1

Growth Trends

PICU and PCS ICU Over Last 5 years

• Totalnumberofadmissionin2017were758.• Averagenumberofannualadmissionsinlast5yearswere764.• PatientswerereferredtousfromotherfacilitiesacrossalloverIndialikeHaryana,Punjab,UttarPradesh,Madhya

Pradesh,Assam,HimachalPradesh,ArunachalPradesh,JammuandKashmirandBihar.• Wealsocaredforsomeinternationalpatients.• Apart from outside referrals, other admissions to PICU were from wards, pediatric emergency room and

operativeroom.

• ApartfromPICU,wealsoprovidecriticalcareservicestopre-opandpost-opPediatricCardiacpatients,whichareadmittedinaseparateICU,atPCS.

• Inlastyear(2017)alone,360childrenwithcardiacproblemswereadmittedwithus,increasingthetallyofsickpatientsto1118(whencombinedwithPICU).

Growth TrendsNumber of Patients Admitted Per Year

779 824 840663

754 809 758

600

800

1000

200

400

600

0

2011 2012 2013 2014 2015 2016 2017

•Total number of admission in 2017 were 758.•Average number of annual admissions in last 5 years were 764.•Patients were referred to us from other facilities across all over India like•Patients were referred to us from other facilities across all over India like Haryana, Punjab, Uttar Pradesh, Madhya Pradesh, Assam, Himachal Pradesh, Arunachal Pradesh, Jammu and Kashmir and Bihar.•We also cared for some international patientsWe also cared for some international patients.•Apart from outside referrals, other admissions to PICU were from wards, pediatric emergency room and operative room.Growth Trends

1200

1400

333307

328391 360

800

1000

PCS ICU

840663 754 809 758

200

400

600PCS ICUPICU

0

200

2013 2014 2015 2016 20172013 2014 2015 2016 2017

•Apart from PICU, we also provide critical care services to pre-op and post-op Pediatric Cardiac patients which are admitted in a separate ICU at PCSPediatric Cardiac patients, which are admitted in a separate ICU, at PCS.•In last year (2017) alone, 360 children with cardiac problems were admitted with us, increasing the tally of sick patients to 1118 (when combined with PICU).PICU).

2

Our Referral Base across The Nation

Total No. of Patients Admitted Per Month In PICU

Our referral base across the nation

National Capital Region-419SAAR countries -7

4SAAR countries 7

12

3

12

4717

786

17

12

3127

12

11

1

Total No. of Patients Admitted Per Month In PICUIn PICU

8187

8290100

66 69 6963

57 60 62

8176

6257

47

67

48

6269 67

72

8273

65 65

607080

4741

48

20304050 2016

2017

01020

•Average number of admissions per month is 63 patients for year 2017.g p p y•We saw a steady rise in number of patients over the year with maximum patients in September.•The number of patients is less in winter months. •The admission pattern has shown a consistent trend over the years.

• Averagenumberofadmissionspermonthis63patientsforyear2017.• WesawasteadyriseinnumberofpatientsovertheyearwithmaximumpatientsinSeptember.• Thenumberofpatientsislessinwintermonths.• Theadmissionpatternhasshownaconsistenttrendovertheyears.

3

Financial Assistance at Admission

Occupancy during Stay

• Patientsareadmitted in fullypaid (NursingHome),subsidized (Semi-Paying)andfree (GW/EWS)categoriesaccordingtoavailabilityofbeds.

• Outof12bedsinthePICU,25%areallottedtoGW/EWScategory.• Wecanseeintheabovegraphthat390(51%)patientswereadmittedinpayingCategory.Approximatelyhalf

ofthepatientsreceivedsubsidizedorfreecaresincethebeginning.

Nursing Home (N.H.)

39051%

Semi Paying (S.P.)31642%

GW/EWS527%

• Only24%ofPICUstaydayswerecontributedbyfullypayingpatients,restwereeitheradmittedorsteppeddowntosubsidizedorfreecategoriesduringthestay.

