NEONATAL INTENSIVE CARE UNIT (NICU)

PAEDIATRIC INTENSIVE CARE UNIT (PICU)

Introduction:
P ed iatric intens ive c are unit where c ritic ally ill c hild ren are
c ared reduce the child mortality.
Advances in the understanding of pathophysiology and management
of complex life threatening processes, such as respiratory failure, shock,

trauma, and increased intracranial pressure and availability of electronic

monitoring and life sustaining procedures such as mechanical ventilators have
dramatically improved the level of care that can be offered to seriously ill
children. Efforts to deliver this highly sophisticated health care in an organized
manner have led to evolution of a new sub specialty intensive care unit.
Pediatric intensive care units for the critically ill are found in many
children hospitals and the large pediatric departments in general hospitals. In
some states, care of the high risk. Children takes place in regional centers
equipped for this purpose. Children who are critically ill are transported from
local hospitals to these centers for care.
Development of separate pediatric intensive care units is only logical in
this process, physiological need and disease patterns of young and infants and
children are distinct from adults.
CONDITIONS REQUIRE PAEDIATRIC INTENSIVE CARE UNIT
PICU is an internal part of the healt4 care services being afforded in a
particular up, an assessment of its need should primarily be based, on the
existing patient load and type Of illnesses cared for, conditions regarding
pediatric intensive care are following
Raised intracranial pressure
- Acute meningitis
- Encephalitis
- Intracranial hemorrhage
- Encephalopathy
- Severe head injury
Shock:
- Hypovolemic
- Septic shock
- Severe burns
 Acute respiratory failure:
- Severe pneumonia
- Severe status asthmatics
- Severe upper airway obstruction
- Diphtheria
- Organophosphate poisoning.
Acute hepatic failure:
- Fulminant viral hepatitis
- Poisoning (paracetamol, sodium valporate).
- Metabolic disorders (Wilson’s disease).
Acute renal failure
- Hemolytic uremic syndrome
- Acute tubular necrosis.
Fulminant metabolic :
- Metabolic Acidosis disease.
Availability of committed and appropriately trained staff and adequate
resources are other important considerations,
An institution providing paediatric intensive care should be capable of
providing hours accessibility to abroad range of paediatric sub-specialties As
these are essential for optimum care.

PHYSICAL SET UP OF PICU

1. Size: - The ideal size is not known as there is no clear standard or method
determine its size. It is felt that a multi-specialty hospital requires about 5%
of beds for care, out of which 1% should be in ICU,
A unit smaller than 6 beds risks in efficiency and units larger than 16 beds
may be manage. In other country 'like Britain, there are 6 beds in PICU
2. Location: location of PISU should be such that there should
be no traffic passing the area and transport of patients and from
 the Unit for diagnostic and aphetic procedure is minimized.
PICU should be located within direct access to paediatric emergency room,
children , radiology department and operating and recovery rooms. It is also
desirable units to be close to each other.
3. Space :Adequate provision of space is essential for the patient care, area
should proximately 20 m2, space available per patient with 3-3.5 rn2 separating
each patient. There must be provision for enough floor space around the
head end of the bed to Me necessary personnel and equipment for
resuscitation In addition, space should be provided for nursing and clinical
activity, equipment, eidoctors duty room, nurses locker room, conference
room, toilets, offices of nursing rvision and consultant physicians, laboratory,
storage area for supplies, linen and entbelongings and a clean and separate
work room. An intermediate care area to allow for continuing care patients
and waiting room hinnies should also be provided immediately adjacent to
the unit.
The total area needed is about 3 times the size needed for beds alone.
4. Design/lay out
- In the design of patient care area is a provision for adequacy of
observation and easy access to the patients.
- A central station for observation, record keeping and charting, preparation o
medications and other functions are necessary.
- The patient care area may have an open ward design or multiple
enclosed room design (each room serving 1-2 patient). Both of their designs
have advantages. In our set up with shortage of nurses, it is better to adopt
for an open ward design.
- For a 6-8 bed unit, a big room serving 4-6 patients and two smaller rooms
(25- 30 m2) serving 1-2 patients are adequate.
- These rooms are required for isolation and dialysis. An area for intermediate
care may be designed within PICU, to look after patients who require
intensive tribnitoring but are not on life supporting therapeutic intervention.
- Each room should have adequate shelf space (cabinet) at growing and hand
washing facility presence of glass covered windows is helpful in providing
adequate light and for patients to maintain day light. Attractive colour
designs
- on walls and ceiling may be helpful.
- Each must be provided, with appropriate electrical sockets, illumination,
suction, air and oxygen outlets.
- Appropriate air conditioning heating, ventilation plumbing and safety
must he observed.

REQUIREMENT FOR A PICU

I. Electrical requirement
A. Electrical outlets 1648 per bed.
- For spot light
- Call bell alarms
- Monitoring equipments
- Vacuum, exhaust fan.
- Air conditioning
- Television.
B. Special outlet
- For ventilator
- Portable x-ray machines.
C. Earthling all the outlet : Must be properly earthed and have earthling circu
breakers to protect against electrocution.
D. Voltage stabilization for all the inlets, voltage fluctuations may damage
sensitive monitoring equipment.
II. Illumination (lighting)
a) Back ground lighting - Low intensity lighting below the patient's bed level
keep a minimum illumination at all times.
b) General and additional illumination - During active patient care for
procedure needing extra brightness additional lights are needed. Full size
florescent tube light fixed in ceilings, 4 per patients, 2 for general and 2 for
additional illumination is minim requirement.
c) One spot light to give high level illumination for procedures, examination
treatment. This may be fixed in ceiling or may be a portable one.
III. Compressed Air :- One outlet per bed, provision of double filtered airat a
pressure of 50-55 psi.
IV. Oxygen outlets :- Two per bed, supplied from a central source should have
dis colour identification, alarm for low pressure and shut off value between the
main the outlet to close the flow if needed.
V. Suction vacuum :- Two per bed, minimum a third outlet may be desirable.
pressure should be adjustable for patient's needs such as nasogastric suction,
tracheostomies tube drainage, endotracheal suction etc.
VI. Physical environment
- Temperature adjustment between 25°-20°C.
- Relative humidity 30-60%
- Positive air pressure inside as compared to adjacent area
- Air conditioning system must allow for the above requirement for air
exchange and filtration.
- Air exchanges at least 12 tithes per day.