PICU SCENARIO IN INDIA
Praveen Khilnani*
Head Pediatric Pulmonology and Critical care, Institute of Pediatrics, MAX Superspeciality Hospital, New Delhi *
Introduction
  1. Quality pediatric care

    requires specialized training and a special sensitivity that is perfected through caring for children full time.
  2. From mild illness and injury to the most severe medical emergency, Children's specially qualified clinical staff and affiliated physicians can provide the best healthcare.
  3. Infant Mortality Rate 2005 (International)
  4. Germany: 4.2; Greece: 5.5; Guatemala 35.9
  5. Hungary: 8.6
  6. India: 56.3
  7. Iran: 41.6; Ireland: 5.4; Israel: 7.0; Italy: 5.9; Japan: 3.3; Kenya: 61.5
  8. Korea, South: 7.0; Mexico: 20.9; Mozambique: 130.8
  9. New Zealand: 5.8; Nigeria: 98.8
  10. Lowest Finland: 3.6; Highest Angola: 191.2
    Source: U.S. Census Bureau, International Database


Infant Mortality Rate


Year 2002
  1. INDIA (70.5);
  2. Kerala (14.1), Maharashtra (48.0), Tamil Nadu (52.6), Punjab (52.8),
  3. West Bengal (53.6),
  4. Karnataka (61.4), Himachal Pradesh (61.4), Gujarat (63.2), Andhra Pradesh (65.2), Bihar (67.0), Haryana (68.6), Assam (76.0), Rajasthan (83.1), Uttar Pradesh (85.1), Madhya Pradesh (94.0), Orissa (96.9)
    Source: The Office of the Registrar General, India


Vital Rates for India (1971 - 2000)
ear

  Crude Birth rate

  Crude Death rate

  Infant mortality rate

 1971

  36.9

  14.9

129
1976

  34.4

  15.0

129
1981

  33.9

  12.5

110
1986

  32.6

  11.1

96
1991

  *29.5

  9.8

  80

1996

  *27.5

  9.0

  72

2000

  25.8

  8.5

68


Source: Sample Registration System, Office of the Registrar General, India (excludes J&K)

Common diseases requiring intensive care


  • Respiratory distress, pneumonia, asthma
  • Septic shock, hypotension
  • Cardiac defects and failure
  • Coma,encephalitis, dengue, malaria
  • Accidents, head, chest, abdominal injury
  • Poisonings
  • Burns
  • Post-surgery, heart surgery, neurosurgery


Children are different:
  • From birth through adolescence, children have special health care needs that are different from those of adults. Their bodies respond differently to injury and illness.
  • And most children do not understand - or know how to deal with - the experience of serious illness or hospitalization.


Why an ICU devoted solely to children?
Children and adults experience different kinds of health problems.
  • Adults typically suffer from chronic, degenerative diseases that appear later in life after developing over many years,
  • Children get immediate effects of Prematurity, Congenital abnormalities, Viral and infectious diseases
  • Even diseases that are common to both children and adults may affect children differently.
  • The cancers that affect adults are generally not found in pediatric patients.
  • Children are more likely to suffer from leukemias, brain tumors and other cancers that develop in growing tissues.
  • Juvenile diabetes, requires management that is different from the management needed when diabetes is diagnosed later in life
  • AIDS often progresses more rapidly in children than in adults, although the virus is the same. ent differs from that of adults. Medications for adults are in standard doses as opposed to /kg/bsa dose
  • Diagnostic/therapeutic equipment must often be tailored to fit a child's smaller size
  • Children need support to cope with their disease or illness from those who are best able and trained to understand their growing minds and bodies.


Is all that really medically important? YES
  • Causes of cardiac arrest are different
  • Airway anatomy,cardiac and respiratory physiology is different
  • Resuscitation(PALS) protocols are different
  • Perioperative respiratory and cardiac care is different
  • Emergency transport for critically ill /injured children requires pediatric trained team available round the clock


Current status of Pediatric Intensive Care Services in INDIA



Government Sector:
  • Inadequate services
  • Disorganized/ Poor infrastructure for large population and high mortality (example Delhi Kalawati Saran Childrens hospital)
  • Multiple small pediatric departments in government hospitals with medical colleges with either small or no PICU
  • Handful of big PICUs at AIIMS, PGI, etc.
  • Very few PICUs in the Government institutions in Eastern India
  • Overall: More is desired

Current Status of PICUs in INDIA:

Private Sector:
  • Multiple small pediatric ICUs in private hospitals (Surat, Nagpur, Hyderabad, Indore, Bengal, etc) and bigger private PICUs at Apollo group hospitals, Ganga Ram, Hinduja, KKCT Chennai, etc.
  • Better PICU services than government institutions BUT in larger picture given the large population GROSSLY INADEQUATE and unaffordable due to high cost


So What's different in Pediatric care in the West?
More than 60 Children Hospitals in the US and More than 100 PICUs in general hospitals. Each medical college affiliated institution has attached speciality services including PICU.
  • CHILDREN'S HOSPITAL
  • Treats all aspects of the patient, including emotional well-being and that of the child's family under one roof by pediatric trained and experienced personnel.
  • Private Comprehensive and High Tech Care with Harvard university affiliation and training programs


Can we do it? In INDIA?
In private sector, probably YES..
  • Though Investors and Land availability remains a challenge
  • Building materials, infrastructure
  • TECHNOLOGY
  • And the Trained
  • Medical Personnel
  • Are becoming more AVAILABLE


Can we do it? In INDIA?

In government sector? MAY BE

Political will and speed of action in Government remains a challenge.

  • THOUGH TECHNOLOGY And the Trained Medical Personnel Are becoming more AVAILABLE
  • Big challenges for the Government sector are Organization & Finances
  • ABSORB/SUBSIDIZE COST OF HIGH TECH UNAFFORDABLE ICU CARE TO COMMON MAN
  • LACK OF CRITICAL CARE AND TRANSPORT FACILITIES
  • LONG DISTANCES :TOO FEW TERTIARY CENTERS


Requirements of a Pediatric Emergency an Intensive Care Service:

  • 24 hour Multi-disciplinary Casualty
  • Emergency transport for critically ill /injured children wth pediatric trained team available round the clock
  • Senior Pediatric emergency and PICU Consultant In charge
  • Space for designated PICU,Emergency and Intensive care equipment
  • STRUCTURED TRAINING: DNB, Fellowship in Pediatric specialities
  • Staff (resident/nursing) education
  • Hands on Training Workshops
  • Clinical Research Program
  • (MEDICAL COLLEGE AFFILIATED) And MCI, DNB recognized


FELLOWSHIP in Pediatric CRITICAL CARE
- For last 4 years

Guidelines for Pediatric Critical Care in Indian Intensive Care Units



Are published IP Jan 2002

  • International Academic Participation Indian clinical data presentation is also important
  • ISCCM Is advocating CRITICAL CARE to be listed as a recognized medical discipline in MCI
  • As it is a life saving field of medicine overlapping with all medical disciplines

Summary

  • More Pediatric intensive care services are needed in our country. CAN BE DONE!
  • Government sector is unable to cope up with the intensive care needs of population
  • Private sector and government sector will have to work hand in hand
  • MORE COMMITMENT IS NEEDED BY THE Government SECTOR to ORGANIZE AND FINANCE SUCH SERVICES THROUGHOUT INDIA TO SERVE CHILDREN OF INDIA
How to Cite URL :
Khilnani P.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=450
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