ADMISSION CRITERIA FOR PICU

Intensive care is a highly specialized and costly service that cannot be provided to each and every sick child. For maximum cost-effective utilization, it is essential to ensure that only critically sick children, who need constant monitoring and advanced therapeutic interventions are admitted in PICUs.

Level III care

• Patients who need invasive monitoring*

• Patients, who have recently recovered after CPR

• Patients with:

- Respiratory failure, requiring mechanical ventilation

- Circulatory shock, arrhythmia, hypertensive crisis

- Acute neurological insult: Coma, status epilepticus

- Acute renal failure, requiring dialysis

- Acute bleeding disorders, requiring transfusions

• Post-operative cases: Unstable or on life-support

Level II care

• Patients, who need close but non-invasive monitoring

• Patients with:

- Severe respiratory distress on oxygen, tracheostomy, etc. (not on mechanical ventilation)

- Impending cardiovascular insufficiency

- Acute neurological injury with patent airway

- Stable cases of single/multi-organ failure (MODS)

• Accident/poisoning victims for observation

• Stable post-operative cases after major surgeries

• Step-down patients from level III care

*CVP lines, ICP catheters etc.

the needs and facilities, two levels of PICUs have been identified: Level II and III in order of increasing facilities, which should be located near the regular wards. A 'step-up and step-down' approach may be used between these two levels and general wards, depending on the individual needs of patients. Some common indications for PICU care are given in Table 27.15.

27.4.3