Intensive Care 2018-05-09T15:27:09+00:00

Medical Services Intensive Care Unit (ICU)

A peaceful environment is vital during one of the most challenging times in life—looking after a critically ill family member. Thus, we have provided lounges adjacent to the Operating Rooms and Intensive Care Units, where family and friends may wait in a private and tranquil environment.

The Asian Hospital and Medical Center’s 35-bed Medical Intensive Care Unit is composed of the following:

  • Cardiovascular surgery intensive care
  • Coronary care
  • Medical surgical intensive care
  • Neonatal intensive care

Environment

A peaceful environment is vital during one of the most challenging times in life—looking after a critically ill family member. Thus, we have provided lounges adjacent to the Operating Rooms and Intensive Care Units, where family and friends may wait in a private and tranquil environment.

Neo Natal ICU

This subspecialty provides comprehensive secondary and tertiary care for newborns in need of intensive care. We have a state-of-the-art 10-bed Neonatal Intensive Care Unit (NICU). The unit is fully equipped for hemodynamic and invasive as well as noninvasive monitoring. A pediatric neonatologist / intensivist provides coverage for all NICU patients 24 hours a day.

The unit is also staffed by specially trained pediatric intensive / neonatology care nurses. We provide critical care for a wide range of patients, including those with respiratory failure, circulatory failure, sepsis, meningitis, multi-system failure, and unusual or perplexing diagnoses. Our team also cares for postoperative cardiac surgery and organ transplant patients, and is responsible for all patients, medical or surgical.

In the Huggery (nursery), we care for newborns with routine care requirement. Consultations with pediatric sub-specialists are available as required.

Pediatric ICU

POLICY STATEMENT

The Department of Pediatrics, Section of Pediatric Critical Care of the Asian Hospital and Medical Center (AHMC) aims to be a world class pediatric critical care unit that seeks to provide state of the art intensive care and shall fulfill the following objectives:

  1. To improve health care delivery to the critically ill child with due medico-moral and ethical considerations;
  2. To reduce morbidity and mortality among critically ill children via an effectual and competent medical and nursing staff and state of the art monitoring; and
  3. To provide higher pediatric training to its staff through research, evidence based journal review and case discussion.

GUIDELINES

I. Administrative policies:

  • The Section of Pediatric Critical Care shall be under the Department of Pediatrics in which a section head shall be appointed, based on the existing policies of the Asian Hospital Medical Center. The head of the section shall develop policies for the section as well as maintain the standards of the facility and the medical staff.
  • The head of the section shall also have administrative jurisdiction over all active associate active and visiting PICU physicians.
  • All active PICU staff members shall have decking privileges on all walk-in patients (outside referrals/ER) who shall be admitted into the unit, unless prior arrangements with an associate active/visiting PICU staff member have been made by the referring physician/institution.
  • Associate active/visiting PICU physicians may be referred patients upon the request of an active staff member of the AHMC.
  • All mechanically ventilated patients shall be referred to or co-managed by a pediatric intensivist/pulmonologist/neonatologist.
  • All patients not under the pediatric service who require PICU monitoring/admission (i.e. post-op) shall be referred to or co-managed by any pediatric staff member of the hospital.

II. Admission Criteria

All neonates, infants and children admitted to the AHMC who need closer observation, monitoring and treatment as deemed necessary by the ER officer/attending physician/pediatric House Staff with the following medical criteria shall be admitted into the PICU:

Respiratory System

All patients with severe or potentially life threatening pulmonary or airway disease.  Conditions include, but are not limited to:

  • Tracheal intubation or potential need for emergency tracheal intubation and mechanical ventilation, regardless of etiology
  • Rapidly progressive pulmonary disease (lower or upper airway) of high severity with risk of progression to respiratory failure and/or total obstruction
  • High supplemental oxygen requirement (FiO2>5), regardless of etiology or requirement for CPAP
  • Acute barotraumas compromising the upper or lower airway
  • Requirement for more frequent (<Q4 hrs) or continuous inhaled or nebulized medications that can be administered safely in the general pediatric patient care unit.