• TheaveragelengthofstayinourICUwas5.17daysfor2017.• ICUbedsarelimitedinanyhospital.Rationalizeduseforneedypatientsthereforeisnecessary.Lengthofstay

(LOS)is,therefore,usedtoassessqualityofcareandresourceutilization.AverageLOSinyear2001atNorfolkGeneralHospitalwas4.36daysingeneralICU;2.43daysinvascularICU.

(QualityindicatorsforICU:ISCCMguidelinesforICUsinINDIA)

Occupancy during stayp y g yN.H.

GW/EWS51213% 927

24%

13%

S.P.245563%

•Only 24 % of PICU stay days were contributed by fully paying patients, rest were either admitted or stepped down to subsidized or free categories during the stay.•The average length of stay in our ICU was 5.17 days for 2017.ICU b d li it d i h it l R ti li d f d ti t th f•ICU beds are limited in any hospital. Rationalized use for needy patients therefore

is necessary. Length of stay (LOS) is, therefore, used to assess quality of care and resource utilization. Average LOS in year 2001 Norfolk General Hospital 4.36 days in general ICU; 2 43 days in vascular ICUgeneral ICU; 2.43 days in vascular ICU.

(Quality indicators for ICU:ISCCM guidelines for ICUs in INDIA)

4

Bed Occupancy

• Inour12beddedPICU,meanbedoccupancywas10.66 (89.45%),which increasedduringbusymonthsofSeptemberandOctober.

• ThegeneralrecommendationisthatgeneralICUsshouldhaveanaveragebedoccupancyof60-70%(BJM,1970).• Patientsstayedforonanaverage5.17daysacrosstheyear.

Bed Occupancy

10.83 11.069 73

10.6111.67

13.23 12.67 12.73

10.4112

14

7.25

9.428.26

9.73

6.435 01 5 16 5 33 4 91 5 02 5 38 5.87

4 966

8

10

4.78 5.01 5.16 5.334.23 4.91 5.02 4.84 5.38 4.96

2

4

6

0

2

Monthly distribution: Mean bed occupancy per day Average PICU stay in days per patient

•In our 12 bedded PICU, mean bed occupancy was 10.66 (89.45%), which increased during busy months of September and October.•The general recommendation is that general ICUs should have an average bed occupancy of 60-70% (BJM,1970).•Patients stayed for on an average 5.17 days across the year.

5

Gender- wise Distribution of Patients

• Aratioof2.1:1isobservedinmale:femaleadmissionsinourPICU.• Thistrendisverysimilartopreviousyears,mightbeduetomorepreferenceforboys,eitherbythedisease

processorbytheparents.

Female24632%

Male51268%

Monthly Distribution of Sex Ratio

• Asimilartrendofmalepredominancewasobservedroundtheyear.

Monthly Distribution of Sex Ratioy

44 46 4642

52

42

5347

4440

50

60

3228

3642 42

23 23 25

40

30

40

15 13

23

1216

23 2520 20 18 17

10

20MaleFemale

0

10

A similar trend of male predominance was observed round the year

6

System Wise Distribution of Patients in 2017

CVS649%

CNS15421%

RENAL497%

GIT89

12%

RESPIRATORY10715%

PHO466%

ENDOCRINE172%

RHEUMATOLICAL122%

POISONING102%

SEPSIS537%

GENETICS193%

TROPICAL DISEASES669%

TRAUMATIC INJURY355%

7

Cardiovascular Disorders in PICU

• Presentationofpatientswithcardiovascularinstability• Congestivecardiacfailure• Cardiogenicshock• Pulmonaryedema

• Patientswithcongenitalheartdiseaseeitherhadlowerrespiratorytractinfectionorperiopertaiveconcerns.

Cardiovascular Disorders in PICU

12 11

Total- 64

8

10 9 9

1110

7

2

4

6

2 23

4 4

12

0

•Presentation of patients with cardiovascular instabilityC ti di f il•Congestive cardiac failure•Cardiogenic shock•Pulmonary edema

•Patients with congenital heart disease either had lower respiratory tract infection or•Patients with congenital heart disease either had lower respiratory tract infection or periopertaive concerns

Central and Peripheral Nervous System Disorders

• PresentationsofpatientswithCNSDisorders• Seizures• Statusepilepticus• Alteredsensorium

• Patientswere diagnosed to have acutemeningoencephalitis (bacterial, viral,TB), space occupying lesions,autoimmuneencephalitis,GuillainBarreSyndrome,ICSOLandmyopathies.

