This document has been reviewed by our critical care physician group.
This is not about the pandemic. These principles apply now under the Healthcare Consent Act.
Can a doctor not offer a therapy?
Yes. Therapies are only on offer if there is believed benefit.
Therapy is likely to benefit the patient – Offer and recommend the therapy.
Therapy less likely to benefit the patient – Offer but do not recommend.
Therapy is not likely to benefit the patient – Do not offer the therapy.
If you are unsure whether the patient will benefit, error on the side of consulting with an intensivist who can inform the patient and family and treating team about the expected course and potential benefit of therapy. The document below may help clarify exploring goals of care discussions.
Contraindications to Invasive Ventilation (advanced critical care)
These patients will not benefit from invasive ventilation.
- Severe progressive cognitive impairment
- Pulmonary fibrosis on home oxygen
- Diffusely metastatic malignant disease
- Frailty score above 6*
*See Dalhousie Clinical Frailty Scale below
Potential Contraindications for Critical Care Admission
Suggest critical care consultation prior to initiation of invasive support
- All patients in Category 1
- Frailty score of 5 or 6
- Moderate and progressive cognitive impairment
- Severe pulmonary hypertension
- Pre-existing severe end-organ failure
- Intermittent hemodialysis or peritoneal dialysis
- COPD on home oxygen
- Cardiomyopathy with Grade IV left ventricular function
- Liver failure
- Symptomatic pulmonary fibrosis, not on home oxygen