Intensive care--a cost effective option for developing countries?

The estimation of cost-effectiveness of pediatric critical care services is an extremely relevant issue for both developing and industrialized nations. Pediatric critical care is expensive and the long outcomes are still relatively unclear. From the perspective of patients who receive the benefits of these services, there may be little controversy regarding cost-effectiveness. However, the issue becomes very complex when attempts are made to identify which patients will benefit most. This also needs to be considered while developing public policy when decisions for allocation of limited resources need to be made within health care systems, and choices need to be made between the provision of health care and other public services. This article addresses the complex issue of economic evaluations and describes various type of cost analyses. The difference between charges and costs is defined, and a discussion of the measurement of costs and benefits, and their relationship to outcomes research is provided. Although there is not a unique answer to the issue of cost-effectiveness for pediatric critical care services, the available literature particularly from the United States is summarized, and the ethical implications explored.

Perioperative management of the pediatric transplant patient.

With advances in surgical techniques, an increasing number of children are becoming transplant candidates. Pediatric critical care physicians may need to manage both transplant donors and recipients in the pediatric intensive care unit. Care of such patients needs to be performed aggressively with complete attention to details in order to obtain successful transplant outcomes. The postoperative management of the transplant recipient includes the basic intensive care monitoring and management of postoperative patients who are critically ill. Besides this, there are some unique features among these patients which may complicate the postoperative stay in the pediatric intensive care unit and these are discussed here. It is important to remember that the successful management of a transplant patient includes the pediatric critical care physician's abilities of not only taking care of acute issues but also of coordinating care between subspecialists. The pediatric critical care physician must always continue to provide support to families of these transplant patients during their intensive care unit stay.