Additional Information for Mary Bridge Society Members

(A Continuation of the June 2014 E-Newsletter)

 

Statistics that Tell a Compelling Story

 In 2013, Mary Bridge Children's Hospital's Child Abuse Intervention Department reported the following information.

These are not numbers -- these are babies, children and teens in our community who have been abused by the very people who should have guarded and protected them.

 

 

 

 

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Additional Information for Mary Bridge Society Members

(A Continuation of the April 2014 E-Newsletter)

 

Mary Bridge Children’s Hospital Pediatric Intensive Care Unit (PICU)

By Iain Aspin, MD, PhD

Program History
The Pediatric Intensive Care Unit (PICU) at Mary Bridge Children’s Hospital (MBCH) was organized in the early 1980s as a collaboration between MBCH and community pediatricians. The PICU enabled pediatricians in Tacoma and the surrounding communities to provide care for infants and children with complicated and high-risk medical needs at MBCH. Dr. Martha McCravey was hired as the first board-certified pediatric intensivist in 1984, giving the PICU a dedicated specialist trained in pediatric intensive care medicine, and allowing us to care for infants and children requiring very complex care. 

Organization
Today, the PICU at MBCH is a staffed by board-certified (or board-eligible) pediatric intensivists, pediatric critical care trained nurses, and respiratory therapists (RTs) to provide care to critically ill infants and children. The PICU is supported by pediatric pharmacists, pediatric nutritionists, Social Work, and Child-Life specialists. Pediatric intensivists are physicians who have trained fully as pediatricians and then undertaken at least three further years of training in pediatric intensive care medicine.

The PICU is a “closed” unit – the pediatric intensivists have primary responsibility for all patients admitted to the PICU. The pediatric intensivists, PICU RNs, and RTs work closely with other pediatric sub-specialists to provide care to the infants and children admitted to the PICU. There are nine pediatric intensivists who provide coverage of the PICU. Due to the critical nature of the illnesses affecting the infants and children admitted to the PICU, a pediatric intensivist is always present in the PICU.

Services
The PICU at MBCH is one of only six units in Washington that can provide “typical” pediatric intensive care services. Examples of such services would be provision of mechanical ventilation in respiratory failure, support of heart function with pressor drugs, intensive asthma care with inhalational and IV drugs, and treatment of severe diabetic ketoacidosis.

Importantly, the PICU at MBCH has the skills and the resources to provide highly-specialized services that go beyond “routine” pediatric intensive care. These skills and services include:
• Extra-Corporeal Life Support (ECLS or “ECMO”), which can replace both heart and lung function when one or both have failed
• High-Frequency Oscillatory Ventilation (HFOV, “Hi-Fi”), a special type of ventilator used in severe lung injury
• Continuous Renal Replacement Therapy (CRRT), a special type of kidney dialysis for acute kidney failure
• Intra-Cranial Pressure Monitoring, used to measure the pressure inside the skull  following head injury, brain surgery, bleeding into or on the brain, or other situations when the pressure inside the skull may be dangerously high
• Provision of inhaled Nitric Oxide (iNO), a medical gas that is used to help improve lung function
• Bronchoscopy, special equipment equipped with a camera that can be inserted into the lungs to help clear blocked airways and obtain samples to diagnose lung infections and other lung problems

Expertise in these areas allow the PICU at MBCH to support  a pediatric Cardiac Surgery and Cardiology program, a Level II pediatric Trauma program, pediatric Neurosurgery, pediatric Surgery, pediatric Ear/Nose/Throat Surgery (focusing on complicated airway abnormalities) and all the other pediatric subspecialty programs at MBCH (e.g. Pulmonary, Hematology/Oncology, Nephrology, Rehabilitation Medicine, Neurology, G.I., etc.) 

MBCH can deliver these highly-specialized critical care services because of a skilled, high-functioning, well-integrated multi-disciplinary PICU team that can successfully provide highly technically sophisticated care to the sickest infants and children. This expertise extends beyond the PICU to the rest of MBCH – as the PICU coordinates this highly sophisticated care with other clinical divisions and departments at MBCH.

Current State
Over the past five years (2009 – 2013), the PICU at MBCH has averaged 694 admissions per year, or about 1.9 admissions per day. Although there is much variation, a patient admitted to the PICU will typically spend about 4 ½ days in the PICU before being well enough to be transferred to the pediatric medical/surgical ward.

In 2013, the PICU at MBCH relocated to new clinical care area, which allowed the PICU to expand to a total of 24 beds, from 12 beds in the prior location. This allows the PICU to increase the number of infants and children who receive intensive care at MBCH and be prepared for future growth in the number of children needing intensive care from our community and region.

 

Iain Asplin, MD, PhD

Dr. Asplin is a pediatric critical care specialist at Mary Bridge Children's Hospital

Medical School: Duke University School of Medicine
Internship and Residency in Pediatrics: Boston Children's Hospital and Boston Medical Center Combined Program in Pediatrics
Fellowship in Pediatric Critical Care Medicine: Seattle Children's Hospital

 

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