PICU, an abbreviation for pediatric intensive care unit, is the section of the hospital that provides critically ill infants, children, and teenagers with the highest level of medical care.
Working in PICU environment can be stressful and requires strict guidelines for procedures and practice, especially for medical students and residents on PICU rotations.
This is the reason why Dr. Marc Anders, a Pediatric Care Specialist from Australia, developed the PICU Doctor app for Android and iOS. The app is designed to be a comprehensive guide to pediatric intensive care, with a specific focus on Cardiac ICUs, i.e. the management of congenital cardiac disease in pediatric patients.
PICU Doctor app is basically a mobile version of the PICU Cardiac Guide, which is available online in a form of PDF and contains a tremendous amount of information, including physiology and pharmacology information.
Before downloading and using PICU Doctor app, keep in mind that many of the clinical recommendations and guidelines provided in the app come from Australia and the UK resources, which may limit its use in the US.
Upon opening PICU Doctor app, you'd notice that it has a simple and straightforward layout, resembling a notebook with sections and chapters, which is perhaps more suited as a reference for students than use at the point of care.
The main sections of the app featured on the main screen include The Basics, Anesthesia, PICU, Cardiac Defects, Heart Failure & Assist and Resuscitation. Each section contains a number of topics.
The Basics section, for example, includes subjects ranging from admitting or discharging a cardiac patient to various infections and a table of antibiotics used to treat them.
Anaesthesia section contains information on various drugs and pharmacology, including analgesics, sedatives, muscle relaxants, intubation drugs, and so on. PICU sections provide various management guidelines, including fluids, feeding, arrhythmias, renal failure, etc. All sections are divided into subsections, each containing different subjects and topics.
The content provided on these topics is mostly text based (text heavy would be more appropriate to say). Many subjects, however, are written in a form of bullets, outlining the most important things.
The app also includes tables that don't fit the screen but can be zoomed in or out by using fingers. There are also charts that suffer from the same formatting problem. Being able to rotate the phone horizontally could help, but the app doesn't support it.
There are a number of formulae within the Basics section of the app, but unfortunately, no calculator capability, neither for formulae nor for medications, which is a shame because the app contains many drug tables.
There are also images included, but they're mostly limited to the section on Cardiac Defects, which is large and covering the most common congenital cardiac anomalies. These images are basically hand drawn illustrations of a defective heart showing pressures and oxygen saturation percentages in the heart chambers and great vessels along with descriptions of the pathophysiology and management tips.
As said, these images look like sketches from the student's notebook, meaning they cannot be managed, viewed in detail, or annotated.
Another cardiology section named Heart Failure & Assist contains a lot of detailed information on heart failure management, ECMO, Berlin Heart, heart transplantation, and ABO incompatibility, which is perhaps misplaced.
The last section of the app includes resuscitation algorithms, with fairly standardized medication dosages. However, the neonatal and pediatric life support guidelines differ from guidelines used in the US.
Also, management tips provided in the app for each section are mostly universal, but there are some that are specific to Australia and the UK. The example is recommending Flucloxacillin as an empiric antibiotic for children over 3 months, which is not available in the US.
The most sections in the app include references with links to their PubMed citation, although they're not linked to the specific text. A lot of sections do not have references at all.
The app also doesn't make clear when the management recommendations are based on broader guidelines or local practice patterns.
All topics can be saved for easier access from the main screen. The app also allows users to search for specific subjects, but this search engine doesn't include autocomplete and it returns too broad results. Users can also download all content as PDF file from the app.
From all I saw during this review, I think that PICU Doctor app could be useful for students and residents as a solid resource they could read before pediatric cardiology or PICU rotations.
However, the lack of important features like calculators, formatting, and differences in management guidelines, make it hard to use at the point of care, especially in US pediatric ICU settings.
Benefit: Medical students and residents on pediatric cardiology or PICU rotations could benefit from this app