how specific comorbidities influence ICU admission decisions, treatment options, and patient outcomes.
- Analysis of the predisposition to complications or organ dysfunction associated with these chronic conditions.
- Discussion on the variability of comorbidity impacts across different patient populations and over time.
Takeaway
Chronic comorbid conditions are prevalent among ICU patients and significantly influence prognosis and care delivery. Recognizing and addressing these comorbidities are essential for optimizing treatment and improving outcomes in critical care settings.
Very old patients
Very old patients in intensive care
ESICM consensus-based recommendations for the management of very old patients in intensive care
Michael Beil et al., Intensive Care Medicine (2025)
What’s inside
This article provides consensus-based recommendations from ESICM for the management of very old patients (≥80 years) in intensive care, focusing on ethical, clinical, and practical considerations.
Why it’s relevant
Very old patients in the ICU present unique challenges due to frailty, comorbidities, and ethical dilemmas, requiring tailored care to optimize outcomes.
Key focus
- Assessment of frailty and functional status
- Ethical considerations in decision-making and goal-setting
- Tailored treatment strategies for common ICU conditions
- End-of-life care and family involvement
Takeaway
The recommendations emphasize individualized care, integrating frailty assessment, ethical considerations, and family involvement to improve outcomes and quality of life for very old ICU patients.
Advanced care planning
Advanced care planning
ESMO Clinical Practice Guidelines on palliative care: advanced care planning
D. Schrijvers et al., Annals of Oncology (2014)
What’s inside
The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines on palliative care provide recommendations on advanced care planning (ACP) for patients with serious illnesses. ACP involves reflecting on and communicating one's values and preferences regarding future health and personal care, particularly when one may become unable to make decisions.
Why it’s relevant
Engaging in ACP ensures that patients receive care aligned with their values and wishes, enhancing patient autonomy and improving end-of-life care quality.
Key focus
- Definition and importance of ACP in palliative care.
- Steps for initiating and conducting ACP discussions with patients and families.
- Integration of ACP into routine clinical practice.
- Legal and ethical considerations in documenting and respecting patients' care preferences.
Takeaway
Implementing ACP as outlined in the ESMO guidelines facilitates patient-centered care, ensuring that treatment decisions respect the individual's values and preferences during serious illness.