ICU ADMISSION ORDERS

ICU ADMISSION ORDERS :  EXAMPLE FOR A PATIENT WITH UROSEPSIS AND ARDS
MANAGEMENT STRATEGY ORDERS REEVALUATE
ACUTE PHASE : 

 1- Mechanical ventilation ;  Target TV 5-7

mL/kg of ideal body weight, PC 16 cm, rate 12,

FIO2 0.7, PEEP 18 cm, plateau pressure <30

cm PRN

 2- Maintenance fluid ;  Ringer’s lactate 75

mL/hr IV PRN

3-  Norepinephrine  ; Titrate to mean arterial pressure >65 mm Hg PRN

4-  Corticosteroids ;  Hydrocortisone 50 mg IV q6h while vasopressor dependent Daily

5- Sedation ;  Midazolam 2-8 mg/hr IV, bolus 2-4 mg PRN PRN

6-Analgesia ;  Morphine 1-4 mg IV PRN PRN

7- Antibiotics ;  Ampicillin 2 g IV q6h Daily

8- Head of bed  ; 45-degree elevation from horizontal PRN

9- Oral antisepsis ;   Chlorhexidine 15 mL q6h Daily

10- Small bowel enteral nutrition ;  10 mL/hr of a commercial balanced feed containing about 1

kcal/mL; increase by 10 mL q6h to 70 mL/hr Daily

11- Stress ulcer prophylaxis  ; Ranitidine 50 mg IV q8h Daily

12- Thromboprophylaxis  ; Unfractionated heparin 5000 U SC q12h Daily

13- Intensive insulin therapy ;  if glucose >180 mg/dL

50 U insulin in 50 mL NS; start at 0.5 U/hr, repeat glucose q1h for 4 hr, and reassess; target 110-150

 mg/dL Daily

14- Glucometer calibration  ; Calibrate glucose from glucometer and central laboratory every

morning Daily

15-  Tests Glucose ;  q4h when stable, ABG with each ventilator change, other tests as per ICU

team (PRN)

16- Monitoring ;  Arterial catheter for systolic blood pressure, central venous catheter for central

venous pressure and mixed venous oxygen saturation, ECG, oximetry, ABGs, sedation scale, Foley

catheter, others as per ICU monitoring protocols( PRN )


RECOVERY PHASE
1- Sedation vacation Daily interruption of sedation from 0700 h until 0900 h; restart at half prior infusion at 0900 h as tolerated Daily
2- Spontaneous breathing trials Spontaneous breathing trial when weaning readiness criteria met Daily
3-  Early mobility Physiotherapy and occupational therapy when able Daily

ABG = arterial blood gas; ARDS = acute respiratory distress syndrome; ECG = electrocardiogram; FIO2 = fraction of inspired oxygen; ICU = intensive care unit; IV = intravenous; NS = normal saline;
PC = pressure control; PEEP = positive end-expiratory pressure; PRN = as needed; SC = subcutaneous; TV = tidal volume.