Laura: I am really excited to be her today to talk about this topic. It is definitely an emerging practice area in occupational therapy and certainly needs some attention in the world of pediatrics. My most recent clinical experience is in the pediatric oncology area. I practiced for about nine years at Memorial Sloan Kettering Cancer Center, and I was there during a very exciting time when they were developing their PICU. It was nice to be part of that transition and I certainly learned a lot in the process.
Background and Common Conditions
I would like to start with the history and development of the Pediatric Intensive Care Unit. The idea started back between the '30s and '50s, when both in the US and in Europe there were polio treatment centers. This is where adults and children were treated for critical illnesses, especially with respiratory involvement. The idea really stemmed from these treatment centers designed for that population back then.
Dr. John Downes was a pediatric anesthesiologist based out of CHOP, the Children's Hospital of Philadelphia. During the '50s and '60s, he received a grant to do some research over in Europe. When he came back he was inspired to start a true PICU setting similar to what he saw over there. He is credited with starting the first PICU in 1967 at the Children's Hospital of Philadelphia (Mai, Shreiner, Firth & Yaster, 2013).
- The Children’s Hospital of Philadelphia 1967
- Children’s Hospital of Pittsburgh 1969
- Yale-New Haven Hospital 1969
- Massachusetts General Hospital 1971
- Children’s National Medical Center 1976
- Johns Hopkins Hospital 1976
- The Children’s Hospital 1980
I just think this is interesting to really see how far we have come in our treatment of this fragile population. The location of PICUs, or Pediatric Intensive Care Unit, can be located in general acute care hospitals. They may be primarily adult hospitals with a pediatric floor or pediatric wing with a PICU in it. They are also located in trauma centers or specialty hospitals, and as I mentioned before I worked in an oncology specialty setting that treated primarily cancer patients, so we had a PICU specific to our population. Before our PICU was developed, the unit we had available to treat that population was called the Pediatric Observation Unit, or as we called it the POU, which later transitioned into a PICU. The difference is it did not serve children who were quite as medically fragile or on mechanical ventilation as they do in the PICU. For children who required more care than we could offer in the POU, we had to transfer them to another facility. So the development of the PICU was a really positive change. You may also hear the unit be referred to as the PCCU, or the Pediatric Critical Care Unit, or the SICU, the Surgical Intensive Care Unit.
There are more than 400 PICUs currently in the U.S. This is according to the current statistics available from the Society of Critical Care Medicine, which is a little over 4,000 beds. Some admission criteria that I think is important to share is shown in Figure 1.
Figure 1. PICU admission criteria- common conditions 1.
This was developed by the American Academy of Pediatrics, the Committee on Hospital Care and Section on Critical Care, as well as the Society of Critical Care Medicine. They came together to create a task force. This is general information. This is updated frequently, but generally speaking the next few slides include some common admission criteria according to their task force.
Respiratory
Intubation, any type of mechanical ventilation or respiratory distress are some of the criteria. Respiratory conditions are the most common condition you will see treated in the PICU. As occupational therapists we certainly play a role in providing care to those patients. A newly placed tracheostomy or high oxygen requirement are others. We will talk more about oxygen requirements in a few minutes.
Cardiovascular
Patients experiencing shock or sepsis are frequently admitted to the PICU. Following resuscitation or unstable congestive heart failure are other reasons for admission.
Neurologic
These are also common neurological conditions, like patients experiencing seizures. If someone has uncontrolled seizures they may be admitted to the PICU if they are not responding to treatment for that. Any type of head trauma, TBI, or spinal cord injury are also common. Anything causing increased intracranial pressure is certainly reason to be admitted to the PICU.
