Table 1.

Specific exclusion criteria.

Category	Specific exclusions	Comments
Futile care	A child who has been declared brain dead	The permanent vegetative state was not addressed in the admission criteria as this was more likely to be encountered as a problem following stay in the PICU
	A child who has had a cardiac arrest and has not reestablished a normal respiratory pattern, or who has fixed dilated pupils	<5% of children in this category survive the PICU admission with an acceptable neurological outcome
	The child who has suffered a head injury such that there is no chance of recovery from that injury
Children with underlying lethal conditions	Children with burns >60% body surface area, where the surgical team are not able to guarantee that debridement and appropriate cover will happen within 24–48 h of admission	Based on data that if children are not debrided and grafted early on in the course of their burn management, they suffer a prolonged course with considerable pain, anxiety, and recurrent infection. The death rate in these children is also unacceptably high
	Children with chronic renal failure where there is no commitment to long-term dialysis
	Children with severe and lethal chromosomal abnormalities (e.g., Edward syndrome or thanatophoric dwarfism)
	Children with malignancies that are not responding to therapy
	Children with inoperable cardiac lesions
Children with currently poor outcomes	Children with established HIV infection. “Children with established HIV infection whose lives are in danger from AIDS-related diseases will not normally be considered for admission. A child who is successfully established on ARV, and where the reason for admission does not relate to the underlying disease and/or its therapy will be considered for admission.”	Based on data that despite the availability of ARV, only approximately 20% of children with HIV infection who were admitted to the PICU were known to be alive and on ARV 6 months later. These data have not changed since the availability of antiretroviral therapy
	Children with kwashiorkor	Based on a virtual 100% mortality in the ICU for these patients
	Children who have been in hospital wards for >5 days and are deteriorating despite appropriate therapy	Based on an extremely high mortality rate in this group of patients. The failure to respond to therapy suggests that they have underlying conditions that are not amenable to conventional therapy
	Children with severe adenoviral pneumonia who have not responded to appropriate therapy in the wards	Based on data showing that children with severe adenoviral infection requiring ventilation have a high mortality and very high morbidity from chronic lung disease
	Children with diagnosed severe metabolic disorders (e.g., maple syrup urine disease) for which established treatment programs in the hospital and community are not established	Based on the fact that these children have a very poor likelihood of reasonable outcome
	Children with acute hepatic failure, unless there is a reasonable likelihood that an acute transplant will be offered within the first 24–48 h of PICU admission
	Children with complications of meningitis requiring ventilation (i.e., the requirement for ventilation is related to CNS disease rather than pneumonia)
	Children with cardiomyopathy unresponsive to therapy, and where transplantation is not being considered	This does not apply to the time of acute, first presentation. It is very difficult to prognosticate at that stage. This comment applies to children who have previously been treated, and where there has been time to make an appropriate assessment of likely prognosis.

Copied with permission from Argent et al. (75).

ARV, antiretroviral drugs.