UNIVERSITY OF CHILD HEALTH SCIENCES, THE CHILDREN'S HOSPITAL

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PEDIATRIC INTENSIVE CARE UNIT (PICU)

MEDICAL INTENSIVE CARE UNIT (MICU)

History & Background

Critical care services being the backbone of any tertiary level hospital, PICU was started right at the time of commissioning of inpatient services in 1998. Starting from a 5-bedded unit catering critical care to all children with medical, surgical and cardiac disease; the PICU has over the years expanded to 30 beds being looked after by 3 teams of Medical ICU, Cardiac ICU and Surgical ICU. PICU at Children Hospital is one of the premier critical care set up in Pakistan providing best services in this domain.

MEDICAL INTENSIVE CARE UNIT (MICU)

Organization:

Medical ICU (MICU) has expanded from 5 to now 15-bedded unit being looked after by

full time intensive care team. All children with medical ailments requiring critical care are admitted in MICU. Cardiac ICU (CICU) and cardiac-surgical ICU (CSICU) are 5 bedded units each looked after

primary by cardiology team with input from MICU team as and when needed. Surgical ICU (SICU) is a separate 4-bedded unit reserved for post-operative and trauma patients with input from anesthesia & MICU teams.

Facilities:

The 15-bedded MICU is equipped with ICU beds, cardiac monitors, pulse oximeters, mechanical ventilators, infusion & syringe pumps, central gas supplies etc for the best possible care and monitoring of critically unwell children. These are backed up by the round-the-clock services from laboratory, radiology, blood bank, pharmacy and physiotherapy departments. The Children’s Hospital & the Institute of Child Health is unique in having semi-ICUs / HDUs in each of general and specialty wards. Medical ICU team also extends their advice and services to the patients in these HDUs.

Staff:

1. Medical Staff

2. Nursing Staff

3. ParaMedical Staff

• Physiotherapist –
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• ICU Technician / Procedure Assistant – 4
• Ward Attendant, Security Guards, Wad Cleaner etc

FUNCTIONING OF MICU:

Children requiring critical and intensive care are admitted from emergency, general, speciality and private wards. Patients from other public and private hospitals are also catered but all admissions are routed through emergency. Children in various HDUs are also managed as out-reach cases and transferred to MICU if indicated. Once the patients are stable after ventilation etc, majority of them are transferred back to the wards pending discharge from hospital. However, some with special needs are also discharged directly from step-down area of MICU.

A part of MICU has also been utilized as Dengue High Dependancy Unit (HDU) during periods of dengue outbreak for the last few years and the MICU team generally leads the management of such cases.

A rough breakdown of the variety of patients admitted to MICU is shown below

TEACHING AND TRAINING:

Resident Medical Officers and Post Graduate Trainees for FCPS, MCPS, MRCP and MRCPCH in Pediatrics are rotated to MICU in 4 months slots when they get hands on training in resuscitation, fluid management, mechanical ventilation, various procedures etc. In addition to day to day leaning activities, workshops on Mechanical Ventilation, management of Dengue Fever, Resuscitation etc are conducted on regular basis. MICU team has been actively involved in CPC and morning conference presentations. We have extended our teaching and training activities to various public and private institutions endeavoring the strengthening of pediatric critical care services.

RESEARCH AND PUBLICATIONS

A number of papers and case reports have been published in peer reviewed national and indexed journals. Following is some of the recent publications:

1. Diphtheritic Neuropathy. Pak Ped J 2012; 36(2):104-6.
2. Pheochromocytoma: A rare cause of Childhood Hypertensive Encephalopathy. J Coll Physicians Surg Pak 2012; 22(8): 536-538.
3. Ventilator-Associated Pneumonia in Children. J Coll Physicians Surg Pak 2012; 22(3): 155-158.
4. Clinical and Laboratory Features of Childhood Acute Disseminated Encephalomyelitis (CADEM): Experience at the Children’s Hospital Lahore. Pak Ped J 2011; 35(2): 94-102.
5. Nosocomial Bloodstream Infection a Tertiary Care Pediatric Intensive Care Unit. J Coll Physicians Surg Pak 2007; 17 (7): 416-9.
6. Acute Poisoning in Children. J Coll Physicians Surg Pak 2005; 15 (12): 805-808.
7. Brain Abscess in Children. J Coll Physicians Surg Pak 2005; 15 (10): 609-611.

Paper Presentations:

• 21^st Biennial Pediatric Conference 2012, Karachi. Invited Talk: “Spotting a Sick Child in Emergency Room”
• 8^th Annual Symposium of the Children’s Hospital Lahore 2011, Paper: “Ventilator-Associated Pneumonia in Children”
• 7^th Annual Symposium Institute of Child Health Lahore 2010. Paper: “Central Venous Access in children- a novel approach in cost constraint settings:
• 20^th International Biennial Conference of PPA Islamabad 2010. Paper: “Clinical Utiltity & Cost effectiveness of Ledercath in comparison Multicath for Central Venous Access in children”
• 14^th National Conference Pakistan Pediatric Association Multan 2009. Paper: “An audit of Mechanical Ventilation in Children”
• 2^nd National Pediatric Infectious Diseases Conference Lahore 2008. Paper: “Impact of Strict Infection Control practices on Nosocomial Blood Stream Infection in PICU”

Workshops:

Following are some of the workshops conducted on regular basis by the MICU team

RAPID RESPONSE TEAM

Rapid Response Team (RRT) is being developed at the hospital level which will be lead by a consultant, assisted by RMO and critical care nurse. The main purpose will be to extend critical care services to various high dependency units for prompt management, intervention and transfer so that morbidity and mortality of admitted children can be curtailed.

UNIT GUIDELINES

Unit guidelines are in the process of finalization for smooth working of PICU. In this regard collaboration with other PICUs from various parts of the country is also there so that uniformity in guidelines can be achieved.

FUTURE VISION

• Expansion of PICU services to cater the growing need of sick children admitted in the hospital and also from outside the hospital.
• Development and approval of
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  Pediatric Critical Care Fellowship program.

• Commissioning of advanced services like High Frequency Oscillatory Ventilation (HOFV), Hemofiltration, Plasmapharesis, ICP monitoring etc.
• Development of Pediatric Retrieval System (PRiSm) for out-reach stabilization and transfer of sick kids.
• Strengthening pediatric critical care services at other institutions by imparting training and sharing experiences. Hence reducing burden on PICU of the Children’s Hospital.
• Targeted research in collaboration with local and international institutions especially in context of local problems.
• Human resource development regarding medical, nursing and support staff.
• CPD workshops in more areas.

CONTACT

Medical Intensive Care Unit

The Children’s Hospital & Institute of Child Health

Ferozpur Road Lahore

Tel: +9242-99230901-20 (Ext: )

Email: [email protected] , [email protected]