Khanal Aayush, Sharma Arun, Basnet Sangita
1Department of Pediatrics, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.2Division of Critical Care, Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL.
Pediatr Crit Care Med. 2016 Nov;17(11):1032-1040. doi: 10.1097/PCC.0000000000000938.
To describe the state of pediatric intensive care and high dependency care in Nepal. Pediatric intensive care is now a recognized specialty in high-income nations, but there are few reports from low-income countries. With the large number of critically ill children in Nepal, the importance of pediatric intensive care is increasingly recognized but little is known about its current state.
Survey.
All hospitals in Nepal that have separate physical facilities for PICU and high dependency care.
All children admitted to these facilities.
None.
A questionnaire survey was sent to the chief of each facility. Eighteen hospitals were eligible and 16 responded. Two thirds of the 16 units were established in the last 5 years; they had a total of 93 beds, with median of 5 (range, 2-10) beds per unit. All 16 units had a monitor for each bed but only 75% could manage central venous catheters and only 75% had a blood gas analyzer. Thirty two percent had only one functioning mechanical ventilator and another 38% had two ventilators, the other units had 3-6 ventilators. Six PICUs (38%) had a nurse-to-patient ratio of 1:2 and the others had 1:3 to 1:6. Only one institution had a pediatric intensive care specialist. The majority of patients (88%) came from families with an income of just over a dollar per day. All patients were self funded with a median cost of PICU bed being $25 U.S. dollars (interquartile range, 15-31) per day. The median stay was 6 (interquartile range, 4.8-7) days. The most common age group was 1-5. Sixty percent of units reported respiratory distress/failure as their primary cause for admission. Mortality was 25% (interquartile range, 20-35%) with mechanical ventilation and 1% (interquartile range, 0-5%) without mechanical ventilation.
Pediatric intensive care in Nepal is still in its infancy, and there is a need for improved organization, services, and training.
描述尼泊尔儿科重症监护及高依赖护理的状况。儿科重症监护在高收入国家现已成为一门公认的专科，但来自低收入国家的相关报告较少。尼泊尔有大量危重症儿童，儿科重症监护的重要性日益得到认可，但对其当前状况却知之甚少。
调查。
尼泊尔所有设有独立儿科重症监护病房（PICU）及高依赖护理设施的医院。
所有入住这些设施的儿童。
无。
向每个设施的负责人发送了问卷调查。18家医院符合条件，16家做出了回应。这16个单位中有三分之二是在过去5年设立的；它们共有93张床位，每个单位的床位中位数为5张（范围为2 - 10张）。16个单位均为每张床位配备了一台监护仪，但只有75%能够进行中心静脉置管操作，只有75%拥有血气分析仪。32%的单位仅有一台可正常使用的机械通气机，另外38%有两台通气机，其他单位有3 - 6台通气机。6个PICU（38%）的护患比为1:2，其他单位的护患比为1:3至1:6。只有一家机构有儿科重症监护专科医生。大多数患者（88%）来自日收入略高于一美元的家庭。所有患者均为自费，PICU床位的每日费用中位数为25美元（四分位间距为15 - 31美元）。住院时间中位数为6天（四分位间距为4.8 - 7天）。最常见的年龄组为1 - 5岁。60%的单位报告称呼吸窘迫/衰竭是其主要收治原因。接受机械通气的患者死亡率为25%（四分位间距为20 - 35%），未接受机械通气的患者死亡率为1%（四分位间距为0 - 5%）。
尼泊尔的儿科重症监护仍处于起步阶段，需要改进组织、服务和培训。
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