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Step down from critical care

Follow the steps below:


AKI transfer policy - ITU to Ward 7B, GRH
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Phone Renal on-call to refer patient
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If patient accepted clear transfer with on-call intensivist

(this also serves as ITU step-down handover)

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Contact Renal on-call to arrange transfer to Ward 7B, GRH

Aim for transfer post ITU within 24 hours

Further discussion with intensivist not required if condition stable or improving


Consider these criteria for safe step-down from ICU to renal unit:



K < 6.0

pH normal

Bicarbonate > 16

Lactate normal



Respiratory rate < 24 / minute

Saturations > 94% on not more than 35% oxygen

If patient required acute CPAP must have been independent of this for 24 hours

Independent of respiratory support for 48 hours

No tracheostomy



HR < 120 / minute

BP > 100 mmHg systolic

MAP > 65 mmHg

Lactate < 4

If given inotropes must have been inotrope independent for > 24 hours



GCS > 12 for > 24 hours