Subject: Proposal for Establishment of Pediatric Intensive Care Unit (PICU)
To
The Dean
MAKNG Medical College Hospital
Respected Madam,
The current infrastructure of the hospital, specifically concerning the Pediatric wards, has been
reviewed in consultation with the Hospital Architect and the approved building layout.
As per the existing hospital design:
• Pediatric inpatient services are located on the 2nd Floor of the hospital building.
• A total of 60 beds have been allocated for Pediatric Wards:
o Ward 1: 30 beds
o Ward 2: 30 beds
• 33 beds have been designated for the Neonatal Intensive Care Unit (NICU).
However, it is observed that no provision currently exists for a Pediatric Intensive Care Unit
(PICU).
In accordance with the National Medical Commission (NMC) guidelines, a total of 75 beds are
required for the Pediatrics specialty. The proposed bed allocation is as follows:
1. Neonatal ICU (Level 2B NICU): 12 beds
2. Pediatric ICU (PICU): 12 beds + 1 Isolation Room
3. Pediatric Ward: 50 beds
The requirements for human resources, equipment, and consumables for the Neonatal ICU have
already been submitted separately. This proposal specifically pertains to the establishment of a
12-bed Pediatric ICU (PICU), which may be accommodated within the existing area allocated
for Pediatric Wards.
Your kind consideration and approval for initiating this process will be highly appreciated. If
agreed, it is requested that the Hospital Architect, through the Director, MASNG Hospital, may
be instructed to take necessary steps to identify and plan the required space.
A detailed plan is enclosed for your reference.
Yours sincerely,
Dr. Anil Kumar Gupta
Assistant Professor (Pediatrics)
Plan for Setting Up Pediatric Intensive Care Unit
No. of Beds :
12 beds : 4 ICU Beds & 8 HDU Beds to start with / or all 12 ICU Beds
Location
• Adjacent to the pediatric ward for quick transfer of children
• Should have a lift nearby for quick transfers from ED, OT, Other wards, etc.
• Laboratory facilities must be in close vicinity.
Lay Out
• U Shaped : U-shaped layout around the central station allows actual
visualization of all patients from a central station
• 12 cubicles/room: Each cubicle of area : 100-150 sq feet
• 1 Isolation Room: Rooms/cubicle with sliding glass doors for taking care of
patients with infectious diseases. Cubicle / room area (200–250 sq. ft), should
have a negative pressure ventilation. An ante room (separate area at least 20
square feet for hand washing and wearing mask and gown) should be there.
• At least one wash basin facility for two beds (preferably 1 per bed)
• Walls, ceilings and the floor should be smooth, non-porous and easy to clean.
All edges must be coved to minimize accumulation of dust.
• Zones for sterile preparation of medicines and intravenous fluids and cabinets,
including a refrigerator should be made available for storing medications and
supplies.
• Access to windows and natural lighting is desirable to prevent a sense of
isolation for the patients and to save energy during the daytime.
• The unit should have a scrub station, a staff changing area with locker facilities,
at least one doctor's duty room, an intensivist's office, a storage facility for
drugs, linens, stationary and other essential items, a medication preparation
area, and a counselling room preferably within the main unit.
• A family waiting room just outside the unit and a receptionist's desk for general
queries and visitation control are recommended for smooth functioning.
• The unit should be manned by security personnel and always be preferably
under electronic surveillance
Beds
• Beds should have removable headboards for easy access during airway
management, maneuverable head and foot end, and railings to prevent
accidental falls.
• Availability of 2 or more air/water mattresses to prevent bed sores.
• Each bed should have an emergency alarm button for the nurse or intensivist to
activate code system for emergencies. An intercom at each bed is desirable.
• Privacy curtains around each bed should be cleaned every 3–4 days
• A bed side cabinet with drawers for storing patient-specific medicines with a
side pouch for keeping radiology films, patient records and treatment charts
and a broad, smooth, easy-to-clean, nonporous surface for keeping the
monitoring chart should be placed at the foot end of each bed.
Monitoring
• ECG, RR, SpO2, NIBP for all beds. Invasive BP monitoring for at least 50% beds
• In house and 24 hours for CBC, RFT, LFT, Coagulation studies, ABG and lactate.
Mechanical Ventilation
• Each of 4 ICU beds should be equipped with one mechanical ventilator
• Should have NIV (CPAP, BiPAP) and HFNC
Air conditioning & power supply
• Unit should be centrally air conditioned and should have central heating for
temperature control.
