Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

Abstract

Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

Characterization and Outcome of Two Pediatric Intensive Care Units with Different Resources

“…erefore, the lack of adequate number and training of the staff members at the SUH PICU might contribute to the higher mortality. e nurse : patient ratios at both units follow the standard recommendation of being at least 1 : 2 [4]. However, the shifts were longer at the SUH PICU due to the shortage in the number of available nurses.…”

“…e structure of any PICU should have four basic components, according to Dr. Paul Farmer, which are (1) staff: properly trained health care professionals; (2) stuff: appropriate medical equipment; (3) space: a clean environment for patients; and (4) systems: the infrastructure and logistical organization to provide the services [4,13,14]. It is obviously understood that the mere presence of an intensive care unit does not guarantee a better outcome; the mortality rates can be as high as 50-58% in some PICUs in the developing world as most of the care is provided by personnel with poor pediatric critical care training [15,16].…”

“…e last decade has also witnessed marked progress in advancing pediatric intensive care to the developing world [1]. However, many PICUs in low-and middle-income countries, where there is a higher percentage of pediatric population, still require a higher number of qualified health care staff as well as rapid access to necessary medication, supplies, and equipment to participate effectively in reducing childhood mortality [4].…”

Simulation Education to Advance Emergency Medicine and Pediatric Critical Care in Nepal

“…Most of the partici-healthcare staff trained to care for critically ill children and rapid access to necessary medications, supplies and equipment. Perhaps one of the most important stumbling blocks in most LMICs is the lack of established training programs for healthcare providers working in clinical environments with a high volume of pediatric patients like emergency departments [4].…”

Consideraciones geográficas en la interpretación de los resultados de revisiones sistemáticas y meta-análisis: fluidos en sepsis pediátrica

“…Los LMIC estuvieron subrepresentados en esta revisión sistemática 6 . Desafortunadamente, esto es muy frecuente en la mayoría de los consensos, guías clínicas e incluso artículos que tratan sobre la salud global y la agenda de LMIC 8,12,13 .…”