The benefits and limitations of intensive care

Physiological derangement and the need for admission to ICU is not the same thing. It would not be in the best interests of all patients to be admitted to an ICU; instead optimising ward care or even palliative care may be required. Intensive care supports failing organ systems when there is potentially reversible disease. Intensive (level 3) care is appropriate for patients requiring advanced respiratory support alone or support of at least two failing organ systems. High dependency (level 2) care is appropriate for patients requiring detailed observation or intervention for a single failing organ system.

For the majority of people who have never worked in an ICU, the benefits and limitations of what is available may be poorly understood. Patients with acute reversible disease benefit most from intensive care if they are admitted sooner rather than later. Waiting for someone to become even more critically ill before contacting the ICU team is not evidence-based. On the other hand, some patients may be so ill they are unlikely to recover at all - even with intensive organ support. All potential admissions should therefore be assessed by an experienced doctor. Patients who are not admitted to the ICU can (and should) still receive good ward care.

The following chapters will describe the theory behind the assessment and management of acutely ill adults. They are intended as a foundation upon which experience and practical training can be built. Understanding and practising the basics well can prevent in-hospital deaths and admissions to ICU.

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