Permissive strategies in intensive care units (ICUs): actual trends?

Abstract

Permissive strategies in the intensive care unit (PSICU) intentionally allow certain physiological parameters to deviate from traditionally strict control limits to mitigate the risks associated with overly aggressive interventions. These strategies have emerged in response to evidence that rigid adherence to normal physiological ranges may cause harm to critically ill patients, leading to iatrogenic complications or exacerbation of underlying conditions. This review discusses several permissive strategies, including those related to hypotension, hypercapnia, hypoxemia, and lower urinary output thresholds. The key principles of these strategies require careful balancing and close monitoring to ensure that the benefits outweigh the risks for each patient. This approach emphasizes individualized care, thoughtful decision-making, and flexible application of guidelines. The use of a PSICU may help minimize the side effects of treatment while addressing the primary condition of the patient and allowing for a more holistic view of critically ill patients.