Pediatric ICUs

Pediatric critical care medicine has evolved over the last 3 decades into a highly respected; board-certified specialty that has become an indispensable service for inpatient programs of most children’s hospitals as well as a highly valued resource supporting most community-based programs. The earlier published guidelines for pediatric critical care medicine; used to help establish the basic needs for a state-of-the-art Pediatric ICU.

Pediatric ICUs patients

These guidelines used by both physician leadership and policy makers to advocate for personnel; supplies, and space that were unique to PICUs. However, three levels of care are recommended for pediatric ICU patients, according to a policy statement published online Sept. 4 in Pediatrics. Benson S. Hsu, M.D., from the Sanford School of Medicine at the University of South Dakota in Vermillion; and colleagues updated the 2004 guidelines and levels of care for Pediatric ICUs.

Outcome and quality research relating to admission, transfer; and discharge criteria and literature relating to PICU levels of care were reviewed. The researchers note that critically ill or injured pediatric patients should receive care in a child- and family-centered environment; by a multidisciplinary care team. Community medical center PICUs play an important role in health care systems; and provide a broad range of services and resources; previous guidelines classified these centers as level II PICUs. Tertiary PICUs provide advanced care; for many medical and surgical illnesses; previously categorized as level I PICUs.

Extracorporeal membrane oxygenation

But the guidelines panel consisted of 2 groups: a voting group consisting of 30 members; and a writing group of 20 members. However, the voting panel used an iterative collaborative approach to formulate 30 statements; on the basis of the literature review and common practice. Five of the 30 statements were multicomponent statements specific to PICU level of care; including team structure, technology, education and training, academic pursuits, and indications for transfer to a tertiary or quaternary PICU. These statements then presented via an online anonymous voting tool to a voting group by using a 3-cycle interactive forecasting Delphi method.

Tertiary PICUs should provide advanced ventilator support, but are not expected to provide extracorporeal membrane oxygenation support. A quaternary or specialized PICU provides regional care and serves a large population or catchment area; these centers can provide comprehensive care for all complex patients and diagnosis-specific care for select patient populations. “These three levels of PICUs will provide the best possible care to the critically ill pediatric patient in an environment that is most appropriate for the medical or surgical issues facing the child and his/her family,” a coauthor said in a statement.