Early detection of acute renal lesions by serum cystatin C in children at hospital and university Centre of Brazzaville

Acute Kidney Injury (AKI) is considered one of the main public health problems. The effective management of these alterations is based on the early detection of renal lesions. The objective of this study was to evaluate the contribution of the Cystatin C (CysC) assay in the early diagnosis of acute kidney injury (AKI) in children hospitalized in pediatric intensive care units in Brazzaville. MATERIALS AND METHODS Sixty children at high risk of developing AKI were included. Consent form signed was obtained from parents, socio-demographic data, weight and height of children recorded. Creatinine (Cr), CysC and urea were assayed in serum 24 hours after admission. Glomerular filtration clearance was estimated using serum creatinine and CysC. Glomerular filtration rate (GFR) was calculated from CysC and Cr. The diagnostic accuracy was determined by comparing the results of CysC to those of Cr (considered as a reference biomarker). RESULTS The median age was 5 years (with extremes ranging from 1 month to 17 years). Cr, CysC, urea, and GFR/Cr (mean ± standard deviation [range]) were 0.94±1.17 (0.2­ 1.4 mg/dl), 0.14 ± 0.062 (0.053-0.095 mg/l), 46.65±47.75 (15.0­45.0 mg/dl), 81.85±31.90 (≥190 ml/min per 1.73 m2 , respectively. The level of CysC in patients with ARL was significantly higher than that of children with normal renal function (p<0.001). Our results show that the performance of serum CysC in detecting AKI early was superior to that of serum Cr in children hospitalized in pediatric intensive care units in Brazzaville

Mortality in children hospitalised with respiratory syncytial virus infection in Singapore

INTRODUCTION@#This study aimed to investigate the trend and seasonality of infection due to respiratory syncytial virus (RSV) at KK Women's and Children's Hospital (KKH) in Singapore and to examine the risk factors for mortality among children with RSV infection requiring admission to the paediatric intensive care unit (PICU).@*METHODS@#A retrospective study was conducted at KKH on children with RSV infections who were admitted to the PICU between January 2004 and December 2010. The medical records of children who died from RSV infections were reviewed. Linear regression was performed to determine the risk factors for RSV mortality.@*RESULTS@#RSV infection was documented in 5,785 children during the study period; the infection was noted to be occurring throughout the year, with a small increase in prevalence between the months of June and August every year. Among 85 (1.5%) out of 5,785 children who were admitted to the PICU for RSV infection, 74 (1.3%) survived and 11 (0.2%) died. Multivariate logistic regression analysis showed that haemodynamically significant cardiac disease (odds ratio [OR] 12.2, 95% confidence interval [CI] 0.9-16.7, p = 0.05), immunodeficiency (OR 71.4, 95% CI 8.2-500, p < 0.001) and metabolic disease (OR 71.4, 95% CI 4.3-1,000, p = 0.003) were independent risk factors for mortality in RSV infections. Prematurity increased the risk of admission to the PICU but was not significantly associated with mortality.@*CONCLUSION@#Children with haemodynamically significant cardiac disease, immunodeficiency and metabolic disease were at higher risk of death after hospitalisation for RSV-related illnesses. These children should be considered for palivizumab prophylaxis.

Clinical profile and outcome of patients admitted to pediatric intensive care unit in a tertiary care teaching hospital of Puducherry, India