Central and Peripheral Nervous System Di dDisorders

TOTAL 154

20

2521

15 16

TOTAL-154

5

10

15 1114

1215

13

5

118

14 14

0

•Presentations of patients with CNS Disorders•SeizuresSeizures•Status epilepticus•Altered sensorium

•Patients were diagnosed to have acute meningoencephalitisPatients were diagnosed to have acute meningoencephalitis (bacterial, viral, TB), space occupying lesions, autoimmune encephalitis, Guillain Barre Syndrome, ICSOL and myopathies.

8

Renal Diseases

• Presentationsofpatients:• Anuria/oliguria• Pulmonaryedema• Fluidoverload/Anasarca• Hypertension• Hypertensiveencephalopathy

Renal conditionsRenal conditionsTotal- 49

8

10

12

7

11

8

0

2

4

6

1 1

43

23 3 3 3

0

•Presentations of patients:•Anuria/oliguriag•Pulmonary edema•Fluid overload/Anasarca•Hypertension•Hypertensive encephalopathy

Gastro Intestinal and Hepatic Diseases

• Presentationofthesepatients• Diarrhea• Poorfeedingwithfailuretothrive• Jaundice• Alteredsensorium• Upper/LowerGIbleed

• Thenonsurgicalreasonsforadmissionwereviralhepatitis,hepaticencephalopathy,Wilson’sdisease.• Patientswithsurgicalcauseslikeperforation,intussusception,tracheoesophagealfistula.

Gastro Intestinal and Hepatic Diseases

14 13

Total- 89

68

1012

108

9

5

9 910

56

0246

2

53

5

•Presentation of these patients •Diarrhea•Poor feeding with failure to thrivePoor feeding with failure to thrive•Jaundice•Altered sensorium•Upper/Lower GI bleed.

Th i l f d i i i l h titi h ti h l th Wil ’•The non surgical reasons for admission were viral hepatitis, hepatic encephalopathy, Wilson’s disease.•Patients with surgical causes like perforation, intussusception, tracheoesophageal fistula.

9

Respiratory Diseases

• Patientswithrespiratorydiseasesmostlypresentedtousinwintermonths.• Presentationofthesepatientswith:• Tachypnea• Respiratorydistress• Cyanosis

• Patients were diagnosed with - Community acquired pneumonia, bronchiolitis, empyema, foreign bodyaspiration,aspirationpneumonia,airwaymalaciaetc.

Respiratory problems

16 1516

Total-107

8101214

119

8 8

13

97

0246 4

34

0

•Patients with respiratory diseases mostly presented to us in winter months.•Presentation of these patients with:p

•Tachypnea•Respiratory distress•Cyanosis

•Patients were diagnosed with - Community acquired pneumonia, bronchiolitis, empyema, foreign body aspiration, aspiration pneumonia, airway malacia etc.

Hemato-Oncological Disorders

• PatientswithHemato-OncologicalDiseasesusuallyshiftedfromwardwiththefollowingpresentations-• Hemodynamicinstability• Respiratoryfailure• Multiorgandysfunctionsyndrome• Alteredsensorium• Sepsis

• MostCommoncomplicationsnoticedwere-cardiogenicshock,intracranialbleed,bronchopneumoniaandARDS.

Hemato-Oncological Disorder

78

8Total 46

34567

3 3

6 6

2

54

32

3

0123

12 2

•Patients with Hemato-Oncological Diseases usually shifted from ward with the following presentations-

•Hemodynamic instabilityR i t f il•Respiratory failure•Multi organ dysfunction syndrome•Altered sensorium•Sepsis•Sepsis

• Most Common complications noticed were - cardiogenic shock, intracranial bleed, bronchopneumonia and ARDS.

10

Endocrinal Disorders

• Patientspresentedwith-• Polyuriawithpolydipsia• Tachypneawithacidoticbreathing• Hyperglycemiaorhypoglycemia• Electrolyteimbalance

• ThemostcommondiagnosiswasDiabeticketoacidosis(DKA).

