PICUs in Portugal

With the upcoming ESPNIC congress taking place in Lisbon, Portugal June 3-5, 2017 and and part of its PICUs series, WFPICCS took the opportunity to ask their member in Portugal some questions and get an insight how PICUs operate in Portugal.

Many thanks to Paula C. Fernandes, President, Portuguese Society of Paediatrics (https://www.spp.pt) and Alexandra Dinis, Centro Hospitalar de Coimbra, Portugal for taking the time out of their busy schedules to answer the questions below.

The population of Portugal is 10,277 million - how many PICUs are there in total?

There are 6 PICUS: 2 at the north of the country (Hospital de São João and Centro Hospitalar do Porto) one at the centre which is both Neonatal and Paediatric (Hospital Pediátrico de Coimbra - CHUC), 3 at the South (Hospital D. Estefânia, Hospital de Stª Maria – CHLN, Hospital Fernando da Fonseca).

There are also some paediatric intensive care beds at neonatal intensive care units at the Algarve – H. de Faro; Madeira´s Island – Hospital do Funchal and one near Lisbon – Hospital Garcia de Orta.

How many children are admitted to a PICU each year?

From 200 admissions, until to 400 admissions at the most, according to the number of available ICU beds which is different in each unit.

What is the average stay at a PICU?

From 4 to 6 days.

Is there anything unique about PICUs in Portugal?

Too many working hours devoted to 24 hours coverage, very little time to investigation activities, not enough nurses, and most of the staff as paediatricians as its original medical speciality board formation. (not sure whether these are unique!

How many years does it take for a PICU specialist to qualify in Portugal?

8 years (5 years of training in Paediatrics Board certification (or Anaesthesia, or Paediatric Cardiology, or Paediatric Surgery in which case would be 6 years) plus 3 years of training in a PICU.

What sort of on-going training is there in Portugal for paediatric intensive and critical care doctors & nurses?

Post-Graduation Specific Courses for nurses in paediatrics and intensive care as well as other subjects of interest (ethics, pain, palliative care, critical care transport). Some of the main hospital develops courses such as transport and ECMO, simulation, ventilation, the serious ill child, shock, echo in the ICU, and so on.

There is a Respiratory Group which organizes ventilation courses, and a Trauma Group both related with the Portuguese Paediatric Intensive Care Society (SCIP). The society organizes one annual meeting at least and participates at the Portuguese National Annual Congress in Paediatrics.

How do you communicate with colleagues from other PICUs across the country?

We meet at the annual meetings and other activities and courses. And of course, also by phone and e-mail. Being a small country we know each other fairly well.

Do PICU professionals from Portugal use social media?  What social media platform do they use the most?

We don´t use it really. Only the official web page at www.spp.pt.

Do PICU professionals collaborate with colleagues from outside of Portugal?

The PICU at Hospital de Sta Maria- CHLN  has a regular collaboration with Karolisnka University Hospital relating to their ECMO programme development. The Respiratory Group has a strong history of collaboration with the Spanish groups.

Portugal has some official collaboration protocols with African countries for serious patients such as congenital cardiac disease, liver failures, paediatric oncology.

Some of us collaborate whenever possible in international multi centre studies.

What professional journals do PICU professionals in Portugal subscribe to?

Mainly: Paediatric Critical Care Medicine and Critical Care Medicine, Intensive Care Medicine, Critical Care, Acta Pediatrica (the official Portuguese Journal in paediatrics).

What are the main objectives of the Portuguese Society of Paediatrics- Intensive Care Section?

To promote partnership and knowledge sharing among it´s PICUs, to organize scientific meetings and formation courses.

Does the society organize any national educational events?

Yes, one annual meeting at least and several variable courses as mentioned above (nº6).

What types of collaborations is the society interested in?

The society would be interested in scientific and clinical research such as multicentre studies, clinical trials, new technologies, in the promotion and organization of scientific events and courses, and in collaborating on international guidelines or work groups.

What expectations does the society have from organizations such as ESPNIC & WFPICCS?

We would value the promotion of collaborative research, and ongoing education by courses (face to face and on-line), scientific meetings which may be specific or monothematic. And also provide the means to accomplish a closer relation with intensive Care Societies from other.

Anything else you would like to share about PICUs in Portugal and your society?

In general Portuguese PICUs are small units, with few beds and not many specialists in Paediatric Critical care (from five to seven). There are mostly women between nurses and doctors. They provide 24-hour specialized coverage on the unit, specialized transport for critical care patients, post graduate formation and some research.The society has no state funding for scientific activity, and the financial resources are scarce.

What does a typical day look like for you personally?

The typical day for a PICU doctor will consist in preparing children for school in the morning and take them there before work, working 09 to 5 on regular days, 24 hour straight when on service, or sometimes during the night shift. After that there has to be some time for teaching medical students, attend at the private clinics, and studying. And then picking up the kids, helping with the homework, providing dinner and stuff, reading a new article on a magazine and finally falling asleep on the couch.

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