Background: This study was undertaken to know about the clinical profile and outcome of patients admitted in paediatric ICU in a tertiary care teaching hospital.Methods: This is a hospital based, retrospective, descriptive study, done on patients admitted to paediatric ICU of Sri Venkateshwara Medical College Hospital and Research Centre Puducherry from Jan 2019 - Dec 2019 (12 months).Results: As about 424 patients were admitted paediatric ICU. 79 patients were excluded from the study. Remaining 345 PICU patients were analysed. According to the age distribution of patients, it showed that < 1year were (25.2%), 1-5 years were (44.3%), > 5years of age were (30.4%). There was a female preponderance (58.8%), males were (41.1%). Patients from rural area were 243 (70.4%) and 102 (29.5%) from urban area. Clinical profile showed that pneumonia was the most common diagnosis (8.4%) for admission in PICU. This was followed by bronchiolitis (6.9%), enteric fever in (6.6%), febrile seizures (6.3%), poisoning (6.0%), renal problems (5.7%), occult bacteremia (5.5%), unknown bite (5.2%), acute severe asthma (4.9%), sepsis (4.6%), severe gastritis (4.3%), clinical dengue (3.7%), seizure disorder (3.4%), croup (3.1%), traumatic head injury (2.8%), wheeze associated LRI (2.6%), acute otitis media (2.3%), migraine (2.0%), meningitis (1.7%), CHD with complications (1.7%), severe anaemia with CCF (1.4%), acute urticarial (1.4%), foreign body (1.1%), electric shock (1.1%), scorpion sting (0.8%), viral hepatitis (0.8%), clinical malaria (0.8%), nephrotic syndrome with complications (0.5%), scrub typhus (0.2%) and (0.2%) was angioedema. The outcome noted was, (87.8%) were discharged, (10.7%) patients went against medical advice, (1.4%) patients were referred at parent's request.Conclusions: Respiratory illness, infectious diseases, neurological problems and poisoning are the most common cause for PICU admissions. But seronegative dengue cases, electric shock, reemergence of scrub typhus, are being increasingly diagnosed. So, emphasis is therefore placed on high index of suspicion for this type of conditions. We also recommend better manpower and infrastructure to improve the outcome of patients admitted to PICU.

Acute kidney injury in paediatric intensive care: need for extended vigil

Background: Acute kidney injury (AKI) is an important contributor towards morbidity and mortality among critically ill children. The objective of this study was to ascertain the etiological factors, categorize the severity and determine the immediate outcome of AKI among children admitted to the pediatric intensive care unit (PICU) of a tertiary referral hospital in south India.Methods: A prospective study was conducted from January to December 2012 in the PICU, Government medical college, kozhikode, a major referral hospital in north Kerala. The institutional ethics committee approved the study. Children in the age group of 1 month to 12 years admitted to the PICU for at least 48 hours were included if they had no previous renal disease/AKI at the time of admission. Serum creatinine levels of the children were measured at the time of admission, at 48 hours, and one month later. Outcome measures included normalization of serum creatinine or persistence of impaired renal function. Mortality was assessed both immediately and after one month.Results: A total of 1716 children were included in the study, of which 107 children developed AKI (6.2%). Among the 107 children, 56 children (52.3%) were boys. Majority of children were infants 75(70.1%). Infection was the commonest underlying condition'' associated with AKI. Most of the children with acute kidney injury were in the earliest phase (Stage 1). Twenty-six children (24.29%) died. Among the survivors, 10% were found to have impaired renal function when followed up a month later.Conclusions: There is a high incidence of AKI in critically ill infants admitted in PICU. Residual renal impairment can persist even after discharge from hospital and these children need follow up for a longer time.

Evaluación del uso de sedación y analgesia en niños con asistencia ventilatoria mecánica / Assessing the use of sedation and analgesia on children under mechanical ventilation / Avaliação do uso de sedação e analgesia em crianças com assistência ventilatória mecânica

Resumen: Objetivo: cuantificar el uso de sedoanalgesia en niños críticamente enfermos con asistencia ventilatoria mecánica (AVM) en la Unidad de Cuidados Intensivos (UCIN) del Centro Hospitalario Pereira Rossell (CHPR). Metodología: estudio observacional descriptivo y prospectivo realizado entre los meses de mayo a setiembre de 2017. Se incluyeron pacientes ingresados a UCIN que requirieron AVM y sedoanalgesia o mioparalización. Se registraron las siguientes variables: sexo, edad, peso, diagnóstico al ingreso. En relación con la sedación y analgesia se registraron dosis indicadas y recibidas de cada fármaco y las dosis acumulativas. Se las comparó con un estudio realizado en 2012 en UCIN. Resultados: se incluyeron 37 pacientes. El promedio de días de AVM fue de 3,7. La causa más frecuente de AVM fue patología respiratoria (n=34). Se observó discordancia entre dosis indicada y dosis recibida tanto de opiáceos, benzodiacepinas y paralizantes musculares, pero en menor medida que lo registrado en el año 2012. Las dosis acumulativas de midazolam, fentanyl y atracurio disminuyeron respecto al año 2012. Conclusión: se observó una disminución de las dosis promedio utilizadas de cada fármaco, de la duración de la AVM y una menor incidencia de síndrome de abstinencia. Las causas de esta observación pueden ser multifactoriales.

