27 Sep :The First Asian Congress of Pediatric Intensive Care and 11th National Conference of Pediatric Critical Care concluded on Sunday. A number of symposia and a panel discussion were held.
In the symposium on cardiac intensive care, Dr Aparna Hosekote from UK spoke about the early detection of low cardiac output and ways to treat the same. Dr Hosekote stressed that the early signs of heart failure in children were often subtle and it was important to have a high index of suspicion to detect and treat it in time. She extensively discussed low cardiac output state in the context of post- cardiac surgery. Dr S Menon from USA discussed the pre- and post-operative stabilization of cardiac patients. Cardiac surgeries of congenital heart diseases in children are being commonly performed in many centres these days. The success of the surgery often depends on the quality of intensive care provided to such patients. Dr Vikas Kohli from Delhi discussed the problems of myocarditis (i.e. inflamed heart) and cardiomyopathies (i.e. weak heart muscle).
An important symposium was held on tropical infections. Dr Suchitra Ranjit from Chennai spoke on the management of Dengue. She said that the severe form Dengue is that which causes bleeding, drop in blood pressure and leaky blood vessels. She emphasized that early aggressive fluid management and intensive monitoring were the cornerstones of treatment. Admission to an ICU is indicated for children with who have low blood pressure, breathing difficulty, abnormal bleeding, unconsciousness, liver or kidney dysfunction. Dr B Ramachandran from Chennai discussed the ICU management of severe complicated malaria. He said that malaria, which is otherwise a common tropical disease, can occasionally have devastating consequences like brain infection, liver and kidney failure. He discussed about the management of these difficult situations, including the use of intravenous anti-malarial drugs such as quinine and artemesine. Dr Jayashree from PGI talked about the ICU management of cases of diphtheria. She said that diphtheria can cause severe breathing difficulties and heart failure.
An interesting symposium was held on the topic “Challenges in PICU care- a typical day in my PICU”. Chaired by Prof Sunit Singhi, this session had speakers from several Asian countries- India, China, Malaysia, the Phillipines, Nepal, Sri Lanka and Bangladesh- discussing about the workload and working patterns in their respective ICU’s. It gave the speakers and delegates an opportunity to learn from the experiences of others.
In the symposium on kidney and liver failure, Dr N Tsoi from Hong Kong spoke about liver failure due to infections (primarily hepatitis viruses) and toxins. Dr Uma Ali from Mumbai discussed about acute kidney failure and ways to support the failing kidney, including various modes of dialysis, in children. Dr Devictor from France discussed issues regarding kidney and liver transplantation in children. He said that these were highly technologically demanding procedures but the results were gratifying. He said that in developing countries, strict legislation and regulations have been established. However, in poorer countries, organ trading or trafficking, transplantation tourism and commercialism still exist. Financially prosperous patients travel to poorer countries and have organ transplant performed. Recipients of the “vended” kidneys are educated, rich and often self-selecting. Their outcome is poor, which will leave them poorer still and back to dialysis if not death. Recently the Declaration of Istanbul on Organ Trafficking and Transplant Tourism has clearly stated that transplant tourism and commercialisation must be prohibited.
A panel discussion was held on the organization of training programs in critical care. Moderated by Dr S Udani from Mumbai, the panelists were Dr Irene Chan, Dr N Kissoon, Dr Andrew Argent, Dr Sunit Singhi, Dr Kishan Chugh and Dr Pravin Khilnani. The panelists felt that each country had to develop their own guidelines and curriculum to suit local needs.
The Asian Congress ended with a unique symposium on terminally ill children in the ICU. This was chaired by Prof BNS Walia, the ex-Head of Department, who is the brain behind the Advanced Pediatric Centre of PGI. Dr Jefferson Piva from Brazil and Dr D Devictor from France spoke about end-of-life-care decisions and about the role of spirituality in the Pediatric ICU, respectively. The speakers agreed that decisions regarding terminating life care were fraught with many psychological, legal, ethical and emotional ramifications. Such decisions had to be made keeping in mind the legal framework of the country and in a sensitive and humane manner. Dr Devictor said that spiritual support is a key indicator of quality for end of life care in an ICU. According to the American College of critical care Medicine, four recommendations should be proposed: (1) Spiritual needs of the patient are assessed by the healthcare team, and findings that affect health and healing incorporated into the plan of care. (2) Physicians will review reports of ancillary team members such as social workers, and nurses to integrate their perspectives into patient care. (3) Nurses and doctors receive training in awareness of spiritual and religious issues so that they may properly assess patients and make use of findings in the plan of care. (4) If a patient requests that a healthcare provider pray with him or her, and the healthcare worker agrees to and feels comfortable with it, the request is honoured and considered to be part of the spectrum of holistic intensive care.
The 4-day Congress- the first of its kind- was an academic feast for all the delegates who attended from various parts of Asia. It laid down the agenda of taking pediatric critical care to the masses who live in every corner of this vast continent.