Endocrinal problems

3 3Total Cases-17

1 5

2

2.5

3

2 2 2

3

2 2

0

0.5

1

1.5 1

0 0

1 1 1

•Patients presented with-•Polyuria with polydipsiay p y p•Tachypnea with acidotic breathing•Hyperglycemia or hypoglycemia•Electrolyte imbalance

•The most common diagnosis was Diabetic ketoacidosis (DKA).

• Patientspresentedwith-• Hemodynamicinstability• Suspectedorprovensepsis• GIbleed• AcuteKidneyInjury(AKI)

• Patients usually diagnosed as Systemic lupus erythematosus, systemic onset juvenile idiopathic arthritis,polyarteritisnodosaandKawasakidisease.

Rhematological DiseasesRhematological issues

22 2 2

TOTAL-12

11.21.41.61.8

2

1 1 1 1 1 1

00.20.40.60.8

0 0 0

•Patients presented with-•Hemodynamic instability•Suspected or proven sepsis•GI bleed•Acute Kidney Injury (AKI)

•Patients usually diagnosed as Systemic lupus erythematosus, systemic onset juvenile idiopathic arthritis, polyarteritis nodosa and Kawasaki disease.

11

Accidental Poisoning

• Patientspresentedtouswith:• Keroseneorotherhydrocarbonintoxication• Organphosphoruspoisoning• Paracetamolpoisoning

• Toddlersweremorepronetopoisoning.

Accidental Poisoning

1.82

2 2 2Total- 10

0 81

1.21.41.6

1 1 1 1 1

00.20.40.60.8

0 0 0 0

•Patients presented to us with:p•Kerosene or other hydrocarbon intoxication •Organ phosphorus poisoning• Paracetamol poisoning

•Toddlers were more prone to poisoning.Infectious Disease/ Sepsis

• Spectrum of manifestations of sepsis included severe sepsis, septic shock and Multi Organ DysfunctionSyndrome(MODS).

Infectious Disease/ Sepsis

8 8

Total -53

5678

4 45 5

4

6 6 6

1234

1

3

1

0

•Spectrum of manifestations of sepsis included severe sepsis septic shock and Multi•Spectrum of manifestations of sepsis included severe sepsis, septic shock and Multi Organ Dysfunction Syndrome (MODS)

12

Metabolic/Genetic Disorders

• Thesepatientspresentedtouswith• Acidoticbreathing• Alteredsensorium• Jaundice• Hypoglycemia• Seizures

Metabolic/Genetic Disorders

4.55 5

Total Cases-19

22.5

33.5

4

2 2 2

3

2

00.5

11.5

2

0 0 0

1 1 1

•These patients presented to us with •Acidotic breathingg•Altered sensorium•Jaundice•Hypoglycemia •Seizures

Tropical diseases

• AmongthetropicaldiseasesDengueFever,Malaria,ScrubTyphusandChikungunyawerepredominant.• MaximalSurgeofpatientswithDengueFeverwasseeninSeptembertoNovember• Thesepatientspresentedtouswith-Shock,respiratoryfailure,ARDSandMODS• PatientswithCo-morbiditieswereathigherriskofcomplications.

Tropical diseases

1820 18 19

Total Cases-66

810121416

9

02468

3 3

0 0 1 13 4 5

•Among the tropical diseases Dengue Fever, Malaria, Scrub Typhus and Chikungunya werepredominant.p•Maximal Surge of patients with Dengue Fever was seen in September to November•These patients presented to us with - Shock, respiratory failure, ARDS and MODS•Patients with Co-morbidities were at higher risk of complications.

13

Traumatic Injury

• Commonestmodeofinjurywerefallfromheightandroadtrafficaccident.• Treatmentmodalitiesincriticallyillpatientsweremechanicalventilation,managementofshockandsometimes

decompressivecraniotomy• IsolatedTraumaticBrainInjurywasseenin20,isolatedabdominaltraumain2andpolytraumain5patients.

