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.

For people with severe/profound and multiple disabilities, managing the basic necessities of daily life often poses myriad challenges. Despite great odds, advances in assistive technology are making a difference in these individuals' lives. Advances in using body signals and micro-movements, e.g. EMG, EEG, eye ball movement, voice or facial expressions, can interface with different controlling units to operate communication aids and computer-based systems. These are creating new opportunities for living independently, improving basic life skills, and reducing burden of care among individuals with combined motor, sensory, and intellectual disabilities resulted from critical illnesses or injuries.
This unique presentation examines how rehabilitation can improve the daily lives of even those individuals most affected by severe/profound and multiple disabilities. Interventions currently in use and in experimental stages are displayed through case studies in terms of how they work and their applicability to clients with various needs through their life span. In addition, it examines the intrinsic and extrinsic factors in choosing suitable technologies. It presents empirical evidence on the advances in improving interaction with caregivers, control of the home environment, handling self-care tasks, and other core skills. 
The interventions that are innovative, respectful of the dignity of clients, and practical for ongoing use, including:
• Various microswitches in habilitation programs.
• Senses controlling devices for communication and home intelligence.
• Brain-computer interface technology for promoting independence.
• Assistive technology for promoting ambulation.
• Robotic systems for promoting movement indoors.
 • Assistive technology for reducing risky behaviours
User satisfaction and Model of practice related to advanced assistive technology service is explored.

Paediatric palliative care (PPC) is a new development in Hong Kong. Hospital Authority set up the first PPC service at Hong Kong Children’s Hospital in 2019, with a designated team of doctor, nurses and social worker. Children with cancer is the major target group at the current phase of PPC development. There are many non-cancer conditions also require PPC service, severe cardiac and renal diseases are also included in the current service. In children, there are special groups of life-limiting conditions (LLC) which happen mainly in children, such as severe inborn error of metabolism, neurodegenerative disease and neuromuscular diseases. In western countries, the non-cancer conditions actually constitute more than 70% of the PPC workload. These LLC may continue for many months or years, and some may also survive beyond childhood with the advances in technological support, such as Duchene Muscular Dystrophy. The service model of PPC is family-centred, and parents are particularly important as the carers and also the sole decision makers for young children. Adolescent patients with life-threatening and LLC should be involved in the decision making which sometimes may be very challenging. PPC team must establish good relationship with the parents, and sometimes the grandparents who are the main carers. While some children with LLC stay mainly in the community, either at home or special residential schools/centres. The staff at special centres are now providing specialized care to these children, some may be on assisted non-invasive ventilator support, on gastrostomy feed and may need frequent suction of excessive secretion. Regular physiotherapy and occupational therapy is very important to children with multiple disability. The psychosocial burden of parents with children receiving PPC needs extra support by social workers and NGOs. A child receiving PPC service is having a long journey which requires support from medical, nursing, allied health, special school workers and NGOs. As some children on PPC now survive into adulthood, transitional care with input from adult PC is urgently needed.