Paediatric critical care medicine is a high subspecialized discipline. A paediatric intensive care unit (PICU) is an area within a hospital specializing in the care of critically ill infants, children, teenagers, and at time young adults. A PICU is staffed by PICU physicians, nurses, and respiratory therapists who are specially trained and experienced in pediatric intensive care. The unit may also have physiotherapists, social workers, child life specialists, and clerks on staff. Complex technology and equipment are often in use, particularly mechanical rsepirators and patient monitoring systems. Within the territories, the 9 PICUs care for over 1.2 million young persons under the age of 18 years and a population of over 7.5 million in Hong Kong. In contrast, there are only two PICUs in Singapore serving an overall population of 5.7 million. Adopting a Pub-and-Spoke model, the Hong Kong Children Hospital (HKCH) serves highly specialized paediatric population of oncology, cardiology and nephrology with a low mortality of less than 3 % of PICU admissions.
Correct staffing is the next vital component to a successful PICU. The nursing staff is highly experienced in providing care to the most critical patients. The nurse-to-patient ratio should remain low. The nurses and physicians must work together as a collaborative team to provide optimal care. The successful collaboration between nurses and physician and all allied health staff has resulted in low mortality rates, approximately 3% at HKCH.
Cardiopulmonary diseases include acute respiratory distress syndrome (ARDS), sepsis, trauma, congenital heart defects, mechanical ventilation, and complications of various complex diseases. Gastrointestinal conditions include gastrointestinal perforations, malignancy/chemotherapy, organ transplants, seizures, and poisoning.
Working in the PICU may result in emotional stress and/or occupational burnout of the staff. The staff must collaborate with other members of the healthcare team to develop the optimal individualized care plan, and work with the patient's family to provide the best care. We share a few cases to illustrate issues we encounter in the PICU. For chronically ill patients, the PICU must also facilitate palliative and transition care. These subject matters will be discussed by the other colleagues in this session.