Cardiovascular System

All patients with severe, life-threatening, or unstable (i.e.hypo- or hypertensive) cardiovascular disease.  Conditions include, but are not limited to:

  • Shock
  • Post-cardiopulmonary resuscitation
  • Life-threatening dysrhythmias
  • Unstable congestive heart failure, with or without need for mechanical ventilation
  • Congenital heart disease with unstable (i.e hypotensive) cardio-respiratory status
  • After high-risk cardiovascular and intra-thoracic procedures (i.e. pericardiocentesis, thoracostomy, PA catheter insertion)
  • Need for monitoring of arterial, central venous, or pulmonary artery pressures
  • Need for temporary cardiac pacing.
  • Use of continuous infusion of vasoactive drugs to maintain hemodynamic stability

Neurologic

All patients with actual or potential life threatening or unstable (i.e.evolving/progressive) neurologic disease.  Conditions include, but are not limited to:

  • Seizures unresponsive to therapy or requiring continuous infusion of anticonvulsive agents
  • Acutely and severely altered sensorium (GCS < 8) where neurologic deterioration or depression is likely or unpredictable, or coma with the potential for airway compromise
  • After neurosurgical procedures requiring invasive monitoring or close observation
  • Acute inflammation or infections of the spinal cord, meninges, or brain with neurologic depression, metabolic and hormonal abnormalities, respiratory or hemodynamic compromise or the possibility of increased intracranial pressure
  • Head trauma with increased intracranial pressure
  • Preoperative neurologic conditions with neurologic deterioration
  • Progressive neuromuscular dysfunction with or without altered sensorium requiring cardiovascular monitoring and/or respiratory support
  • Spinal cord compression or impending compression
  • Placement of external ventricular drainage device

Hematology/Oncology

All patients with life-threatening or unstable hematologic or oncologic disease or active life-threatening bleeding.  Conditions include, but are not limited to:

  • Exchange transfusions
  • Plasmapheresis or leukopheresis with unstable clinical condition
  • Severe coagulopathy
  • Severe anemia resulting in hemodynamic and/or respiratory compromise
  • Severe complications of sickle cell crises, such as neurologic changes, acute chest syndrome, or aplastic anemia with hemodynamic instability
  • Initiation of chemotherapy with anticipated tumor lysis syndrome
  • Tumors or masses compressing or threatening to compress vital vessels, organs, or the airway
  • Dengue hemorrhagic fever with unstable vital signs (Grade III-IV, DSS)

Endocrine/Metabolic

All patients with life-threatening or unstable endocrine or metabolic disease. Conditions include, but are not limited to:

  1. Severe diabetic ketoacidosis with hemodynamic and/or neurologic compromise
  2. Other severe electrolytes abnormalities, such as:
    • Hyperkalemia, requiring cardiac monitoring and acute therapeutic intervention (serum K+>5 mEq/L)
    • Severe hypo- (serum Na++ < 130 mEq/L) or hypernatremia (serum Na++ > 150 mEq/L)
    • Hypo- (serum ionized Ca++ < 2.0 mEq/L) or hypercalcemia (serum ionized Ca++ >5 mEq/L)
    • Hypo-or hyperglycemia requiring intensive monitoring (levels may be individually set by the attending physician according to acceptable guidelines)
    • Severe metabolic acidosis requiring bicarbonate infusion, intensive monitoring, or complex intervention
    • Complex intervention to maintain fluid balance
  3. Inborn errors of metabolism with acute deterioration requiring respiratory support, acute dialysis, hemoperfusion, management of intracranial heypertension, or inotropic support.

Gastrointestinal

All patients with life-threatening or unstable gastrointestinal disease.  Conditions include, but are not limited to:

  • Severe acute gastrointestinal bleeding leading to hemodynamic or respiratory instability
  • After emergency endoscopy for removal of foreign bodies
  • Acute hepatic failure leading to coma, hemodynamic or respiratory instability
  • Acute gastroenteritis with severe dehydration or potential for deterioration

Surgical

All postoperative patients requiring frequent monitoring and potentially requiring intensive intervention.  Conditions include, but are not limited to:

  • Cardiovascular surgery
  • Thoracic surgery
  • Neurosurgical procedures
  • Otolaryngologic surgery
  • Craniofacial surgery
  • Orthopedic and spine surgery
  • General surgery with hemodynamic or respiratory instability
  • Organ transplantation
  • Multiple trauma with or without cardiovascular instability
  • Major blood loss, either during surgery or during the postoperative period

Renal

All patients with life-threatening or unstable renal disease.  Conditions include, but are not limited to:

  • Renal failure
  • Requirement for acute hemodialysis, peritoneal dialysis, or other continuous renal replacement therapies in the unstable patient.
  • Acute rhabdomyolysis with renal insufficiency

Multi-System and Others

All patients with life-threatening or unstable multi-system disease.  Conditions include, but are not limited to:

  • Toxic ingestions and drug overdose with potential acute decompensation of major organ systems
  • Multiple organ dysfunction syndrome
  • Suspected or documented malignant hyperthermia
  • Electrical or other household or environmental (e.g. lighting) injuries
  • Burns covering > 10% of body surface area or those involving the face and/or airway with potential for respiratory or hemodynamic compromise

Isolation Criteria

All patients with infectious disease requiring intensive care shall be admitted only to the isolation room of the unit.  Conditions include, but are not limited to:

  • Communicable diseases as defined by the latest US-CDC guidelines
  • Meningitis/encephalitis of infectious origin
  • Meningococemia
  • Active tuberculosis

III. Discharge/Transfer Criteria

Patients will be considered for discharge from the PICU based on the reversal of the disease process or resolution of the unstable physiologic condition that prompted admission.  Likewise, pre-discharge evaluation determines that the need for complex intervention exceeding general patient care unit capabilities is no longer needed.

