PICU Thesis Topics - Limited Resource Settings

1. Scoring Systems & Outcome Prediction

• Validation of PELOD-2 / PIM3 / PRISM III scores in your PICU population
• Comparison of two scoring systems (e.g., PRISM III vs PELOD-2) for predicting mortality
• PEWS (Pediatric Early Warning Score) - accuracy in predicting ICU deterioration

2. Sepsis & Infectious Diseases (high burden in govt hospitals)

• Clinical profile and outcomes of pediatric septic shock - impact of time-to-antibiotic
• Dengue with severe manifestations - predictors of ICU mortality
• Scrub typhus presenting as PICU admission - clinical spectrum and outcomes
• Antibiotic resistance patterns in PICU-acquired infections
• Procalcitonin vs CRP as early sepsis markers (cheap, widely available)

3. Respiratory

• Outcome of high-flow nasal cannula (HFNC) vs standard oxygen in bronchiolitis / pneumonia
• Predictors of failed non-invasive ventilation (NIV) requiring intubation
• Ventilator-associated pneumonia (VAP) bundle compliance and outcomes
• Duration of mechanical ventilation and predictors of extubation failure

4. Nutrition & Metabolic

• Nutritional assessment on admission and its correlation with PICU outcomes (MUAC, WAZ)
• Time to achieve caloric goals and its impact on mortality/length of stay
• Hyperglycemia in non-diabetic PICU patients - prevalence and outcome correlation
• Hyponatremia/electrolyte disturbances on admission as outcome predictors

5. Neurological

• Status epilepticus - etiology, management, and outcomes in resource-limited PICU
• GCS at admission and neurological outcomes in encephalitis / meningitis
• Outcome of children with traumatic brain injury (common in govt hospitals)

6. Quality Improvement / Audit Studies (no extra cost)

• PICU-acquired infections - point prevalence survey
• Adherence to WHO/IAP sepsis bundles and outcomes
• Medication errors in PICU - types and frequency (observational)
• Family-centered care practices and parental satisfaction scores

7. Fluid Management

• Fluid overload (>10% body weight) and its association with mortality/ventilator days
• Conservative vs liberal fluid strategies in septic shock outcomes (retrospective)

8. Renal

• AKI in PICU - incidence, etiology, KDIGO staging, and outcomes
• AKI as a predictor of PICU mortality (can use serum creatinine - widely available)

9. Low-cost Investigations as Predictors

• Lactate clearance at 6 hours as a predictor of survival in septic shock
• Neutrophil-to-lymphocyte ratio (NLR) as a sepsis severity marker
• SOFA/qSOFA applicability in pediatric age group

10. Descriptive / Epidemiological (easiest to execute)

• Disease burden and mortality profile of your PICU over 2-3 years (retrospective audit)
• Seasonal variation in PICU admissions and diagnoses
• Referral patterns and outcome of transferred-in patients vs direct admissions

Tips for Choosing

1. AKI incidence + KDIGO staging + outcomes
2. Fluid overload and PICU mortality
3. Lactate clearance in septic shock
4. PELOD-2 validation in your population
5. VAP bundle audit

Additional PICU Thesis Topics

11. Cardiovascular / Shock

• Shock index (HR/SBP) as a predictor of PICU mortality in children
• Profile and outcomes of myocarditis presenting to PICU
• Inotrope score and its correlation with duration of ICU stay and mortality
• Central venous oxygen saturation (ScvO2) as a resuscitation endpoint in septic shock
• Supraventricular tachycardia (SVT) in PICU - management patterns and outcomes

12. Hematology / Oncology

• Febrile neutropenia in oncology patients admitted to PICU - outcomes and predictors
• Disseminated intravascular coagulation (DIC) scoring and outcome in PICU
• Thrombocytopenia on admission as an independent predictor of PICU mortality
• Anemia on admission - prevalence, severity, and association with outcomes
• Blood transfusion practices and transfusion-associated adverse events in PICU

13. Liver & Gastrointestinal

• Acute liver failure in children - etiology, course, and predictors of mortality
• Refeeding syndrome in malnourished children admitted to PICU
• GI bleeding in PICU - etiology, management, and stress ulcer prophylaxis practices
• Liver function derangement as a component of multi-organ dysfunction scoring

