Thursday, November 7, 2024

Pediatric Intensive Care Units: A critical aspect of healthcare  

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This can be a cause of too much anxiety and stress amongst parents and other family members who may find themselves in need of such services unexpectedly.
Pediatric Intensive Care Unit (PICUs) are specifically designed to provide high-level medical care to children from infancy to adolescence who are critically ill, some even with life-threatening medical conditions.
Understanding PICU
A Pediatric Intensive Care Unit is significantly more specialised than a typical hospital ward. It is equipped with cutting-edge medical technology and staffed by specialised healthcare professionals trained to handle severe and acute conditions in children.
A PICU is equipped with complex medical equipment, including mechanical ventilators, advanced monitoring devices (cardiac monitors etc) and specialised equipment to support failing kidney or liver functions.
These units are intended to address a variety of serious health issues in. children, such as severe respiratory distress, serious neurological disorders, heart ailments and other organ injuries like the involvement of the liver or kidneys. PICUs are geared to manage children needing complex surgeries or those with severe infections(Dengue, Malaria, Brain fever, pneumonia, etc), children with trauma (road traffic accidents, children with burns, drowning, those with falls from heights, poisoning, etc).
Not all PICUs can manage all types of emergencies and complexities in child healthcare. Depending upon the expertise and the availability of trained and skilled manpower, PICUs are stratified into Level-1 to Level-4 units, with Level-4 units having competencies of the highest order.
Some PICUs are highly specialised to take care of specific categories of clinical conditions, e.g. children after liver transplant or kidney transplant surgeries, or children who are operated on for heart conditions, etc.
Pediatric intensivists are physicians working in the PICUs with advanced training in critical care for children. These specialists understand how children’s physiological needs differ from those of adults in critical care situations.  The PICU team also includes a highly skilled and specialised team of nurses, which are the most critical part of any good PICU.
Apart from physicians and nurses, a good PICU team comprises respiratory therapists, clinical pharmacists, nutritionists, and social workers, all of whom play critical roles in each patient’s care.
The Role of Pediatric Intensivists
Pediatric intensivists are essential to the operation of a PICU. They oversee the child’s care plan and participate in all aspects of their treatment. These professionals are trained to make quick decisions about life-saving interventions and manage complex technologies like mechanical ventilators, intravenous lines, and monitoring systems, frequently required for their pediatric patients.
Support from Paediatric Sub-Specialties:
A level-3 or Level-4 PICU can not be complete without round-the-clock support from important paediatric subspecialists like a paediatric neurologist, pulmonologist, haematologist, nephrologist, gastroenterologist, endocrinologist, surgeons (paediatric surgeons, plastic surgeons, orthopaedic surgeons, fascio-maxillary surgeon, neuro surgeon etc).
The PICU team also needs support from microbiology, pathology and radiology departments and, if possible, a reliable blood bank.
Financial aspects of care
The cost of PICU care can be a major concern.
Insurance coverage can prove very useful in facing the rising cost of care in PICUs. Various government schemes and contributions from various charitable organisations also help families in meeting the cost of care.
Counselling of families and
family-centric care:
Modern PICU teams are increasingly focusing on families’ involvement in caring for their children in PICUs. In any good PICU, the treating team of physicians is involved closely with the family members in daily counselling and discussion regarding not only the treatment and cost of care of their child but also how the overall progress is taking place and how they plan to work together for early liberation of their child from PICU.
Awareness and Education
The general public is unaware of when and why a child may need to be admitted to a pediatric intensive care unit.
Parents frequently fail to recognise the severity of a condition until it is far advanced, delaying potentially life-saving medical care.
Educating the public on the warning signs of severe illness and the availability of PICU services is critical. This includes recognising the signs of serious conditions such as meningitis (brain fever), septic shock (blood infection with a fall in blood pressure), or severe allergic reactions that necessitate immediate medical attention.
Preventive measures
Preventive healthcare is also important in lowering the need for PICU services. This includes ensuring that children have received all necessary vaccinations, which can help them avoid serious illnesses.
Improving hygiene and cleanliness also can prevent many diseases.
Furthermore, promoting safe practices at home and on the road can reduce the number of injuries and accidents that may necessitate emergency care.
Conclusion
To summarise, while PICUs in India play an important role in pediatric healthcare, there is a significant need for increased public awareness and education about these facilities.
Parents and caregivers should be educated on the symptoms of critical illnesses, the operation of a PICU, and preventive measures that can help keep children healthy.
Understanding these aspects can help improve the timely and effective use of PICU resources, resulting in better health outcomes for children.

(The author, Dr. Farhan AR Shaikh, is the Head of the Department of Paediatric Intensive Care Unit, at Rainbow Children’s Hospital, in Banjara Hills.)

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