The Assessment, Evaluation, and Management of the Critically Ill Child in Resource-Limited International Settings

Slusher, Tina M.; Bjorklund, Ashley; Aanyu, Hellen T; Kiragu, Andrew; Philip, Christo

doi:10.1055/s-0036-1584677

Cited by 3 publications

(10 citation statements)

References 18 publications

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“…Many of the conditions that contribute to the burden of disease in LMICs, such as dehydration and respiratory distress, can be mitigated through prompt, simple treatments (14). Pediatric emergency and critical care services do not need to be expensive, nor excessively dependent on complex technology (19). Critical care services can be utilized to improve outcomes if combined with a focus on community recognition of serious illness, early access to care, referral, and safe transport (15).…”

Section: The Arguments Against and The Case For Picus In Lmicsmentioning

confidence: 99%

“…Critical care services can be utilized to improve outcomes if combined with a focus on community recognition of serious illness, early access to care, referral, and safe transport (15). A robust triage system, the first component of critical care, is still formally lacking in many hospitals in LMICs despite the WHO ETAT recommendations (19). The South African Triage Scale (SATS), for example, employs clinical signs and a triage early warning score to assist in the early identification of acute illness.…”

Section: The Arguments Against and The Case For Picus In Lmicsmentioning

confidence: 99%

“…When developing critical care services for children in LMICs, a step-wise approach to introducing equipment is an effective way to build a sustainable service without overwhelming the system. Use of low cost, simple technologies and techniques early in the development of critical care can be lifesaving, and improve quality of care in a sustainable long-term manner (19). Resuscitation kits containing an appropriate-sized neonatal and pediatric bag valve mask systems, adrenaline, cannulas, glucose containing fluids, and normal saline should be readily available in the PICU.…”

Section: Basics Of Developing a Picu In A Lmic: Lessons Learnedmentioning

confidence: 99%

“…Examples of low cost medical equipment substitutes include adapting plastic water bottles as spacers for inhaler therapy and the use of sterile nasogastric tubes as umbilical vein catheters (19, 23, 24). When purchasing equipment, the availability in the LMIC or region should be considered, so that it may be maintained and repaired locally (19). Additionally, buying equipment locally supports the regional economy while providing a much-needed service to the hospital.…”

Section: Basics Of Developing a Picu In A Lmic: Lessons Learnedmentioning

confidence: 99%

“…The most difficult question is often the dilemma of “what can be done, what should be done and what will be done.” Those making the decisions in a resource-limited setting need to be aware of anticipated outcomes for specific illnesses and should avoid the use of limited resources on patients that have a terminal illness (19). Additionally, long-term use of limited resources, such as pumps and ventilators needs to be considered part of resource stewardship.…”

Section: Basics Of Developing a Picu In A Lmic: Lessons Learnedmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: The Arguments Against and The Case For Picus In Lmicsmentioning

confidence: 99%

Section: The Arguments Against and The Case For Picus In Lmicsmentioning

confidence: 99%

Section: Basics Of Developing a Picu In A Lmic: Lessons Learnedmentioning

confidence: 99%

Section: Basics Of Developing a Picu In A Lmic: Lessons Learnedmentioning

confidence: 99%

Section: Basics Of Developing a Picu In A Lmic: Lessons Learnedmentioning

confidence: 99%

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

et al. 2018

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Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi

Purcell

Prin

Sincavage³

et al. 2020

Journal of Tropical Pediatrics

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Introduction The burden of critical illness in low- and middle-income countries (LMICs) is high; however, there is a paucity of data describing pediatric critical care outcomes in this setting. Methods We performed a prospective observational study of the pediatric (≤18 years) intensive care population in Malawi, from August 2016 to May 2018. Data collected include patient demographics and clinical data, admission criteria and outcome. A multivariate Poisson regression was performed to determine risk factors for mortality. Results Over the study period, 499 patients were admitted to the intensive care unit (ICU) and 105 (21.0%) were children. The average age was 10.6 ± 5.4 years. Primary indications for ICU admission were sepsis (n = 30, 30.3%) and traumatic brain injury (TBI, n = 23, 23.2%). Of those who died, sepsis (n = 18, 32.7%), acute respiratory failure (n = 11, 20.0%) and TBI (n = 11, 20.0%) were the primary admission diagnoses. Overall, ICU mortality was 54.3% (n = 57). Multivariate regression for increased ICU mortality revealed: age ≤5 years [risk ratio (RR) 1.96, 95% CI 1.10–2.26, p < 0.001], hemoglobin < 10 g/dl (RR 1.58, 95% CI 1.08—2.01, p = 0.01) and shock requiring epinephrine support (RR 2.76, 95% CI 1.80–4.23, p < 0.001). Conclusions Pediatric ICU mortality is high. Predictors of mortality were age ≤5 years, anemia at ICU admission and the need for epinephrine support. Training of pediatric intensive care specialists and increased blood product availability may attenuate the high mortality for critically ill children in Malawi.

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Pediatric critical care services in resource-limited settings; a current state and approaches to improvement.

Abdelatif

Mohamed

Mahmoud

et al. 2023

Sohag Medical Journal

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Pediatric critical care (PCC) plays a crucial role in reducing illness and death rates globally. However, in low and middle-income countries (LMICs), PCC services are not yet well-established in many hospitals. Necessary resources, including trained healthcare staff and access to necessary medications and equipment are lacking in many pediatric intensive care units (PICUs) in LMICs. Moreover, there is a shortage of PCC training programs and certification process for healthcare providers working in PICUs and high dependency areas. Establishing a PICU in a resource-limited setting (RLSs) requires careful resource utilization. The fundamental building blocks include training healthcare staff, selecting appropriate cost-effective equipment, and having supportive leadership. If these building blocks are established in a sustainable manner, a suitable PCC service can be maintained, leading to a significant reduction in pediatric mortality and morbidity. Furthermore, there is a pressing need for conducting more researches on PCC in RLSs to provide a comprehensive view of the epidemiology and outcomes of critical illness in children. Additionally, researches should be advanced to develop appropriate guidelines for managing pediatric critical illness in RLSs and focus on low-cost critical care technology, which is vital to support critical care in LMICs. In this review, we provide an overview of the current state of PCC services in LMICs based on the current literature, and propose a contextual framework to improve these services.

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The Assessment, Evaluation, and Management of the Critically Ill Child in Resource-Limited International Settings

Cited by 3 publications

References 18 publications

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

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

Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi

Pediatric critical care services in resource-limited settings; a current state and approaches to improvement.

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