| Clinical Service | Pediatric CCM Division
The Pediatric Intensive Care Unit (PICU) complex at the Children’s Hospital of Pittsburgh is the only full-service PICU in Western Pennsylvania. It is comprised of four units: the Pediatric Intensive Care Unit (PICU), Cardiac Intensive Care Unit (CICU), Neonatal Intensive Care Unit (NICU) and Intermediate Intensive Care Unit (IICU). The Pediatric CCM division receives patients from all of Western Pennsylvania, as well as much of West Virginia, Ohio, and Maryland. In addition, it serves as a referral center for patients from distant regions of the United States and many international sites. It is well recognized as one of the leading centers in the world for patient care, education, and research in pediatric critical care. Outcomes for our patients continue to surpass that predicted by national norms.
Under the direction of Ann Thompson, MD, Vice Chair for Pediatric Clinical Affairs and Chief of the Pediatric CCM Division, eleven faculty members, 2 research scholars, 12 critical care fellows, and one cardiac critical care fellow provide outstanding care each year for over 2,300 critically ill infants and children (ranging in age from newborn to young adult). The Division provided over 12,000 patient-days of care in 2003 and over 13,500 patient-days in 2004. The patient population is divided approximately evenly between medical and surgical subspecialties. Within these major groups, the distribution of patients reflected the activity of Children’s Hospital as a whole. Services using the PICU complex include General/ Trauma Surgery, ENT, Cardiovascular Surgery, Neurosurgery, Transplantation Surgery, and the full spectrum of pediatric medical subspecialties.
The PCCM physicians serve as the attending physicians of record for most medical patients while they are in the ICUs and share management responsibilities with all surgical services. Approximately one-third of the medical patients were admitted directly to the Pediatric Critical Care Medicine service from the emergency department or transport system.
Emergency transport for critically ill children is provided by PCCM physicians as a major service to Children’s Hospital of Pittsburgh and the region. The service began in 1980 as the Children’s Hospital of Pittsburgh Transport Team under the recommendation from Dr. Jeff Malatack and with the aid of Peggy Slota, RN. At that time, it was becoming more apparent that the needs of pediatric patients were not being met. In 1983, Dr. Richard Orr was appointed Medical Director of the Transport Team. He served in that position solely until 2005 when Kate Felmet was appointed co-director. The Transport Team has grown significantly since then, transporting approximately 2,800 in academic years 2003-2005.
There are two transport teams in house 24 hours a day with RN and RT coverage and physician availability when needed to include an ICU fellow or a neonatal fellow/CRNP for the neonates. The Communication Center located at CHP provides coverage 24 hours a day and assists with setting up the transportation and coordinating the vehicles. This includes the tri-state referral area as well as national and international flights. Transports are accomplished by ambulance, helicopter, and fixed-wing aircraft. Fifty to 60% of transports are air transports. Approximately half of transported patients have a respiratory diagnosis, 22% a neurologic diagnosis, 12% have sepsis or septic shock, 7% a gastrointestinal problem, and 6% a cardiac disorder. Approximately half of the patients are transported from EDs and half from inpatient units. A nurse/respiratory therapist team under the medical direction of the critical care physician, completes the majority of transports. PCCM fellows remain an essential part of the team, specifically for those patients judged to be a particularly high risk for complicated illness or death. Research from the pediatric division has provided critically important, and perhaps startling, data that pediatric specialty transport teams not only minimize adverse events, but significantly decrease in-hospital mortality.
The new Cardiac Intensive Care Unit, opened in February 2002, is increasingly busy. It is currently an eight-bed unit for pediatric patients recovering from cardiac surgery or with a primary cardiac disorder as the indication for intensive care. As need for cardiac intensive care beds increases, this unit affords physicians and staff the advantage of a space specially designed to care for critically ill heart patients or those recovering from cardiac surgery. Doctors have access to the latest technology, can operate at a moments notice and are able to isolate patients who have recently received heart transplants and are in need of immunosuppressive drugs. The hospital accepts the toughest cases and performs the most demanding surgeries on some of the youngest patients. Children's highly trained heart specialists are centered in one unit where they are able to focus their efforts to meet the unique needs of pediatric heart patients. Children's CICU is one of the nation's few pediatric units specially designed for this purpose. The CICU also provides training to Fellows in Critical Care Medicine, Cardiology and Cardiothoracic Surgery from Children’s Hospital of Pittsburgh. Fellows from other institutions rotate through the CICU to gain knowledge and experience in the complex cases that we treat.
The PICU provided support for the entire pediatric general and subspecialty medical community, as shown in Figure 1; and, in this way, is a microcosm of the Institution.
Distribution of patients by age is shown in Fig. 2. The shift in the median age of patients noted over the last few years toward older patients persists, reflecting the complex treatments newly being offered to children with conditions such as complex congenital anomalies, cancer, and organ failure. Newer treatments may extend life dramatically, but also extend the potential period of major interventions or (sometimes) severe illness, well beyond the first year of life.
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