• Air flow should be always from a clean to dirty area.
• Unit should have an uninterrupted power supply by means of backup power
sources such as invertors and generators.
Medical gas supplies and electrical circuits per bed
• Located near the head end 2 feet away.
• 2 outlets, each O2, Air, & Vacuum suction
• 10 electrical outlets per bed
Crash carts:
• Number: 2
• Location: At two ends of the PICU
• Stocked with all emergency and essential drugs &
• Portable monitor/defibrillator
Central Station
• A central station should provide visibility to all patient areas.
• It should have ample area to have capacity for all necessary staff functions.
• Patient records should be easily available.
• Adequate space for 2 computers, printers and central monitor is essential.
• Ample space for staff to write on patient files, and space for unit secretarial staff
is essential.
• At least 2 telephone lines should be available. If possible, a telephone line may
be dedicated to incoming calls only to facilitate critical care transport requests
or other urgent calls.
Blood Bank
• 24 hours access to blood bank
Human Resource
• PICU In charge: 2 PICU Consultants : Trained Pediatricians
• Medical StaK: Senior Residents: 04, Junior Residents: 04
• Nursing StaK: 1 S/N In charge (ALS Trained) , 1 S/N per ventilated beds per shift , 1
S/N for 3- 4 HDU beds per shift (24-25 StaK Nurses)
• Specialty Support: Anesthesia, Surgery, and Radiology, Pathology, Microbiology
• Support staK:
-Ward attendant (5), Cleaning staO (5), Security personal (5), Data entry oOicer/
clerk (1)
Admission Criteria
1. ICU Bed Admission
• All patients requiring mechanical ventilation
• Patients with impending respiratory failure
o Upper airway obstruction
o Lower airway obstruction
o Alveolar disease
o Unstable airway,
o Increasing O2 requirements to maintain acceptable saturation
• Altered sensorium ( Hepatic encephalopathy, Cerebral malaria, status epilepticus,
head injury, poisoning)
• Hemodynamic instability (shock of all types, hypertensive emergency), massive
blood loss, cardiac arrythmia, RTA, Cardiogenic shock - myocarditis,
cardiomyopathy, congenital heart disease
• Bleeding emergencies such as gastrointestinal bleeding, bleeding diathesis,
Disseminated Intravascular Coagulation.
• Severe acid base disorders, Severe electrolyte abnormalities
• Malignant hyperpyrexia
• Renal failure patients with dys-electrolytemia, those requiring PD/HD/RRT
• Acute Hepatic Failure , bleeding diathesis, etc.
• Post operative patients needing prolonged care or monitoring
• All patients after successful resuscitation
• Critical diseases: ARDS, Sepsis, Septic Shock, MIS-C, etc
2. HDU Bed Admission (step down)
• All ward patients requiring close monitoring due to potentially unstable conditions.
• Croup (laryngotracheobronchitis) requiring oxygen.
• Asthma requiring hourly nebulization/getting tired with increasing oxygen
requirement/mental status change.
• All patients requiring more than 50% oxygen to maintain saturations.
• Closed head injury/skull fracture admitted for observation.
• Diabetes ketoacidosis with pH <7.2.
• Patients with episodes of apnea.
• Patients with significant abdominal trauma with suspected renal/splenic/hepatic injury.
• Severe dehydration with mental status change.
• Post-operative patients after major surgery with significant post-operative pain/blood
loss/stress.
• Patients recovering from critical illness but requiring close monitoring
Discharge criteria
• Once the primary indication for admission is taken care of and the child has
recovered without complications, discharge or transfer to step down unit should
be planned.
• Timely transfer from ICU is equally important to reduce costs and secondary
infections.
• It is important that each child is given a written PICU transfer summary with a
plan that can be followed during the further hospital stay or at home as the case
may be
Parent's counselling
• The PICU setup should have a dedicated area for counseling the parents and
caregivers.
• Counselling should be done by a reasonably senior member of the team who
understands the disease process, parental concerns, and medicolegal issues.
Annexure
• Equipment & Consumables
• Drugs & Medicines
Consumable/Non-Consumable Required (Ref. J Paeditr Crit Care): Can be readjusted
/modified
Drugs/Medicines ( Ref. J Paeditr Crit Care) : Can be readjusted /modified
