Aims & Objectives:
To describe organizational characteristics and resources of PICUs in Latin-America.
Web-based survey submitted to Latin-American PICUs.
50 out 98 centers responded the survey from 10 countries (38% Chile, 20% Uruguay, 20% Argentina). Centers characteristics: 66% public, 74% mixed [intermediate (IMCU) and intensive care (PICU)], 76% academic, 24% have critical care training program. PICU beds median 7(6,12) and IMCU 6(5,10). Physician/patient ratio was 0.3(0.2,0.5) and 0.25(0.16,0.4) for PICU and IMCU (p<0.05 for difference between centers). 24h intensivist presence was full in 56%, but <50% in 32% centers. Nurse/patient ratio was 0.5 (0.33,0.5) and 0.33 (0.2,0.5) for PICU and IMCU; nurse technician(clinical-assistant)/patient ratio 0.33 (0.25,0.5) (p<0.05). 37% centers had respiratory therapist dedicated to ICU, 54% available during night shift. Clinical protocols use for cardiac arrest 94%, Sepsis 80%, MV 78%, weaning 66%. All centers have invasive and non-invasive MV, HFNC was available in 78%. Scores use for pain56%, sedation62%, withdrawal42% and delirium12%. Severity scores use: PIM2/3 70%, PRISM 26%, PELOD 24%. Basic monitoring was available in all centers; advanced monitoring availability: cardiac output 26%, PAC 6%, FHM 32%, NIRS 22% and volumetric capnography 50%. Rescue therapies available: iNO50%, surfactant60%, TRRC60%, ECMO16%, TTM48%. 24h blood chemistry, Blood cultures and CRP were available in all centers, but lactate only in 94% and procalcitonin 64%.
This survey highlights substantial variation in critical care organization and resources in Latin-American PICUs. These disparities must be considered for guidelines and collaborative interventional studies. On future research, is the impact of these differences on clinical outcomes will be studied.