Directorate of Medical Affairs, Quality and Safety, Beatrix Children's Hospital, Groningen, Netherlands.
Pediatr Crit Care Med. 2010 Mar;11(2):185-98. doi: 10.1097/PCC.0b013e3181cbdd76.
To assess the adequacy of preparedness planning for an influenza pandemic by modeling the pediatric surge capacity of healthcare facility and pediatric intensive care unit (PICU) requirements over time. Governments and Public Health authorities have planned preparedness activities and training for a flu pandemic. PICU facilities will be the limiting factor in healthcare provision for children but detailed analyses for needs and demands in PICU care have not been published.
Based on the Center for Disease Control and Prevention and World Health Organization estimates and published models of the expected evolution of pandemic flu, we modeled the pediatric surge capacity of healthcare facility and PICU requirements over time. Various scenarios with different assumptions were explored. We compared these demands with estimates of maximal PICU capacity factoring in healthcare worker absenteeism as well as reported and more realistic estimates derived from semistructured telephone interviews with key stakeholders in ICUs in the study area.
All hospitals and intensive care facilities in the Northern Region in The Netherlands with near 1.7 million inhabitants, of whom approximately 25% is <18 yrs.
Using well-established modeling techniques, evidence-based medicine, and incorporating estimates from the Centers for Disease Control and Prevention and World Health Organization, we show that PICU capacity may suffice during an influenza pandemic. Even during the peak of the pandemic, most children requiring PICU admission may be served, even those who have nonflu-related conditions, provided that robust indications and decision rules are maintained, both for admission, as well as continuation (or discontinuation) of life support.
We recommend that a model, with assumptions that can be adapted with new information obtained during early stages of the pandemic that is evolving, be an integral part of a preparedness plan for a pandemic influenza with new human transmissible agent like influenza A virus.
通过建立模型来评估医疗设施和儿科重症监护病房（PICU）的儿科资源扩充能力，从而评估流感大流行的准备情况。政府和公共卫生当局已经为流感大流行制定了准备活动和培训计划。PICU 设施将成为儿童医疗服务的限制因素，但尚未公布 PICU 护理需求和需求的详细分析。
基于疾病控制和预防中心以及世界卫生组织的估计以及已发表的大流行性流感预期演变模型，我们建立了医疗设施和 PICU 资源随时间扩展的儿科资源扩充能力模型。探讨了不同假设下的各种情况。我们将这些需求与最大 PICU 能力的估计进行了比较，其中考虑了医疗工作者缺勤以及从研究区域 ICU 关键利益相关者的半结构化电话访谈中得出的报告和更现实的估计。
荷兰北部地区所有的医院和重症监护设施，拥有近 170 万居民，其中约 25%的人口年龄在 18 岁以下。
使用成熟的建模技术、循证医学，并结合疾病控制和预防中心以及世界卫生组织的估计，我们表明，在流感大流行期间，PICU 容量可能足够。即使在大流行高峰期，大多数需要 PICU 入院的儿童也可能得到服务，即使是那些患有非流感相关疾病的儿童，只要维持了严格的适应症和决策规则，既适用于入院，也适用于继续（或停止）生命支持。
我们建议在为具有新的人类可传播病原体（如甲型流感病毒）的流感大流行制定准备计划时，将具有可以随着大流行早期获得的新信息进行调整的假设的模型作为计划的一个组成部分。
