Secondary Logo

Institutional members access full text with Ovid®

Current State of Pediatric Intensive Care and High Dependency Care in Nepal*

Khanal, Aayush MD; Sharma, Arun MD; Basnet, Sangita MD, FAAP, FCCM

doi: 10.1097/PCC.0000000000000938
Feature Articles

Objectives: To describe the state of pediatric intensive care and high dependency care in Nepal. Pediatric intensive care is now a recognized specialty in high-income nations, but there are few reports from low-income countries. With the large number of critically ill children in Nepal, the importance of pediatric intensive care is increasingly recognized but little is known about its current state.

Design: Survey.

Setting: All hospitals in Nepal that have separate physical facilities for PICU and high dependency care.

Patients: All children admitted to these facilities.

Interventions: None.

Measurements and Main Results: A questionnaire survey was sent to the chief of each facility. Eighteen hospitals were eligible and 16 responded. Two thirds of the 16 units were established in the last 5 years; they had a total of 93 beds, with median of 5 (range, 2–10) beds per unit. All 16 units had a monitor for each bed but only 75% could manage central venous catheters and only 75% had a blood gas analyzer. Thirty two percent had only one functioning mechanical ventilator and another 38% had two ventilators, the other units had 3–6 ventilators. Six PICUs (38%) had a nurse-to-patient ratio of 1:2 and the others had 1:3 to 1:6. Only one institution had a pediatric intensive care specialist. The majority of patients (88%) came from families with an income of just over a dollar per day. All patients were self funded with a median cost of PICU bed being $25 U.S. dollars (interquartile range, 15–31) per day. The median stay was 6 (interquartile range, 4.8–7) days. The most common age group was 1–5. Sixty percent of units reported respiratory distress/failure as their primary cause for admission. Mortality was 25% (interquartile range, 20–35%) with mechanical ventilation and 1% (interquartile range, 0–5%) without mechanical ventilation.

Conclusions: Pediatric intensive care in Nepal is still in its infancy, and there is a need for improved organization, services, and training.

1Department of Pediatrics, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

2Division of Critical Care, Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL.

*See also p. 1089.

This work was performed at the Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail:

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies