ICU分诊标准英文课件.ppt

ICU Admission and Triage Criteria Pat Melanson, MD McGill University Health Center Requests for ICU Beds excellent care abundant resources high nurse-patient ratios pharmacists,nutritionist, RT’s, etc high tech equipment signs of deterioration quickly identified “give them a chance” discomfort with death convenience Demand frequently exceeds supply The “Expensive” Care Unit Canada 8% of total inpatient cost 0.2 % of GNP $1500 per day USA 20 - 28 % of total inpatient cost 0.8 to 1 % of the GNP 1 ICU day = 3 to 6 times non-ICU day Higher costs in non-survivors ICU resources are finite ICU Admission Criteria A service for patients with potentially recoverable conditions who can benefit from more detailed observation and invasive treatment than can be safely provided in general wards or high dependency areas ICU Triage admission criteria remain poorly defined identification of patients who can benefit from ICU care is extremely difficult demand for ICU services exceeds supply rationing of ICU beds is common Prioritization Model Priority 1 critically ill, unstable require intensive treatment and monitoring that cannot be provided elsewhere ventilator support continuous vasoactive infusions mechanical circulatory support no limits placed on therapy high likelihood of benefit Prioritization Model Priority 2 Require intensive monitoring May potentially need immediate intervention No therapeutic limits Chronic co-morbid conditions with acute severe illness Prioritization Model Priority 3 Critically ill Reduced likelihood of recovery Severe underlying disease Severe acute illness Limits to therapies may be set no intubation, no CPR Metastatic malignancy complicated by infection, tamponade, or airway obstruction Prioritization Model Priority 4 Generally not appropriate for ICU May admit on individual basis if unusual circumstances Too well for ICU mild CHF, stable DKA, conscious drug overdose, peripheral vascular surgery Too sick for ICU (terminal, irreversible) irreversib