Introduction: Pakistan has one of the highest under five mortality and limited critical care services. Telemedicine has emerged as a promising solution to improve outcomes in such settings. We developed a tele-intensive care service providing peer-to-peer teleconsultation for physicians in remote and resource-constrained settings for treatment of critically ill pediatric patients and describe the implementation and outcomes of this initiative in Pakistan. Methods: A retrospective observational analysis of pediatric tele-ICU consultations provided by a tertiary care hospital in Pakistan was conducted from April 2021 to June 2025. A central command center utilized two-way audiovisual technology to link experienced intensive care specialists with clinical teams in remote hospital locations. The service, available at all times, relied on messaging apps and phone calls for communication. Data was extracted from a centralized tele-ICU registry, including patient demographics, consultation characteristics, investigations, recommended interventions, and communication modalities. Descriptive statistics summarized key findings. Results: A total of 932 tele-ICU consultations were completed, spanning 42 hospitals across Pakistan. The mean time to accept a call was 22 minutes, with an average consultation lasting 9 minutes. The mean patient age was 6.1 ± 6.3 years, with nearly half (47.4%; 387) aged between 1 month and 5 years. Daily rounds accounted for 93% of consultations. Respiratory (50.9%; 379) and neurological (40%; 238) issues were the most common presenting concerns. Laboratory investigations such as complete blood count (42.6%; 394) and electrolytes (37.4%; 345) were frequently discussed, alongside chest X-rays (47.3%; 133) and head CT scans (20.6%; 58). Recommended interventions primarily included respiratory support management (21.4%; 352), laboratory investigations (22.6%; 372), and medical therapies (16.7%; 276). Conclusions: Our tele-intensive care service assisted in managing critically ill patients in areas where intensive care services were previously unavailable. This model can be implemented to effectively bridge critical care gaps in remote and resource-constrained settings.
Abbas et al. (Sun,) studied this question.