Perioperative Anesthesia Reports
Perioperative Anesthesia Reports
Narrative Review

First proposed guideline for the allocation of surgical patients in an intensive care unit

Roseny dos Reis Rodrigues, Luiz Marcelo Sá Malbouisson, Vinicius Caldeira Quintão, Tatiana Goldgraber, Claudia Marquez Simões, Filomena Regina Barbosa Gomes Galas, Juliano Pinheiro de Almeida, João Manoel da Silva Júnior, José Otávio Costa Auler Júnior, Maria José Carvalho Carmona

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The increasing number and complexity of surgeries worldwide necessitate effective preventive measures and appropriate postoperative care to avoid complications and organ dysfunctions. However, the scarcity of intensive care unit (ICU) bed space in most hospitals poses challenges in allocating surgical patients to the ICU. This article proposes a protocol and algorithm for indicating ICU hospitalization of surgical patients based on international guidelines and a national survey with anesthesiologists. The protocol aims to improve resource utilization, ensure appropriate patient allocation, and reduce surgery cancellations or postponements. The proposed algorithm considers factors such as surgical complexity, patient’s physical status, and risk of acute organ dysfunction to determine ICU indication. The protocol provides guidance for both elective and urgent/emergency surgeries, emphasizing the need for individualized clinical judgment in exceptional cases. Implementing this protocol and developing a national guideline can optimize postoperative care, mitigate the impact of limited ICU bed space, and enhance patient outcomes. The proposed algorithm aims to rationalize ICU bed requests, reduce patient waiting times, and minimize financial costs associated with postoperative care.


Surgical patient; intensive care unit admission; intensive therapy allocation.


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