Discharge/Transfer shall be based on the following criteria:

  • Stable hemodynamic parameters
  • Stable respiratory status (patient extubated with stable arterial blood gases) and able to maintain airway patency
  • Minimal oxygen requirements (FiO2 < 0.4) that do not exceed general patient care unit guidelines
  • Aerosolized medications (i.e. B-agonists) are being given > Q 4 hours
  • Intravenous inotropic support, vasodilators, and antiarrhythmic drugs are no longer required or, when applicable, low doses of these medications can be administered safely in otherwise stable patients in a designated patient care unit
  • Cardiac dysrrhythmias are controlled
  • Intracranial pressure monitoring equipment has been removed
  • Neurologic stability with control of seizures
  • Removal of all hemodynamic monitoring catheters
  • Chronically mechanically ventilated patients whose critical illness have been reversed or resolved and are otherwise stable may be discharged to a designated patient care unit that routinely manages chronically ventilated patients, when applicable, or to home when adequate medical and nursing care is assured.
  • Routine peritoneal or hemodialysis with resolution of critical illness not exceeding general patient care unit guidelines
  • Patients with mature artificial airways (tracheostomies) who no longer require excessive suctioning

IV. Manpower:

  1. Staff
    • Head (Intensivist)
    • Active/Associate Active/Visiting Intensivist/Other subspecialty consultant
    • Fellow in Critical Care/Pulmonology
    • House-staff
    • Nursing staff
  1. Definition of functions
    • Head
      • Oversees the activities of the PICU with regards service, training and research
      • Deals with administrative problems pertaining to the PICU and is directly responsible to the Department Head and the Hospital Administrator
      • Is responsible for upgrading and procuring PICU equipment
    • Active /Associate Active/Visiting Intensivist/Other subspecialty consultant
      • Makes daily rounds of all referred or admitted patients and guides the fellows, House Staffs and other allied staff in the diagnosis, management and disposition of patients admitted into the unit.
      • Participates in the clinical training and research activities of fellows/nursing staff together with the Section Head
    • Fellow in Critical Care/Pulmonology
      • Makes daily rounds of all admitted patients and is on call for all medical problems of PICU patients
      • Answers all consults and referrals to the section head
      • Prepares and coordinates the teaching /training activities of the PICU in consultation with the Section Head/Training Officer
      • Supervises the house-staff in rendering psychological support and anticipatory guidance to the family of the patients
      • Prepares the census of the PICU and, together with the Section Head/Intensivists, conducts the monthly audit of the unit
      • Attends the autopsies of all mortalities in the unit
      • Conducts clinical researches on pediatric critical care medicine utilizing clinical materials of admitted patients after obtaining informed consent
    • House-staff
      • Notifies the attending physician and the subspecialty physician to which the patient is referred
      • Obtains a complete clinical history and physical examination of all patients admitted into the unit
      • Writes the admitting orders after consultation with the attending physician
      • Attends rounds with the consultants and fellows at the PICU
      • Goes on rounds of the patient as frequently as necessary and writes staff notes for the duration of the patient’s confinement
      • Conducts daily rounds with the other PICU House Staffs, nursing staff and allied staff
      • Attends to all medical needs and is responsible for their management after consultation with the attending physician
      • Attends the autopsies of all mortalities in the PICU
      • Conducts clinical researches on pediatric critical care/pulmonology/neonatology
      • Supervises the use and maintenance of PICU equipment
      • The Chief House Staff
        • Informs the fellows concerned after thorough discussion with the junior and senior House Staff regarding problems that may arise in connection with the admission, diagnosis, management and disposition of patients in the PICUnecessary
        • Monitors and coordinates the activities of the unit and reports problems to the fellows and the Head of the unit as necessary
      • Performs appropriate nursing care and assists in the patient’s particular needs
      • Administers medications, keeps accurate records/notes and reports adverse drug reactions to the medical staff immediately
      • Observes, records and reports all clinical observations to the PICU medical staff routinely
      • Is responsible for the operation, care and maintenance of all equipment in the PICU
      • Assists the consultants/fellows performing diagnostic and therapeutic procedures on patients
      • Is responsible for providing nutritional support to the patients upon orders of the medical staff
      • Assists the patients’ and/or parents/ education and rehabilitation including the promotion of mental and physical health
      • Assists in the orientation and training of nursing personnel in the PICU
      • Helps in maintaining a harmonious working relationship among the PICU staff and the patients and their families
      • Checks and maintains the availability of unit supplies and keeps an inventory of these. He/she shall submit this inventory list to the Section Head/Head Nurse at the end of each monthNursing Staff
      • Explains to the parents/guardians the administrative and admitting procedures of the unit upon admission

