Slusher Tina M, Kiragu Andrew W, Day Louise T, Bjorklund Ashley R, Shirk Arianna, Johannsen Colleen, Hagen Scott A
Department of Pediatrics, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN, United States.
London School of Hygiene & Tropical Medicine, London, United Kingdom.
Front Pediatr. 2018 Mar 16;6:49. doi: 10.3389/fped.2018.00049. eCollection 2018.
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.
儿科重症监护是全球降低发病率和死亡率的重要组成部分。目前，大多数中低收入国家（LMICs）医院的儿科重症监护仍处于起步阶段。大多数医院缺乏指定的重症监护病房、接受过危重症儿童护理培训的医护人员、足够数量的工作人员，以及无法快速获取必要的药物、用品和设备。此外，大多数中低收入国家缺乏针对医疗服务提供者的儿科重症监护培训项目，也没有认证程序来认可在其儿科重症监护病房（PICU）和高依赖区工作的医疗服务提供者。一般来说，PICU可以提高儿科护理质量，如果组织得当，可以使用低成本干预措施有效治疗腹泻、重症疟疾和呼吸窘迫等高负担疾病的严重并发症。在中低收入国家建立PICU需要规划、特定资源，最重要的是对护理人员和长期医务人员的投入。在中低收入国家发展儿科重症监护服务的一种深思熟虑的方法始于基本要素：对医疗专业人员进行技能和知识培训、选择适合资源的有效设备，以及有支持性的领导来提供适宜护理的有利环境。如果能够以可持续的方式建立这些基本要素，就将建立起适当的重症监护服务，有望在我们朝着可持续发展目标努力的公共卫生目标背景下显著降低儿科发病率和死亡率。
