Can this patient be safely discharged from the ICU?

Abstract

It is 3:00 a.m. on Saturday morning, and there are no empty beds in your ICU. The trauma team has requested a bed for an unstable abdominal gunshot wound victim. Only two current patients are not receiving mechanical ventilation or vasopressors: one is a 63-year-old diabetic, dialysis patient who was admitted 3 days ago for heart failure. After overnight mechanical ventilation and emergency dialysis, she is now extubated and on a highflow oxygen mask. The other is a 75-year-old man who underwent elective coronary bypass surgery on Friday morning and is doing well 12 h after ventilator liberation. Beds are available on wards and a step-down unit. Which patient is at higher risk for readmission or adverse events if discharged to make room for the trauma patient? Intensivists are routinely presented with discharge decisions similar to the one above. In this article we focus on two major concerns when making ICU discharge decisions: the possibility of ICU readmission, and death on a ward or intermediate care unit.