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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 24
| Issue : 3 | Page : 168-169 |
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Challenges in establishing a pediatric intensive care unit: Experiences from a tertiary care center
Ashish Kumar Simalti1, Shuvendu Roy2, Jyotindra Narayan Goswami1
1 Department of Pediatrics, Army Hospital (Research and Referral), New Delhi, India
2 Command Hospital, Kolkata, West Bengal, India
| Date of Submission | 29-Jun-2021 |
| Date of Acceptance | 23-Jul-2021 |
| Date of Web Publication | 01-Apr-2022 |
Correspondence Address:
(Dr) Ashish Kumar Simalti
Army Hospital (Research and Referral), New Delhi - 110 010
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_98_21
How to cite this article:
Simalti AK, Roy S, Goswami JN. Challenges in establishing a pediatric intensive care unit: Experiences from a tertiary care center. J Mar Med Soc 2022;24, Suppl S1:168-9 |
Existing vulnerabilities of pediatric intensive care services in resource-constrained settings are being increasingly recognized in the backdrop of predictions about ensuing the waves of COVID-19 predominantly targeting children.[1] Pediatric intensive care unit (PICU) is essential for the delivery of quality care in pediatrics.[2] The experience of establishing PICU in a service hospital is being reported in this background.
The Indian Academy of Pediatrics (IAPs) consensus guidelines for establishing PICU (2014) were followed for establishing the PICU.[3],[4] PICU should ideally be separate from the neonatal and adult intensive care units (ICUs) and should be located near lift with easy access to emergency department, operation theater, laboratory, and radiology department. The design needs to factor adaptability and expansion. A 10-bedded PICU was planned with approximately 200 square feet space per bed with easy access to wash basin facility. One 250 square feet cubicle was planned with walls for isolation capability. Adequate space was earmarked around beds to ensure access for procedures and equipment. It was ensured that all the walls, floor and ceilings were amenable to cleaning and devoid of unnecessary edges or texture paintings that may collect dust. An elevated Central Nursing Station with all-round bed visibility, central monitor, computer, and patient-record storage cabinet was created. Other zones which were designed at this stage included equipment storage bay, clean and dirty utility rooms, area for preparation of medicines, waste disposal facility, and a separate counseling room.
PICU beds with facility to move head-end and foot-end, removable head panel, and adjustable railings and wheels were procured. It was ensured that the beds could pass through the PICU doorways and elevators. Ten electrical outlets, oxygen, air, and suction outlet were provided per bed. Adjustable, wash-proof synthetic curtains on a sliding frame were fitted around each bed. Equipment purchased before making PICU functional included two crash carts with standard emergency drugs, two portable defibrillators, central monitor with multiparameter monitors for each bed, six ventilators, six high flow nasal cannulas, ten infusion stands with 10 infusion pumps per bed, and cardiac tables. Remaining necessary equipment such as portable ultrasound and point of care ABG machine were procured later with provision to utilize adult ICU facilities in the interim period.
One of the challenges faced while operationalizing the PICU was regulating admissions for which criteria for admission to PICU were developed [Table 1]. Another challenge was continuity of staff which was circumvented by developing a pool of nurses with hands-on training. Suboptimal nurse patient ratio was another challenge which persists due to issues in recruiting extra workforce. For workforce training in house training program was initiated for six freshly passed out nurses who were trained for 6 months by pediatric intensivist and senior pediatric matrons through lectures, simulation on mannequin, demonstration and supervised training.
Lack of transport medicine is another challenge in pediatric critical care delivery in India.[5] Establishing protocols and ensuring that they are followed remains an ongoing process. Critical care is a dynamic field with new equipment and changing protocols. Maintenance of equipment also needs regular vigilance.
The authors wish to sensitize the readers about the challenges in setting up a PICU in resource-constrained settings. There are challenges related to resource allocation because unlike neonatal and adult ICUs, PICU is yet to be a norm in government health-care institutes. Modification of existing protocols to suit the unique strengths and weaknesses of the system is another challenge. Long-term planning aided by the optimum management of human resources, time, and finances aided in establishing our PICU. It is noteworthy to state that the aforementioned PICU got accredited as a Level III PICU by the IAP Intensive Care Chapter College of Pediatric Critical Care in September 2019.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: A systematic review and meta-analysis. Arch Dis Child 2021;106:440-8.  |
| 2. | |
| 3. | Khilnani P, Indian Society of Critical Care Medicine (Pediatric Section), Indian Academy of Pediatrics (Intensive care Chapter). Consensus guidelines for pediatric intensive care units in India. Indian Pediatr 2002;39:43-50. |
| 4. | Khilnani P, Ramachandran B, Shaikh F, Sharma R, Sachdev A, Deopujari S, et al. Consensus guidelines for pediatric intensive care units in India, 2020. Indian Pediatr 2020;57:1049-54. |
| 5. | Turner EL, Nielsen KR, Jamal SM, von Saint André-von Arnim A, Musa NL. A review of pediatric critical care in resource-limited settings: A look at past, present, and future directions. Front Pediatr 2016;4:5. |
[Table 1]
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