Prepared by:

Dr. Michael Wassmer
Pediatric Intensivist

Approved by:

Dr. Miguel Celdran
Chairman – Department of Pediatrics

Dr. Rodrigo B. Floro
Vice PHouse Staff – Medical Affairs

Adult ICU

GUIDELINES FOR THE STAFFING AND EQUIPMENT REQUIREMENTS OF THE
INTENSIVE CARE UNITS OF ASIAN HOSPITAL AND MEDICAL CENTER

Medical Staff Organization

  1. A distinct medical staff critical care organizational entity (department, division, section, or service) exists.
    • Privileges (both cognitive and procedural) for members of the critical care physician team are approved by the medical staff credentials committee based on previous training and experience as defined by the medical staff
    • A section of the medical staff bylaws delineate the regulations governing the implementation of these conditions
    • Budgetary activities relating to unit function, quality assurance, and utilization review are conducted as joint medical/nursing/administrative endeavors
    • A critical care representative serves on the medical staff Executive Committee
  2. The team is organized and led by an intensivist with time, expertise in, and significant commitment to the care of the critically ill patient within the hospital.
  3. Patient management is directed by an attending level physician who:
    • Is privileged by the medical staff to have clinical management responsibility for critically ill patients
    • Is board certified in critical care medicine or has equivalent qualifications
    • Sees the patient as often as required by acuity but at least twice daily
    • Is either the patient’s attending physician or a consultant who provides direct management of critically ill patients
  4. Medical Staff members should participate on the institutions Bioethical Committee.

Unit Organization

  1. A physician Unit Director is required.
  2. Specific requirement for the Unit Director include:
    • Training, interest, and the time availability to give clinical, administrative, and educational direction to the ICU
    • Board certification in critical care medicine.
    • Time and commitment to maintain active and regular involvement in the care of the patients in the unit
    • Expertise necessary to oversee the administrative aspect of unit management. including formation of policies and procedures, enforcement of unit policies, and the education of unit staff
    • The ability to assure the quality safety and the appropriateness of care in the ICU
    • Availability (either the Director or similarly qualified surrogate) to the unit 24 hrs/day, 7 days/wk for both clinical and administrative matters
    • Active involvement in local and/or national critical care societies
    • Participation in continuing education programs in the field of critical care medicine
    • Hospital privileges to perform relevant invasive procedures
    • Active involvement as an advisor and participant in the organization of the care of the care of the critically ill patient in the community as a whole
    • Participation in the education of unit staff, other physicians, housestaff, and medical staff as indicated
    • Participation in scholarly activity
    • Active participation in the review of the appropriate utilization of ICU resources in the hospital
  3. A nurse manager is appointed to provide precise lines of authority, responsibility. And accountability for the delivery of high-quality patient care. Specific requirement for the nurse manager includes:
    • An RN with a BSN or preferably a MSN degree
    • Certification in critical care or has equivalent graduate education
    • At least 2 yrs. of experience working in critical care unit
    • Previous management experience, including experience with health information systems, quality improvement/risk management activities, and healthcare economics
    • Preparation to participate in the on-site education of critical care unit nursing staff and physicians-in-training
    • Ability to foster a cooperative atmosphere with regard to the training of nurses, physicians, respiratory therapists, and other personnel involved in the care of critical care patients
    • Regular participation in ongoing continuing nursing education
    • Ability to participate in and foster cooperation in, scholarly activity in the ICU
    • Knowledge about current advances in the field of critical care nursing
    • Participation in strategic planning and redesign effort

Contact Us

Location

The Cardiovascular surgery intensive care unit, Medical surgical intensive care unit and the Dialysis Center are located on the 2nd Floor of the Hospital. The Neonatal intensive care unit is located on the 3rd Floor of the Hospital.

Cardiovascular ICU
Direct line: (63 2) 876-5790
Trunk line: (63 2) 771-9000 ext. 8290 / 8291

Neonatal Intensive Care Unit (NICU)
3rd Floor of the hospital.
Direct Line: (632) 876-5772
Trunk Line: (632) 771-9000 ext. 8352.