14. Toxicology / Poisoning (very common in govt hospitals)

• Profile and outcomes of acute poisoning admissions to PICU
• Organophosphate poisoning - severity grading, ventilator requirement, and mortality
• Kerosene/hydrocarbon ingestion - predictors of respiratory failure
• Snake envenomation requiring PICU admission - clinical profile and outcomes
• Drug-induced acute liver failure in children

15. Neonatal-Pediatric Interface (if NICU overlap exists)

• Outcomes of late preterm infants admitted to PICU vs NICU
• Neonatal sepsis score validation in resource-limited settings
• Hypothermia on admission as a predictor of neonatal/infant PICU outcomes

16. Endocrine & Metabolic

• Diabetic ketoacidosis (DKA) - severity, complications (cerebral edema), and outcomes
• Adrenal insufficiency in critically ill children - screening and outcomes
• Thyroid dysfunction in non-thyroidal illness in PICU (sick euthyroid)
• Hypocalcemia in PICU - prevalence and association with adverse outcomes
• Blood glucose variability vs mean glucose as predictor of PICU outcomes

17. Coagulation & Thrombosis

• Incidence of catheter-related thrombosis in PICU
• Coagulation profile on admission and correlation with organ dysfunction score
• Fresh frozen plasma (FFP) use - indications, appropriateness, and outcomes

18. Pain, Sedation & Delirium

• Sedation practices in PICU - agent choice, depth, and duration vs outcomes
• Incidence of PICU-acquired delirium using pCAM-ICU / CAPD scale
• Pain assessment tool validation (FLACC/NRS) in intubated children
• Opioid weaning protocols - incidence of withdrawal syndrome
• Nurse-driven sedation protocols vs physician-directed - feasibility study

19. Procedures & Complications

• Central line-associated bloodstream infection (CLABSI) - rate, organisms, risk factors
• Complications of endotracheal intubation in PICU (first-pass success rate, desaturation)
• Ultrasound-guided vs landmark-guided central venous access - success and complication rates
• Incidence and risk factors for pressure ulcers in PICU
• Accidental extubation - incidence, risk factors, and preventive strategies

20. Mental Health & Family Issues

• Post-traumatic stress in parents of PICU-admitted children (using IES-R scale)
• Parental anxiety and depression during child's PICU admission
• Palliative care referral patterns in PICU - timing and family satisfaction
• Communication practices at end-of-life in resource-limited PICUs

21. Long-term Outcomes / Post-PICU

• Post-intensive care syndrome in pediatrics (PICS-p) - functional outcomes at 3 months
• Cognitive and neurodevelopmental outcomes after PICU stay (phone/OPD follow-up)
• Readmission to PICU within 48 hours - incidence and preventable causes
• Health-related quality of life in PICU survivors (PedsQL tool)

22. Tropical & Region-Specific Diseases

• Malaria with severe manifestations - cerebral malaria, respiratory failure, outcomes
• Leptospirosis in PICU - Weil's disease profile and predictors of dialysis need
• Enteric fever complications requiring PICU admission
• Rickettsial disease (scrub typhus, murine typhus) - PICU profile
• Japanese encephalitis / viral encephalitis - outcomes and prognostic markers

23. Technology & Monitoring (low-cost)

• Point-of-care ultrasound (POCUS) - feasibility and learning curve in resource-limited PICU
• Capillary refill time as a resuscitation monitoring tool in septic shock
• Bedside echocardiography for fluid responsiveness assessment
• Transcutaneous bilirubin monitoring vs serum in neonates/infants in PICU

24. Drug & Antibiotic Studies

• Antibiotic de-escalation practices and outcomes in PICU
• Duration of antibiotic therapy in culture-negative sepsis and outcomes
• Colistin/carbapenem use - indications, outcomes, nephrotoxicity in PICU
• Zinc supplementation in PICU - effect on duration of mechanical ventilation
• Steroid use in refractory septic shock - practices and outcomes

25. Multi-Organ Dysfunction

• pSOFA score - applicability and outcome prediction in your PICU population
• Sequential organ failure and its day-1 vs day-3 trajectory as mortality predictor
• Hepatic, renal, and hematologic organ dysfunction triad as mortality predictor

Quick Selection Matrix

Most Unique / Less Saturated Topics Right Now:

1. pCAM-ICU delirium screening in Indian PICU
2. PICS-p (post-intensive care syndrome) follow-up
3. Shock index as bedside mortality predictor
4. NLR + CRP ratio in pediatric sepsis
5. Parental PTSD during PICU admission