Today, highly skilled pediatric intensivists ensure
safe transition from the emergency department or operating room
to recovery for approximately 1,000 pediatric patients per year
in The Cleveland Clinic Pediatric Intensive Care Unit (PICU).
They come from Northeast Ohio, other states and even foreign countries.
In the critical-care setting, nothing substitutes
for experience. Six highly skilled board-certified pediatric intensivists
work closely with 40 skilled critical care nurses, 12 respiratory
therapists and numerous nursing assistants on the 14-bed PICU.
Standing vigil day and night over pediatric and adolescent patients,
they provide a level of safety few other major children's teaching
hospitals can offer.
A full-staff, attending pediatric intensivist and
two respiratory therapists are on duty 24 hours a day, seven days
a week, including weekends and holidays. After years of working
in the field, PICU staff can quickly recognize early signs of
respiratory failure, cardiac instability, changes in mental status
and pain. The extra seconds or minutes gained permit faster intervention,
staving off medical crises and often saving lives.
Collaboration and communication are essential to
the successful outcomes. PICU physicians, nurses and respiratory
therapists co-manage patients with Children's Hospital specialists
and subspecialists, such as pediatric epileptologists, pediatric
cardiologists, pediatric cardiothoracic surgeons and pediatric
neurosurgeons. Developmental pediatricians and physiatrists from
The Cleveland Clinic Children's Hospital for Rehabilitation evaluate
potential candidates for follow-up rehabilitation, often initiating
therapy prior to discharge.
Pediatric nutritionists, child life specialists
and social workers provide support to patients, parents and siblings.
Patients admitted to the PICU range from premature,
1,500-gram neonates with congenital heart disease and respiratory
failure to adults who have undergone congenital heart surgery.
Approximately half of all PICU admissions come from the Cleveland
Clinic's Center for Pediatric and Congenital Heart Diseases.
Every child who has undergone general anesthesia
is admitted to the PICU for a minimum of 12 to18 hours postoperatively.
Nurse-to-patient ratios are generally 1:1 immediately postoperatively
and 1:2 thereafter.
Respiratory failure is one of the most common reasons
for PICU admission. A potential complication of certain types
of surgery, it may also arise from acute pneumonia, airway obstruction
or status asthmaticus. Multiple types of ventilator support are
available: noninvasive, conventional and high-frequency oscillatory
ventilation.
Status epilepticus -- another reason for PICU admission
- frequently calls for mechanical ventilation plus pharmacotherapy.
Pediatric intensivists work in concert with nationally respected
Cleveland Clinic pediatric epileptologists in managing such patients.
The PICU staff is committed to safeguarding the
80 percent of PICU patients who require ventilatory support at
The Children's Hospital. A fast-track extubation protocol they
have developed reduces the potential for iatrogenic complications
(pneumonia, line infections, feeding difficulties, aspiration,
sedative dependence) in selected patients.
Referrals
For consultations with intensivists or to arrange admission to
the Pediatric Intensive Care Unit, please call the unit directly,
any time of day or night, at 216/444-2060, or toll-free 800/553-5056,
ext. 42060.
To arrange for hospital transfers, locally
or regionally, call 216/738-5050 or toll-free 866/CCF-TOTS (223-8687).
These physician lines are open 24 hours a day, seven days a week.