Summary: Objective: to quantify benzodiazepines and opioids dosages used in critically ill children under invasive mechanical ventilation (IMV) hospitalized in a Paediatric Intensive Care Unit (PICU). Methodology: an observational study was carried out from May to September 2017. It included children who under IMV hospitalized in a PICU and who were treated with benzodiazepines, opioids and/or neuromuscular blockers. These children key clinical features were recorded. Cumulative doses of benzodiazepines, opioids and neuromuscular blockers were recorded. Results were compared with the data obtained in a previous experience in the same PICU in 2012. Results: 37 children were included. IMV average duration of was 3.7 days. Cumulative doses and treatment duration of midazolam, fentanyl and atracurium decreased from 2012 to 2017. There were differences between the doses prescribed and the doses actually received in both periods. Conclusion: cumulative doses of benzodiazepines, opioids and neuromuscular blockers decreased in the 2012-2017 period.

Resumo: Objetivo: quantificar o uso da sedação e analgesia em crianças criticamente doentes com Assistência de Ventilação Mecânica (MAV) na Unidade de Terapia Intensiva (UTIN) do Centro Hospitalar Pediátrico Pereira Rossell (CHPR). Metodologia: estudo observacional descritivo e prospectivo realizado de maio a setembro de 2017. Incluíram-se pacientes internados em UTIN que necessitaram de MAV e sedação e analgesia e / ou bloqueadores neuromusculares. Registraram-se as seguintes variáveis: sexo, idade, peso, diagnóstico no momento da admissão. Foram registradas as doses indicadas e recebidas de cada droga de sedação e analgesia, assim como as doses cumulativas. Os resultados foram comparados com um estudo realizado em 2012 na UTIN. Resultados: incluíram-se 37 pacientes. O tempo médio de AVM foi de 3,7 dias. A causa mais frequente de MAV foi doença respiratória (n = 34). Observou-se dissonância entre a dose indicada e a dose recebida dos opiáceos, benzodiazepínicos e agentes paralisantes musculares, mas em grau menor do que o registrado em 2012. As doses cumulativas de midazolam, fentanil e atracúrio diminuíram em relação a 2012. Conclusão: observamos uma diminuição nas doses médias de cada droga utilizada, na duração da MAV e uma menor incidência de síndrome de abstinência. Esta observação pode ter causas multifatoriais.

Influence of nursing work environment on nurse job satisfaction from 25 hospitals in China / 中国实用护理杂志

Objective@#To describe job satisfaction of paediatric intensive care units in China, and analyze the relationship of nursing work environment between job satisfaction.@*Methods@#From November 2017 to May 2018, a total of 1 414 nurses of paediatric intensive care units from 25 hospitals of 16 provinces and cities nationwide in China were selected using convenient sampling, and surveyed by Nurses Job Satisfaction Scale and Practice Environment Scale. Descriptive statistics and Hierarchical multiple regression analysis were performed by SPSS 20.0.@*Results@#The average score of nurse job satisfaction of paediatric nurses was 3.29 ± 0.49, which was in the middle level in China. Hierarchical regression results showed that the area where the hospital was located, monthly income could affect the nurse job satisfaction, and nursing work environment played an important role for nurses job satisfaction, the model explained 73.1% amount of variance (R2=0.731, P<0.01).@*Conclusions@#The nursing work environment is the important factor influencing the nurses job satisfaction of paediatric intensive care unit, how to balance the domestic resources and reduce the regional differences, we work together to create a healthy environment in paediatric intensive care unit, further improving the nurses job satisfaction will be the important issues in the future.

Influence of nursing work environment on nurse job satisfaction from 25 hospitals in China / 中国实用护理杂志

Objective To describe job satisfaction of paediatric intensive care units in China, and analyze the relationship of nursing work environment between job satisfaction. Methods From November 2017 to May 2018, a total of 1414 nurses of paediatric intensive care units from 25 hospitals of 16 provinces and cities nationwide in China were selected using convenient sampling, and surveyed by Nurses Job Satisfaction Scale and Practice Environment Scale. Descriptive statistics and Hierarchical multiple regression analysis were performed by SPSS 20.0. Results The average score of nurse job satisfaction of paediatric nurses was 3.29 ± 0.49, which was in the middle level in China. Hierarchical regression results showed that the area where the hospital was located, monthly income could affect the nurse job satisfaction, and nursing work environment played an important role for nurses job satisfaction, the model explained 73.1％ amount of variance (R2=0.731, P<0.01). Conclusions The nursing work environment is the important factor influencing the nurses job satisfaction of paediatric intensive care unit, how to balance the domestic resources and reduce the regional differences, we work together to create a healthy environment in paediatric intensive care unit, further improving the nurses job satisfaction will be the important issues in the future.

