Duration of Critical Care Therapy
Patients admitted to critical care should be reassessed at 48 hours and 120 hours (day 2 and day 5), with decisions regarding management beyond day 5 dependent upon resource availability. 1
Standard Reassessment Timeline
The typical framework for critical care duration involves structured reassessment intervals rather than a fixed duration:
Initial 48-hour assessment (Day 2): All patients receiving critical care undergo formal reassessment by the triage officer or support team at 48 hours to evaluate response to therapy and appropriateness of continued ICU-level care 1
120-hour assessment (Day 5): A second critical reassessment occurs at day 5, which has proven particularly useful in mechanically ventilated patients, including those with complex conditions like malignancy 1
Beyond Day 5: Management decisions after the first 5 days depend on resource availability and may include daily reassessment using the 120-hour criteria for either unlimited or limited time periods, institution of alternative criteria, or transition to palliative care 1
Duration Varies by Clinical Context
Critical illness duration is highly variable and depends on underlying pathophysiology and treatment response:
- Acute critical illness: Can last from hours to days 1
- Chronic critical illness: Associated with prolonged immobility and ICU stay, accounting for 5-10% of ICU admissions, and this proportion appears to be increasing 1
Key Clinical Considerations
The 5-day mark represents a critical decision point where the Central Triage Committee should provide direction regarding treatment continuation, particularly during mass casualty events or resource-limited scenarios 1
Continuous monitoring and frequent reevaluation are essential because the critical patient's condition changes rapidly, and complications may not become evident for 24-72 hours post-trauma or initial insult 2
Trend analysis matters more than single values - the trajectory of monitored parameters over time provides more clinically significant information than isolated measurements 2
Common Pitfalls
- Assuming stability: Never take a patient's stable condition for granted, as there is less tolerance for error or delay in critical patients 2
- Delayed complication recognition: Many post-trauma complications do not manifest until 24-72 hours after the initial event 2
- Premature discontinuation: Patients require intensive monitoring throughout their ICU stay, with rehabilitation needs extending beyond ICU discharge to address physical, cognitive, and psychological sequelae 1