Traumatic Injury

910 10

Total Cases-35

45678

45

3 34

01234

0

2 2 23 3

0 0

•Commonest mode of injury were fall from height and road traffic accident.•Treatment modalities in critically ill patients were mechanicalventilation, management of shock and sometimes decompressive craniotomy•Isolated Traumatic Brain Injury was seen in 20, isolated abdominal trauma in 2 andpolytrauma in 5 patients.

14

Mechanical Ventilation in PICU

• Total448(59.1%)patientsrequiredventilatorysupportoutof758patientsadmittedinPICU.• NoninvasivemodalitieslikeNon–invasiveventilation(NIV)andhighflownasalcannula(HFNC)wereusedin

35%ofthepatients.• UseofnoninvasivemodesofventilationhasprogressivelyincreasedinourICUoverpastfewyears• Highfrequencyoscillationwasusedin8patients(3%)

Invasive Ventilation

29165%

NIV86

19%

HFNC71

16%

Indications of Invasive Ventilation

Indicationofmechanicalventilationinrecentyears:

2017 20161. RespiratoryFailure 32% 46%

2. Alteredlevelofconsciousness 53% 35%

3. CompromisedAirway 2% 3%

4. HemodynamicInstability 10% 12%

5. Electiveforsurgery 3% 4%

9232%

15653%

52% 30

10%

83%

Respiratory Failure

Altered level of Conciousness

Compromised Airway

Haemodynamic Instability

Elective for Surgical Procedure

15

Outcome of Mechanically Ventilated Patients

• Outof291mechanicallyventilatedpatients,wewereabletosuccessfullyextubate68%ofpatientsascomparedtoonly46%in2016.

• Outofthetotalpatientswhoweremechanicallyventilated,11%patientsexpiredascomparedto18%in2016

Extubated19768%

Expired32

11%

Transfer to Other ICU

3512%

Tracheostomy279%

Tracheostomy and Home Ventilation

• 27patients(outof291patientswhorequiredinvasiveventilation),neededtracheostomytomaintainairwayorforprolongedventilation.

• 3patientsweresentonhomeventilation.

00.5

11.5

22.5

33.5

43 3 3

0

3

2

3

1 1

0

4

2

16

Patients Outcome in 2017

• Outof758admittedpatients,majority (538)ofpatientswereshifted towardsafter improvement,90weredirectlydischargedfromPICU,67peopleleftagainstmedicaladvice(LAMA)and52patientsexpired.

Shifted to wards53872%

Discharged90

12%

LAMA679%

Death527%

System Wise Distribution of Expired Patients

Central Nervous System; 7; 13%

Cardio Vascular

System; 5; 10%

Gasterointestinal and Hepatic

Disease; 5; 10%

Haemato-Oncological

Disease; 15; 29%

[CATEGORY NAME], 7, [PERCE

NTAGE]

Renal Disease; 3;

6%

Respiratory Disease; 4; 8%

Trauma; 2; 4%

Dengue; 4; 8%

Total Death -52

17

PRISM Score of Patients at 24 hours

• PRISMScoreofmostofthepatientswerelessthan10.• Around9%ofthepatientshadPRISMscoremorethan20atadmission• HigherPRISMscoreatadmissionwasassociatedwithincreasedlengthofstayandincreasedmortality.

59.02%

22.26%

5.66%1.84%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0-10 >10-20 >20-30 >30

Correlation of PRISM 24 Score with Outcome

• HigherPRISMScoreswereassociatedwithincreasedmortalityrates.• MortalityrateswereevenhigherinpatientswithPRISMScore>20.

9.135

20.61

28.66

05

101520253035

ALL PATIENTS NON- SURVIVORS PATIENTS WHO EXPIRED WITHIN 48 HRS OF

ADMISSIONMean PRISM SCORE AT 24 HR OF ADMISSION

18

Quality Indicators

291

9.75

5.61

0.53

3.90

%

434

501

100

300

200

5

10

Num

ber

of P

roce

dure N

umbers/1000 days

Incidence of VAP

• MostcommonorganismsresponsibleforVentilatorassociatedPneumonia(VAP)inourICUwere-Acientobacterbaumanii,Klebsiellapneumonia,andE-coli.