An outbreak investigation of paediatric severe acute respiratory infections requiring admission to intensive care units – Fiji, May 2016

Introduction@#Influenza-associated severe acute respiratory infections (SARI) are a major contributor to global morbidity and mortality. In response to a cluster of SARI cases and deaths in pregnant women, with two deceased cases testing positive for influenza A(H1N1)pdm09, an investigation was initiated to determine whether there was an increase of paediatric SARI cases admitted to divisional hospital intensive care units in Fiji in may 2016 compared to May 2013–2015.@*Methods@#Retrospective case finding was conducted at the paediatric intensive care units (PICUs) in Fiji’s three divisional hospitals. Data were collected from 1 January 2013 to 26 May 2016. Cases were identified using a list of clinical diagnoses compatible with SARI. Results: A total of 632 cases of paediatric SARI with complete details were identified. The median age of cases was 6 months (Interquartile range: 2–14 months). Children aged less than 5 years had a higher rate of paediatric SARI requiring admission to a divisional hospital PICU in May 2016 compared to May 2013–2015 (Incidence rate ratio: 1.7 [95% CI: 1.1–2.6]). This increase was not observed in children aged 5–14 years. The case-fatality ratio was not significantly different in 2016 compared to previous years.@*Conclusion@#The investigation enabled targeted public health response measures, including enhanced SARI surveillance at divisional hospitals and an emergency influenza vaccination campaign in the Northern Division.

Déficit de vitamina D en niños ingresados en cuidados intensivos pediátricos / Vitamin D deficiency in children admitted to the paediatric intensive care unit

Introducción: La vitamina D posee múltiples acciones sobre el organismo: es necesaria para la salud ósea, la función cardiovascular y del sistema inmune. En adultos críticos, el déficit de vitamina D (DVD) es frecuente y se ha asociado a sepsis y a desenlaces clínicos desfavorables. Objetivos: Determinar la prevalencia del DVD y establecer su asociación con desenlaces clínicos relevantes en niños ingresados a una Unidad de Cuidados Intensivos Pediátricos (UCIP) en Concepción, región del centro-sur de Chile. Pacientes y método: Estudio de cohorte prospectivo observacional en 90 niños. Los niveles plasmáticos de vitamina D fueron medidos al ingreso en la UCIP. Se analizaron características demográficas, escalas de gravedad (PRISM, PELOD, VIS) y desenlaces clínicos. El déficit de 25OHD se definió como niveles < 20 ng/mL. Se determinó la asociación entre el DVD y desenlaces relevantes mediante el cálculo del riesgo relativo (RR). Resultados: El valor promedio (DE) de la vitamina D en toda la cohorte fue de 22,8 (1,0) ng/mL. La prevalencia del DVD fue del 43,3%. El DVD se asoció significativamente con el uso de fármacos vasoactivos (RR 1,6; IC 95%: 1,2-2,3; p < 0,01), ventilación mecánica (RR 2,2; IC 95%: 1,2-3,9; p < 0,01), shock séptico (RR 1,9; IC 95%: 1,3-2,9; p < 0,001) y necesidad de fluidos de reanimación > 40 ml/kg en las primeras 24 h (RR 1,5; IC 95%: 1,1-2,1; p < 0,05). Conclusiones: En este estudio, el DVD al ingreso en UCIP fue prevalente en pacientes pediátricos críticos y se asoció a desenlaces clínicos adversos. Se requieren más ensayos para determinar si la restauración rápida de los niveles de vitamina D permitiría mejorar los desenlaces clínicos en niños críticamente enfermos.

