Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital (original) (raw)
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Nepal Pediatric Society Guidelines for the Safe Transport of Critically Ill Children in Nepal
Journal of Nepal Paediatric Society
Transport of critically ill children is associated with increased risk of morbidity and mortality in developing countries due to the lack of adequate resources and skilled personnel. Transport of the sick child remains a major challenge in Nepal as well. The main objective of this article is to describe the importance of safe transport, and be a resource and guide for health care personnel during inter-facility transport of sick children in Nepal. This guideline is based on consensus statement of Nepal Pediatric Critical Care Working Group (NPCCWG) under the aegis of the Nepal Pediatric Society (NEPAS). It includes different components of transport, namely essential equipment, patient preparation, communications, medications, and transport checklist, that are required during transport of sick children, taking into consideration the current resources available in our health care facilities.
Transport of critically ill children: how to utilize resources in the developing world
Indian journal of pediatrics, 2008
Safe transport of critically ill children remains a globally important issue, particularly in the developing countries such as India and Africa where the high risk mortality and morbidity exists during the transport process that may be less than optimal due to personnel and resource limitation. This article is intended to familiarize the reader with essential components of a good ground pediatric critical care transport program with special reference to developing countries. Essential equipment, medications, training requirement and responsibilities of transport team have been discussed in detail. In addition, recommendations from American (American academy of pediatrics-Transport section) and British pediatric critical care transport systems have been included, keeping in mind the practical feasibility in the Indian scenario where resources are limited.
Outcome of children transported for pediatric intensive care to a tertiary care setting in Sri Lanka
Sri Lanka Journal of Child Health, 2016
Introduction: Patient transport remains a necessary facet of today's health care environment and transport conditions bear a major impact on the outcome. There is a recent move in Sri Lanka to establish retrieval teams. Thus, identifying problems faced by the present system will be of utmost importance in development of transport teams. Objective: To evaluate the present system of transportation of sick children to the Medical Intensive Care Unit (MICU), Lady Ridgeway Hospital for Children (LRH), Colombo. Method: A prospective, descriptive, observational study of transferred patients was conducted at the MICU LRH, Colombo. All children admitted to MICU from 1 st March 2014 to 1 st June 2014 were included in the study. Data was collected using a selfadministered questionnaire. The Wilcoxon significant rank test and the Chi squared test were utilized in statistical analysis. Results: There were 200 patients comprising 105 (52.5%) out-of-hospital transfers and 95 (47.5%) inhospital transfers. Of the admissions, 72% were live discharges while 28% expired; 42.5% of transfers were from the Colombo district. Pneumonia was the ___________________________________________
Journal of Nepal …, 2011
Introduction: Although preventive medicine and primary care are priorities in developing countries, they must be supported by appropriate care of sick and extremely sick children in the medical facilities. Lack of resources and absence of skilled physicians and nurses may lead to poor outcomes in critically ill patients. Intensive care of newborns and children is thought to be very expensive with a low cost-benefit ratio. This presentation discusses the critical factors that facilitated the establishment of PICU and NICU in an urban public hospital in Nepal, where a good standard of Level 2 care was already provided. Aims and objectives: A cooperative model of creation and transfer of technology from the West to a resource-poor country was envisaged. PICU and NICU with six beds each were established. Design and setting: The Nick Simons Foundation, USA provided financial support for design, building and furnishing of a new Mother and Child Wing at Patan Hospital. A generous grant of $300,000 again by the Nick Simons Foundation helped equip the units. Donated equipments also included procedures, medication and storage carts. Methodology: A total of 22 volunteers, 21 from USA and one from Netherlands, were recruited to complete the three months of training. An extensive curriculum was prepared. The trainer team had monthly teleconferences and regular communications with the Chief of Paediatric Services and Nursing Director of Patan Hospital via e-mails and telephone. Responsibilities of volunteers and the host hospital were identified. Results: After 3 years of preparation, the project started in June 2009. All day lectures on topics in critical care, mock case scenarios, practical equipment training and simulated procedures led to the graduation of 60 nurses. Twenty five physicians were trained for three months. The expert team worked with the locals in preparing the units, arranging furniture and equipment, stocking carts, making inventory and preparing protocols. A protocol handbook was developed on topics such as mechanical ventilation, sedation, admission/discharge criteria, procedures and management of different disease states. Various charts such as nurse observation charts, notes by residents, procedure hand offs at change of shifts were designed and printed. Infection control practices and methods of sterilizing non disposable articles were identified and protocols written. At the end of three months the units were functioning with trained local manpower and reasonable modern equipment. Conclusion: Developing nations may not have enough resources to establish much needed critical care facilities. Developed countries can help by funding basic infrastructure and providing expertise in order to transfer knowledge and technology. Involvement in planning from the beginning and training at the host site is a preferred model of transfer of technology.
