Common ICU Protocols Every Medicine PG Must Know

January 23, 2026

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For a Medicine PG, the Intensive Care Unit is where theory meets real-time decision-making. From managing critically ill patients during night duties to facing rapid-fire questions during ICU rounds and exams, ICU protocols form the backbone of safe and standardised care. These intensive care unit protocols help PGs respond confidently to emergencies, reduce errors and ensure uniform treatment across patients, especially in high-pressure ICU settings.

What are the ICU Protocols?

ICU protocols are standardised, evidence-based guidelines designed to manage common and life-threatening conditions in the ICU.

Definition

Predefined step-by-step approaches for diagnosis, monitoring, and treatment
Applied to common ICU scenarios like sepsis, ventilation, sedation, and shock

Importance in ICU Decision-Making

Helps PGs act quickly during emergencies
Reduces variability in clinical decisions
Improves patient outcomes and safety

Standardisation of Patient Care

Ensures uniform care irrespective of the doctor or shift
Facilitates better communication among ICU teams

Intensive Care Unit Protocols Followed in Hospitals

Why Hospitals Use Standard ICU Protocols

To maintain quality and patient safety
To comply with accreditation and medico-legal standards
To train residents and nursing staff uniformly

Common Areas Covered Under Hospital ICU Protocols

Sepsis and shock management
Mechanical ventilation
Sedation, analgesia, and delirium
Thromboprophylaxis and stress ulcer prevention
Infection control and antibiotic stewardship

Common ICU Protocols Every Medicine PG Must Know

Sepsis Management Protocol

Early recognition using qSOFA/SOFA
Blood cultures before antibiotics
Broad-spectrum antibiotics within 1 hour
Fluid resuscitation (30 ml/kg crystalloids)
Vasopressors if MAP <65 mmHg

Mechanical Ventilation Protocol

Lung-protective ventilation (low tidal volume)
Target SpO₂ and ABG monitoring
Prevention of VAP (head-end elevation, oral care)

Sedation & Analgesia Protocol

Analgesia-first approach
Sedation targets using RASS
Daily sedation interruption

DVT Prophylaxis Protocol

Pharmacological (LMWH/UFH)
Mechanical methods if contraindicated

Stress Ulcer Prophylaxis Protocol

PPIs or H2 blockers in high-risk patients
Avoid unnecessary prophylaxis

ICU Nursing Protocols (Important for Team Coordination)

Effective ICU care is incomplete without strong coordination with nursing staff.

Monitoring vitals: Hourly BP, HR, SpO₂, GCS
Drug administration: Correct dose, infusion rates, pump usage
Infection control: Hand hygiene, line care, catheter protocols
Intake–output charting: Accurate fluid balance and urine output

Weaning Protocol in ICU

When to Start Weaning

Hemodynamic stability
Adequate oxygenation
Improvement in the primary disease

Spontaneous Breathing Trial (SBT)

T-piece or low-pressure support
Observe for tachypnea, desaturation, and distress

Common Mistakes PGs Make During Weaning

Premature extubation
Ignoring fatigue signs
Inadequate secretion clearance

Vasopressin ICU Protocol

Indications for Vasopressin in ICU

Septic shock refractory to norepinephrine
Catecholamine-sparing agent

Dosage & Administration

Fixed dose: 0.03 units/min
Not titrated like other vasopressors

Monitoring & Adverse Effects

Ischemia (gut, skin, digits)
Hyponatremia
Reduced cardiac output

ICU Protocols vs Individual Clinical Judgment

Protocols guide care, not replace thinking
Individualization needed based on patient response
Senior input is crucial in complex cases

Why Medicine PGs Must Master ICU Protocols

Improves confidence during night duties
Essential for ICU postings and exams
Enhances teamwork with nurses and seniors
Builds a strong foundation for critical care

For structured learning and deeper understanding, Medicine PGs can explore a critical care course online and strengthen their ICU basic knowledge through expert-led resources.