Introduction: Vitamin D is essential for bone health, as well as for cardiovascular and immune function. In critically ill adults vitamin D deficiency (VDD) is common, and is associated with sepsis and higher critical illness severity. Objectives: To establish the prevalence of VDD and its association with clinically relevant outcomes in children admitted to a Paediatric Intensive Care Unit (PICU) in Concepcion, Chile. Patients and method: Prospective observational cohort study in 90 consecutive children admitted to the PICU in a university general hospital. Blood was collected on admission to PICU and analysed for 25-OH-D levels. Severity of illness and vasopressor use were assessed using PRISM, PELOD, and vasoactive-inotropic score (VIS) score. VDD was defined as a serum 25-OH-D level < 20 ng/ml. Relative risks (RR) were calculated to determine the association between VDD and relevant clinical outcomes. Results: Mean (SD) serum vitamin D (25-OH-D) level in the cohort was 22.8 (1.0) ng/ml. The prevalence of VDD was 43.3%. VDD was associated with vasopressors use (RR 1.6; 95%CI: 1.2-2.3; P<.01), mechanical ventilation (RR 2.2; 95%CI: 1.2-3.9, P<.01), septic shock (RR 1.9; 95%CI: 1.3-2.9, P<.001), and fluid bolus > 40 ml/kg in the first 24 h of admission (RR 1.5; 95%CI: 1.1-2.1, P<.05). Conclusions: In this study, VDD at PICU admission was prevalent in critically ill children and was associated with adverse clinical outcomes. Further studies are needed to assess the potential benefit of optimizing vitamin D status in the PICU.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient’s length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ` 2,04,787 (US$ 3,413) and ` 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ` 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Impact of infection control training for interns on PICU-acquired bloodstream infections in a middle-income country

<p><b>INTRODUCTION</b>The present study aimed to determine the impact of an extended infection control training programme, which was conducted for all interns posted to the Department of Paediatrics, on the incidence of paediatric intensive care unit (PICU)-acquired bloodstream infections (BSIs) in University Malaya Medical Centre, Malaysia.</p><p><b>METHODS</b>The development of nosocomial BSIs during the baseline period (1 January-31 October 2008) and intervention period (1 November-31 December 2009) was monitored. During the intervention period, all paediatric interns underwent training in hand hygiene and aseptic techniques for accessing vascular catheters.</p><p><b>RESULTS</b>A total of 25 patients had PICU-acquired BSIs during the baseline period, while 18 patients had PICU-acquired BSIs during the intervention period (i.e. infection rate of 88 per 1,000 and 41 per 1,000 admissions, respectively). The infections were related to central venous catheters (CVCs) in 22 of the 25 patients who had PICU-acquired BSIs during the baseline period and 11 of the 18 patients who had PICU-acquired BSIs during the intervention period. Thus, the incidence rates of catheter-related BSIs were 25.2 per 1,000 CVC-days and 9.3 per 1,000 CVC-days, respectively (p < 0.05). The Paediatric Risk of Standardised Mortality III score was an independent risk factor for PICU-acquired BSIs and the intervention significantly reduced this risk.</p><p><b>CONCLUSION</b>The education of medical interns on infection control, a relatively low-cost intervention, resulted in a substantial reduction in the incidence of PICU-acquired BSIs.</p>

Clinical features and diagnosis of severe tuberculosis infection in PICU / 中国小儿急救医学

Objective To explore the clinical features and diagnostic methods of tuberculosis infection in PICU,and improve the understanding of tuberculosis.Methods We analysed the clinical features and diagnostic methods of severe tubercle bacillus infectious diseases in PICU from Jan 2009 to Dec 2012.Severity of disease was graded by pediatric critical illness score.The diagnosis of the pulmonary tuberculosis was in accord with the diagnostic criteria of paediatric pulmonary tuberculosis established by Chinese Medical Association paediatrics branch.And the diagnosis of tuberculosis meningitis and tuberculosis peritonitis based on the clinical physical examination,laboratory examination and pathologic finding.Results Among 22 cases enrolled in this study,totally 16 cases were pulmonary tuberculosis,6 cases were extrapulmonary tuberculosis,and 3 cases were tuberculosis meningitis.The clinical feature of severe tuberculosis infection in PICU was accompanying with one or multiple organ dysfunction besides tuberculosis infection symptom,among them,respiratory dysfunction occurred in 16 cases,cardiovascular dysfunction was observed in 2 cases,and central nervous system dysfunction was found in 3 cases,even 1 patient experienced cardiovascular system dysfunction,respiratory disorder as well as gastrointestinal system dysfunction simultaneously.Sixteen cases of pulmonary tubercle bacillus infection manifested respiratory failure besides fever,cough,shortness of breath and tuberculosis toxicosis symptom,2 cases of them developed into acute respiratory distress syndrome,8 cases needed mechanical ventilation.Two cases of pericardial effusion presented cardiac tamponade.The level of adenosine deaminase elevated in 12 cases,and the positive result of enzyme-linked immunospot assay for tubercle bacillius was observed in 14 cases.Conclusion It is very important to be aware of that severe tubercle bacillus infection exist in critically ill patients admitted in PICU,measuring the level of adenosine deaminase and taking enzyme-linked immunospot assay for tubercle bacillius test are important accessory examination for tuberculosis diagnosis in children.