Birat Journal of Health Sciences, 2023
Introduc on Paediatric Intensive Care Unit (PICU) is a rela vely new concept with rapidly growing paediatric subspecialty in resource limited-countries. Introduced in Nepal in the 1980s, the first PICU was established in 1986 in Kan Children's Hospital, Kathmandu with 4 beds. Later in BPKIHS in Eastern Nepal. Currently only a few dedicated PICU running in Nepal. Our PICU was started in 2021 with 8 beds in the private sector for the management of cri cally ill children. Objec ves To study the admission pa ern and outcome of the children at our paediatric intensive care unit. Methodology This was a Cross Sec onal Descrip ve study conducted at PICU of Birat Medical College Teaching hospital in Eastern Nepal. From August 2021 to July 2022, records of all possible admissions in PICU were reviewed. Demographic profile, diagnosis, outcome and dura on of stay were analysed. Result Out of 260 analysed data, there were 156 (60%) males and 104 (40%) females. Age wise distribu on was 101 (38.85%), 82 (31.5%), 38 (14.6%) and 39 (15%) for 1 months-1 year, 1-5 year, 5-10 year and 10-15 year respec vely. Disease wise distribu on was 129 (49%) respiratory, 49 (18.8%) neurological and 26 (10%) gastrointes nal, mostly infec ve causes like Pneumonia (78, 30%), Bronchioli s (34, 13.1%), febrile convulsion (29, 11.2%) meningi s/encephali s (19, 7.3%), Sepsis (12, 4.6%), dengue (6, 2.3%) other infec ons (19,6.3 %). In outcome, discharged (231,88.85%), DOPR (5,1.92%), LAMA (4,1.54%), Death (16,6.2%) and Referral (4,1.54%). Mortality was high (11, 38.6%) in under five years. Sepsis (4, 33.3%), Meningi s / encephali s (3, 15.8%) and pneumonia (4, 5.1%) were the common causes. Mean dura on of PICU stay was 2.73 days (median=2). Overall mortality rate was 6.2% (16). Sepsis, LOS and need of mechanical Ven la on were significant predictors of mortality. Conclusion Respiratory illnesses including infec ons were common causes of admission with low mortality (6.2%). Sepsis, Meningoencephali s and pneumonia were common causes of death in our PICU. Sepsis, LOS and need of mechanical Ven la on were significant predictors of mortality.
Background and Objectives: Prehospital transport practices prevalent among children presenting to the emergency are under-reported. Our objectives were to evaluate the prehospital transport practices prevalent among children presenting to the pediatric emergency and their subsequent clinical course and outcome. Methods: In this prospective observational study we enrolled all children ≤17 years of age presenting to the pediatric emergency (from January to June 2013) and recorded their demographic data and variables pertaining to prehospital transport practices. Data was entered into Microsoft Excel and analyzed using Stata 11 (StataCorp, College Station, TX, USA). Results: A total of 319 patients presented to the emergency during the study period. Acute gastroenteritis, respiratory tract infection and fever were the most common reasons for presentation to the emergency. Seventy-three (23%) children required admission. Most commonly used public transport was auto-rickshaw (138, 43.5%) and median time taken to reach hospital was 22 min (interquartile range: 5, 720). Twenty-six patients were referred from another health facility. Of these, 25 were transported in ambulance unaccompanied. About 8% (25) of parents reported having diffi culties in transporting their child to the hospital and 57% (181) of parents felt fellow passengers and drivers were unhelpful. On post-hoc analysis, only time taken to reach the hospital (30 vs. 20 min; relative risk [95% confi dence interval]: 1.02 [1.007, 1.03], P = 0.003) and the illness nature were signifi cant (45% vs. 2.6%; 0.58 [0.50, 0.67], P ≤ 0.0001) on multivariate analysis. Conclusions: In relation to prehospital transport among pediatric patients we observed that one-quarter of children presenting to the emergency required admission, the auto-rickshaw was the commonest mode of transport and that there is a lack of prior communication before referring patients for further management.
The key to understanding the present practice of intensive care for children lies with its history. "The past matters more than we realize…we walk on its ground, and if we don't know the soil we are lost". Modern pediatric critical care has its root in the development of adult intensive care and neonatal intensive care. 1 Intensive care has ABSTRACT Background: The care of the critically ill children remains one of the most demanding and challenging aspects in the field of paediatrics. The main purpose of Paediatric Intensive care unit is to prevent mortality by intensively monitoring and treating critically ill children who are considered at high risk of mortality. In the developing countries, there is a scarce data on paediatric critical care. Evaluation of the outcome of medical interventions can assess the efficacy of treatment. This helps in better decision making, improving the quality of care and modifying the future of management if required. This study will also help to study the causes of morbidity and mortality among paediatric age group in our hospital. Aims and Objectives of the study is to evaluate the morbidity pattern and outcome of admissions in the PICU of a rural teaching hospital, and to take measures to prevent morbidity and mortality by improving critical care facilities. Methods: This was a retrospective study, the cases admitted in paediatric ICU in our teaching hospital in last two and a half considering the estimated sample size. Data will be collected from PICU and Medical record Department. Details will be studied with the help of medical record and will be analysed and interpreted according to the medical record details. Results: During a period of 30 months of the study, total of 417 patients were admitted in our PICU. Of the total cases studied, Maximum i.e. 180(43.2%) had age below 1 year. The minimummaximum range of age was between 1 day to 18 years. About 228(54.7%) cases were males and 189(45.3%) were females. The most common diagnosis was LRTI which was observed in 61(14.7%) of cases. The most common system involved was respiratory system which was observed in 101(21.8%) cases. Of total cases studied, 357(85.6%) were discharged, 36(8.6%) had DAMA (discharge against medical advice) and 24(5.8%) expired. Conclusions: Mortality was low in our PICU. We conclude based on the present study that in our rural set up PICU, with better treatment protocols, skilled expertise/ Paediatric Intensivist we have chances to facilitate the care of critically ill patients giving desirable outcome.
