Background: Intensive care units (ICUs) are vital for managing life-threatening conditions. In many developing countries, critical care delivery is constrained by bed and equipment shortages, insufficient skilled personnel, and cost. Admission patterns have also changed with increase in prevalence of non-communicable diseases. Mortality rates in African ICUs remain high, about 30% in Nigeria and 60% in Kenya. Rivers State University Teaching Hospital (RSUTH) ICU faces staffing shortages and inconsistent application of admission criteria. Characterizing the local epidemiology of ICU admissions at RSUTH is essential to guide resource allocation, improve patient outcomes, and strengthen critical care delivery. Objective: To evaluate the pattern of ICU admission in RSUTH over a 31-month period. Methods: This retrospective cohort study reviewed all patients admitted to RSUTH’s 8-bed mixed medical-surgical ICU from June 2023 through January 2026. Following Ethical approval, data was extracted from the admission and discharge register and nurses’ records. Data obtained included patients biodata, diagnosis, interventions received and outcome. Data analysis was done using appropriate statistical methods. Results: 367 patients were admitted, with a mean age of 47.9 ± 19.8 years and a male preponderance (52.6%). Neurological conditions accounted for the highest indication for ICU admission (34.9%), while renal conditions were the least (1.9%). Forty two percent (42.5%) had invasive mechanical ventilation, while 41.1% had inotropic support. Duration of stay ranged from 1 hour to 32 days, with a mean of 6.5 ± 5.3 days. One hundred and eighty-one (49.3%) of the patients were transferred from the ICU to another ward of the hospital, while 159 (43.3%) died while in the ICU. Conclusion: This review shows that neurological conditions dominate ICU admissions at RSUTH, with a mortality of 43.3%, highlighting need for enhanced critical care resources to reduce mortality in this resource