Deaths in a paediatric intensive care unit: A review over three years.

Background: Deaths in paediatric intensive care units (PICUs) are sometimes unavoidable. The decision to withdraw or withhold treatment is important especially in places where there are limited resources. Objective: To evaluate the modes of death and underlying diseases of patients’ deaths in a PICU. Method: We retrospectively reviewed the clinical features and management of consecutive non-survivors in the PICU at a tertiary care University Hospital in a developing country over a three-year period. Results: Of 1,389 admissions, 110 (8%) patients died. The median age of the deaths was 4.1 years. Most (86%) patients had underlying diseases including congenital heart diseases (27%) and malignancies (23%). Forty-seven patients died with active treatment (AT), 60 died with life support limitation (LSL), and 3 had brain death (BD). The median length of stay (LOS) in AT group was 3 days and this was not significantly different (p=0.056) from the median LOS in LSL group which was 5 days. LOS less than 3 days, postoperative cases and underlying diseases of the cardiovascular system were factors associated with the AT group. The three common complications leading to death were multi-organ failure, septicaemia with septic shock and respiratory failure. Conclusions: Congenital heart diseases and malignancies were the two common underlying diseases found in non-survivors. LSL was the common mode of death in PICU.

Establishment of Paediatric and Neonatal Intensive Care Units at Patan Hospital, Kathmandu: Critical Determinants and Future Challenges.

Introduction: Although preventive medicine and primary care are priorities in developing countries, they must be supported by appropriate care of sick and extremely sick children in the medical facilities. Lack of resources and absence of skilled physicians and nurses may lead to poor outcomes in critically ill patients. Intensive care of newborns and children is thought to be very expensive with a low cost-benefit ratio. This presentation discusses the critical factors that facilitated the establishment of PICU and NICU in an urban public hospital in Nepal, where a good standard of Level 2 care was already provided. Aims and objectives: A cooperative model of creation and transfer of technology from the West to a resource-poor country was envisaged. PICU and NICU with six beds each were established. Design and setting: The Nick Simons Foundation, USA provided financial support for design, building and furnishing of a new Mother and Child Wing at Patan Hospital. A generous grant of $300,000 again by the Nick Simons Foundation helped equip the units. Donated equipments also included procedures, medication and storage carts. Methodology: A total of 22 volunteers, 21 from USA and one from Netherlands, were recruited to complete the three months of training. An extensive curriculum was prepared. The trainer team had monthly teleconferences and regular communications with the Chief of Paediatric Services and Nursing Director of Patan Hospital via e-mails and telephone. Responsibilities of volunteers and the host hospital were identified. Results: After 3 years of preparation, the project started in June 2009. All day lectures on topics in critical care, mock case scenarios, practical equipment training and simulated procedures led to the graduation of 60 nurses. Twenty five physicians were trained for three months. The expert team worked with the locals in preparing the units, arranging furniture and equipment, stocking carts, making inventory and preparing protocols. A protocol handbook was developed on topics such as mechanical ventilation, sedation, admission/discharge criteria, procedures and management of different disease states. Various charts such as nurse observation charts, notes by residents, procedure hand offs at change of shifts were designed and printed. Infection control practices and methods of sterilizing non disposable articles were identified and protocols written. At the end of three months the units were functioning with trained local manpower and reasonable modern equipment. Conclusion: Developing nations may not have enough resources to establish much needed critical care facilities. Developed countries can help by funding basic infrastructure and providing expertise in order to transfer knowledge and technology. Involvement in planning from the beginning and training at the host site is a preferred model of transfer of technology.