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Updated: Jul 31, 2026
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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
[Inadequate ICU-admissions : A 12-month prospective cohort study at a German University Hospital]
K Bangert1, J Borch2, S Ferahli2
1Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. kbangert@uke.de.
Medizinische Klinik, Intensivmedizin Und Notfallmedizin
|September 5, 2015
Summary
Annually, 1% of intensive care unit (ICU) admissions are inappropriate, often due to patient wishes or futile treatment. Improving information flow before ICU admission respects patient autonomy and optimizes resource allocation.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Medical Ethics
Background:
- Intensive care medicine (ICM) use is rising globally due to aging populations and medical advancements.
- Inappropriate intensive care unit (ICU) admissions challenge resource allocation and patient autonomy.
Purpose of the Study:
- To determine the incidence and characteristics of patients inappropriately admitted to the ICU.
- To analyze resource utilization in cases of inappropriate ICU admission.
Main Methods:
- Prospective study of ICU admissions over one year at a German university hospital.
- Inappropriate admission defined by Society of Critical Care Medicine (SCCM) criteria (futility or patient decline).
- Determined through interdisciplinary consensus discussions involving care givers and referring teams.
Main Results:
- 1% of 6452 ICU admissions were suspected inappropriate; consensus reached for 0.8% (50 patients).
- 82% of these patients had previously declined ICU treatment (via next of kin or advance directive).
- 18% of cases involved perceived futility of ICU treatment; lack of information was a key factor.
Conclusions:
- Patients are sometimes admitted to the ICU against their wishes or when treatment is futile.
- Optimizing pre-ICU admission communication regarding exclusion criteria enhances patient autonomy.
- Improved information flow supports more appropriate resource allocation in intensive care.