• WeareworkingtowardsfurtherreductioninVAPincidenceinourICU.

9.618.19

11.799.61

6.28

13.6

8.77 8.4

5.52 5.98

13.98

6.57

0

5

10

15

January February March April May June July August September October November December

Mean Incidence is 9.75 Per 1000 ventilator days

19

Incidence of CAUTI

• MeanincidenceofCAUTIinourPICUis0.53per1000catheterdaysfor2017.

0

10

20

30

40

50

60

29 29

3731

3841 41 41

51

4438

17

0 0 06.45

0 0 0 0 0 0 0 0

No. of Foley's Catheteriation Rate of CAUTI

Incidence of CRBSI

• Bloodstreaminfection(BSI)hademergedasamajorkiller.• CommonorganismsresponsibleforCentralLineAssociatedBloodStreamInfections(CRBSI)were-Pseudomonas

aeruginosa,E-coli,Klebsiellapneumoniae

02468

109.7

5.2

0 0

9.7

7.35

0

4.143.13

7.27 7.16

4.03

Mean incidence of CRBSI is 5.61 Per 1000 central line days

20

Central Line Insertion

• Threesitesarecommonlyusedforpediatriccentralvenouscatheter(CVC)placement:femoral,internaljugularandsubclavianvein.• FemoralCVC-342lines,• InternalJugularCVC-104lines,• Subclavian-1lines.

• WeusedmostlytriplelumenCVCinourICU

0

10

20

30

40

50

2231 31 33 33 33 32

46 4438 41 38

Arterial Line Insertion

• Total-533lines,• Siteswhichare commonlyused forpediatricarterial lineplacement:Radial,Ulnar,Dorsalispedis,Posterior

tibial,Femoral.

0102030405060

3037

58

38

5043 43

33

52

39

5258

21

Chest Tube Insertion

• Atotalof43chesttubeinsertionweredoneinPICU• IndicationforChesttubeinsertion

1. Tensionpneumothorax2. Pleuraleffusion3. Empyema

01234567

32

01 1

56 6

43

5

7

Intracranial Pressure Monitoring

• ICPmonitoringwasdonefor15patientsinPICU• Mostofthepatientswereofseveretraumaticbraininjury.• WeuseIntraparenchymalcatheterforICPmonitoring.

0

0.5

1

1.5

2

2.5

3

2 2

0 0

2

1

0 0

1

2 2

3

22

Renal Replacement Therapy

• HDistheextracorporealexchangeoffluidandsolutethatoccursacrossanartificial,semipermeablemembranebetweenbloodanddialysisfluidthataremovinginopposite(countercurrent)directions.

• Wecommonlyusethismodalityforthepatientswithchronicrenalfailureoracuterenalfailure.• We also use CRRT in patients where there is hemodynamic instability and we need some type of renal

replacementtherapy.

32

0 0

21

3

01

5

1

56

11

0 0 0 0

6

45

8

65

01

01 1

0 0

3

5

3

12

0

2

4

6

8

10

12

CRRT HD PD

23

Number of Blood Transfusions in PICU

Age wise Distribution of Blood Transfusion

• InourPICU,wecommonly requiredPlatelet transfusions (300),RedBloodCell transfusions (399)andFreshfrozenplasmas(222).

• Patients with Sepsis, Dengue fever, fulminant hepatic failure and other comorbidities (Pediatric hemato-oncologicaldisease,Rheumatologicaldisease)usuallypresentedwithDICwhorequiredfrequenttransfusionwithPlatelet,FFP,CryoprecipitateandPRBCs.

• From the above chart we can see that patients with age of 5 years and above required more frequenttransfusions.

399

222

300

68 48

050

100150200250300350400450

PRBC FFP RDP cryoprecipitate SDP

148 134 123

226

406

0

50

100

150

200

250

300

350

400

450

Infants 1-2yrs 2-5yrs 5-10yrs >10yrs

24

Monthly Blood Transfusion

• Wecanseefromtheabovechartthatmaximumtransfusionwasrequiredinlast6monthsduetohigherrateofadmissionswithseveredenguefeverandseveresepsis.

