Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA.
Pediatr Crit Care Med. 2012 Jan;13(1):e1-4. doi: 10.1097/PCC.0b013e3181fe390a.
Previous simulation studies suggest that temporary pediatric mass critical care approaches would accommodate plausible hypothetical sudden-impact public health emergencies. However, the utility of sustained pediatric mass critical care responses in prolonged pandemics has not been evaluated. The objective of this study was to compare the ability of a typical region to serve pediatric intensive care unit needs in hypothetical pandemics, with and without mass critical care responses sufficient to triple usual pediatric intensive care unit capacity. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: The Monte Carlo simulation method was used to model responses to hypothetical pandemics on the basis of national historical evidence regarding pediatric intensive care unit admission and length of stay in pandemic and nonpandemic circumstances. Assuming all ages are affected equally, federal guidelines call for plans to serve moderate and severe pandemics requiring pediatric intensive care unit care for 457 and 5,277 infants and children per million of the population, respectively.
A moderate pandemic would exceed ordinary surge capacity on 13% of pandemic season days but would always be accommodated by mass critical care approaches. In a severe pandemic, ordinary surge methods would accommodate all the patients on only 32% of pandemic season days and would accommodate 39% of needed patient days. Mass critical care approaches would accommodate all the patients on 82% of the days and would accommodate 64% of all patient days.
Mass critical care approaches would be essential to extend care to the majority of infants and children in a severe pandemic. However, some patients needing critical care still could not be accommodated, requiring consideration of rationing.
先前的模拟研究表明，临时儿科重症监护方法可以应对合理假设的突发公共卫生紧急情况。然而，在长期大流行中维持儿科重症监护反应的效果尚未得到评估。本研究的目的是比较典型地区在假设大流行中满足儿科重症监护需求的能力，包括有无足以将常规儿科重症监护单位容量增加两倍的大规模重症监护反应。
设计、地点、患者和干预措施：使用蒙特卡罗模拟方法，根据国家关于儿科重症监护病房入院和大流行及非大流行情况下住院时间的历史证据，对假设大流行的反应进行建模。假设所有年龄段的人都受到同等影响，联邦指南要求制定计划，以应对需要儿科重症监护的中度和重度大流行，分别为每百万人口中有 457 和 5277 名婴儿和儿童。
中度大流行将在 13%的大流行季节天数超过普通应急能力，但始终可以通过大规模重症监护方法来应对。在严重大流行中，普通应急方法只能在 32%的大流行季节天数内容纳所有患者，只能容纳所需患者天数的 39%。大规模重症监护方法将在 82%的天数内容纳所有患者，并容纳所有患者天数的 64%。
在严重大流行中，大规模重症监护方法对于向大多数婴儿和儿童提供护理至关重要。然而，仍有一些需要重症监护的患者无法得到安置，需要考虑配给。
