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      Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

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          Abstract

          Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU) is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

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          Most cited references33

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          Critical care delivery in the intensive care unit: defining clinical roles and the best practice model.

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            A history of pediatric critical care medicine.

            Critical care medicine developed out of other subspecialties' need to provide care for their most critically ill patients. Advanced technologies, the understanding of the pathophysiology of critical illness, and the development of the multidisciplinary team have made this care possible. Pediatric critical care medicine emerged in the 1960s and has expanded dramatically since then. The field has made major advances in the areas of lung injury, sepsis, traumatic brain injury, and postoperative care. We review here the evolution of modern pediatric critical care medicine from its roots in general pediatric and cardiac surgery, adult respiratory care medicine, neonatology, and pediatric anesthesiology to its current state as a unique discipline.
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              The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery.

              The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/].
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                Author and article information

                Journal
                Ann Pediatr Cardiol
                APC
                Annals of Pediatric Cardiology
                Medknow Publications (India )
                0974-2069
                0974-5149
                Jan-Jun 2010
                : 3
                : 1
                : 40-49
                Affiliations
                Pediatric Cardiac Intensive Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
                [1 ]Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India
                [2 ]Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
                Author notes
                Address for correspondence: Dr. Krishna Kumar, Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Kochi- 682 041, Kerala, India. E-mail: rkrishnakumar@ 123456aims.amrita.edu , kumar_rk@ 123456yahoo.com
                Article
                APC-3-40
                10.4103/0974-2069.64374
                2921517
                20814475
                a6ee3542-e73f-4b4f-8c2b-0a315c2c1a76
                © Annals of Pediatric Cardiology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Mini Symposium: Postoperative Care

                Cardiovascular Medicine
                developing country,critical care,congenital heart surgery
                Cardiovascular Medicine
                developing country, critical care, congenital heart surgery

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