Experiences and Challenges Faced During Transportation of Critically Ill Patients
https://www.ijhsr.org/IJHSR\_Vol.11\_Issue.7\_July2021/IJHSR-Abstract.018.html, 2021
Objective: This study is aimed to assess the incidence of major events during transportation of critically ill patients. Methods: A prospective observational study was conducted in 200 patients during inter hospital transportation from January 2017 to December 2017 at Amrita Institute of Medical Sciences (AIMS), Kochi after fulfilling both inclusion and exclusion criteria. The main objective is to assess the incidence of major events during transportation of critically ill patients. The variables recorded in this study includes age, gender, co-morbidities, airway, breathing, circulation-related events during inter hospital transportation and duration of transportation. Inclusion criteria include critically ill patients in the age group of 18-100 years and exclusion criteria include pregnant patients. Results: On assessing the data of all 200 critically ill patients who had undergone inter hospital transport about 38.5% patients had major events compromising the circulation .In this study Hypertension (27.5%) is the more common baseline disease that deteriorated while transportation.38.5% of study population had major events compromising the circulation ,12.5% had major events in breathing and 35.5% patients had no major events in their airway, breathing and circulation during transportation. Conclusion: During the transportation of critically ill patients under the monitoring of trained medical personnel 38.5% of major events occurred in the circulation part. Respiratory issues were presented in 27% patients (54), of which 30 had desaturation and remaining had tachypnea, which was managed by NIV or Invasive ventilation. 5% of patients had airway compromise, managed by appropriate basic or advanced airway maneuvers. Hence pre transport checklist and continuous monitoring by an experienced medical personnel is necessary for the prevention of adverse events during transportation.
Admission pattern and outcome in a pediatric intensive care unit of Gondar University hospital
Ethiopian Medical Journal, 2019
Background: -Knowledge of the characteristics and outcomes of critically ill children admitted to PICU in low income countries may help with the identification of priorities and the resources required for improvement of the care of critically ill patients. Aim : The objective of this study is to describe the pattern of admission and outcome of patients admitted to the pediatric intensive care unit (PICU) in Gondar University Hospital. Methods: - A retrospective study of all children (beyond 30 days of age and <14yrs of age) admitted to the pediatric ICU of Gondar University hospitalwas made for a period of 3 years from August 2013 to July 2016. Data was retrieved from all available patient Charts and health management information system (HMIS) documentation log of PICU in the study period. Results : Total of 330 (80%) patient case note was available for review out of which 197(59.7%) were male and the rest 133(40.3%) were female giving the male: female ratio was 1.5:1. The media...
Indian Journal of Critical Care Medicine, 2015
Background and Objectives: Prehospital transport practices prevalent among children presenting to the emergency are under-reported. Our objectives were to evaluate the prehospital transport practices prevalent among children presenting to the pediatric emergency and their subsequent clinical course and outcome. Methods: In this prospective observational study we enrolled all children ≤17 years of age presenting to the pediatric emergency (from January to June 2013) and recorded their demographic data and variables pertaining to prehospital transport practices. Data was entered into Microsoft Excel and analyzed using Stata 11 (StataCorp, College Station, TX, USA). Results: A total of 319 patients presented to the emergency during the study period. Acute gastroenteritis, respiratory tract infection and fever were the most common reasons for presentation to the emergency. Seventy-three (23%) children required admission. Most commonly used public transport was auto-rickshaw (138, 43.5%) and median time taken to reach hospital was 22 min (interquartile range: 5, 720). Twenty-six patients were referred from another health facility. Of these, 25 were transported in ambulance unaccompanied. About 8% (25) of parents reported having diffi culties in transporting their child to the hospital and 57% (181) of parents felt fellow passengers and drivers were unhelpful. On post-hoc analysis, only time taken to reach the hospital (30 vs. 20 min; relative risk [95% confi dence interval]: 1.02 [1.007, 1.03], P = 0.003) and the illness nature were signifi cant (45% vs. 2.6%; 0.58 [0.50, 0.67], P ≤ 0.0001) on multivariate analysis. Conclusions: In relation to prehospital transport among pediatric patients we observed that one-quarter of children presenting to the emergency required admission, the auto-rickshaw was the commonest mode of transport and that there is a lack of prior communication before referring patients for further management.