82

65

45

75 69 64

119

100109

127

75

107

0

20

40

60

80

100

120

140

26

Intravenous Sedation Procedure Wise

• Above Pie chart depicts that maximum intravenous sedation was used in Pediatric Haemato-oncologydepartmentforBonemarrowaspirationandbiopsy&Lumbarpuncture,followedbyGIendoscopy,Radiology,FlexibleBronchoscopy,DentalProceduresandPICClineinsertion.

127, 13%

265, 27%

176, 18%

106, 11%36, 4%

9, 1%46, 5%

14, 1%14, 1%

190, 19% Bone Marrow Aspiration & Biospy

Endoscopy

Lumbar Puncture

Radiological Procedure

PICC Line Insertion

Drain Insertion

Bronchoscopy

Dental Procedures

Incision & Drainage

Others

Intravenous Sedation

• Weservepediatricsedationservicesacrossthehospitalforvariousoutpatientandinpatientprocedures.• Mostcommondrugsusedforsedationareketamine,midazolamandpropofol.

0

20

40

60

80

100

120

69 68

9990 88 87

101

7684 87 90

44

28

Pediatric Emergency Room Data

• Total 11,650patients attendedPediatric EmergencyRoom,outofwhich1413patientswere admittedandanother569patientsadvisedadmissionbuttheyleftagainstmedicaladvise(LAMA).

Total Attendance

1165086%

Admission 141310%

LAMA5694%

System-wise Distribution of Patients Admitted from Emergency

• Out of 1413 admissions, maximum patients admitted with gastrointestinal diseases (423) followed byRespiratory Disease (375), infectious diseases (338), Accidental Injuries (108), Renal Disease (36), Hemato–OncologicalDisease(36),CardiovascularDisease(33),CentralNervousSystemDisease(30),EndocrinologicalDisease(29)andpatientswithBurnInjury(5).

33 30

375423

29 36

338

108

536

050

100150200250300350400450

30

No. of Patients Admitted Per Month In PCS -ICU

Gender- wise Distribution

• Averagenumberofadmissionspermonth-30foryear2017.

• Aratioof2.1:1isobservedinmale:femaleadmissionsinourPCS-ICU.• Thistrendisverysimilartopreviousyears.

2123

28

32

24

29

35

4341

36

27

21

05

101520253035404550

January February March April May June July August September October NovemberDecember

Female11432%

Male24668%

31

Diagnosis of Patients Admitted for Cardiac Procedures

Monthly Cardiac Procedures

• Atotalof244cardiacsurgeriesand133cardiaccauterizationprocedureweredonein2017.

47

21 23 24 2219 21

31

1611

19

62 2

05

101520253035404550

NO. OF PATIENTS

NO. OF PATIENTS

1012

23

1815

1822 23

25

18 19

118

6

129

6

11

1713 13

17

129

0

5

10

15

20

25

30

CARDIAC SURGERYCARDIAC CATH

32

Outcome of Patients Admitted in PCS

Indications of ECMO in 2017

• Outof360patientsadmittedinourcardiacICU,91%patientsweredischargedhomeaftersuccessfultreatment.

• ECMOwas instituted inatotalof5patients in2017.Outofwhich3were inPCS ICUand2 inPICU.All thepatientswereputonV-AECMO.

DISCHARGED32391%

LAMA134%

DEATH195%

POST cardiac surgery

360%

Cardiogenic Shock

240%

34

Total FFB - 238

Month-Wise Distribution of FFB

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Bedside FFB Wards

81

23

9

125

Wards

PCS

NICU

PICU

20

12

24

16

23 24

1619 20

22

26

15

No of FFB

35

Bedside Flexible Bronchoscopy

• Intheyear2017therewere230bronchoscopiesweredone,outofwhich61bronchoscopiesweredoneinPICUand25weredoneinpediatriccardiacscienceICUunitonbedside.

0123456789

10

0

4

2

67

32 2

3

54

10

36

Indications of FFB

Persistent Atelectasis, 86

Persistent Oxygen requirement, 43Stridor, 21

Feeding difficulty, 5

Hemoptysis, 3

For BAL, 71

Trauma, 3

Foreign body aspiration, 18

38

Allergy Services

Allergy Testing

Distribution of Patients with different Panels of Allergy Test

• WehaverecentlystartedAllergyservicesatSGRH.• We are performing in-vivoAllergy testing (Skin test) to all refractory or persistent cases of allergies (aero-

allergenandfoodAllergen)inallagegroups.• WehavealsostartedfacilitiesforImmunotherapyforselectedcohortofallergypatients.

• Intheyear2017,87patientswereskintestedforvarioustypesofallergies.• Outofwhich68testsweredoneforaero-allergenand19weredoneforfoodallergy.

0123456789

10

7 7 7

98

9

6 6

8

5 5

10

0%

20%

40%

60%

80%

100%

Aeroallergen panelFood panel

48

9

20

10

CommonComprehensive

39

Age- Wise Distribution of Patients for Allergy Testing

Common Allergens Sensitization in Patients with Positive Aeroallergens

<1 year, 2

1-12 years, 58

12-18 years, 15

>18 years, 12

<1 year1-12 years12-18 years>18 years

40

Common Sensitization among Food Allergens

• Milk(44.4%)wasthepredominantfoodallergeninunder-fivechildrenpresentingwithallergicsymptoms.Egg(33.3%)andsoya(22.2%)wereonsecondandthirdplace.

• Bengalgram(63.6%)contributedmaximallyinolderchildrenandadolescents,whereasmilkwasresponsibleforallergicsymptomsinonly18.2%ofthesecases.

42

Research Papers (published/accepted)

Research Papers (poster/oral)

Conferences Conducted

Upcoming Conferences

• Safetyprofileofblindbronchial sampling–Aprospective study inpediatric intensivecareunit–PediatricPulmonology

• RefractoryHypoxemiainaninfant–AcaseforExtracorporealsupport• Pre-decannulationflexiblebronchoscopyintracheostomizedchildren–PediatricSurgeryInternational• Achallengingcaseofneonatalhyperparathyroidism.• Hospital-acquiredHyponatremiainPediatricIntensiveCareUnit–IndianJournalofCriticalCareMedicine• DisseminatedCryptococcosisinanimmunocompetentToddler–IndianPediatrics• Correctionto:CommonPediatricMedicalEmergenciesinOfficepractice–IndianJournalofPediatrics• UtilityofLipidSinkinTreatmentofRefractoryAcquiredMethemoglobinemia• Etiologyandriskfactorsdeterminingpooroutcomeofseverepneumoniainunder5children–IndianJournal

ofPediatrics

• MotorStereotypiesandAllergy:Aretheycousins?–WorldAllergyCongress,Florida• AirwayAnomaliesinCongenitalHeartDiseases:UtilityofbedsideFibreopticFlexibleBronchoscopy–NCPCC,

Chandigarh• Airway Anomalies detected in Neonates by Fibreoptic Flexible Bronchoscopy – experience of 7 years –

RESPICON,Bangalore• ClinicalprofileofpatientswithviralpneumoniainPICU–NCPCC,Chandigarh• Earlyenteralnutritioninpost-opinfantsaftercardiacsurgery–Apilotstudy–NCPCC,Chandigarh• MortalitypredictorsofDengue fever inPediatric IntensiveCareUnit in tertiaryhealthcarecenter– ISCCM,

Varanasi(won1stprize).

• PediatricRespiratoryCriticalCareConference–August2017• 23rdAdvancedCourseinPediatricIntensiveCare–October2017• 4thIntensiveReviewCourseinPediatricEmergencyMedicine(IRCPEM)–December2017• 4thPediatricNursingCriticalCareCourse–March2018• 2ndCMEonChildhoodAllergies–March2018

• PointofCare-CerebrocardiopulmonaryMonitoring&Management(POCCMM)-August2018• 24thAdvancedCourseinPediatricIntensiveCare-October2018• 5thIntensiveReviewCourseinPediatricEmergencyMedicine(IRCPEM)-December2018• 3rdInternationalCMEonChildhoodAllergies&8thRefreshercourseinAllergy&Asthma-March2019