Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Pediatr Crit Care Med. 2020 Sep;21(9):797-803. doi: 10.1097/PCC.0000000000002413.
To assess the distribution, service delivery, and staffing of pediatric cardiac intensive care in the United States.
Based on a 2016 national PICU survey, and verified through online searching and clinician networking, medical centers were identified with a separate cardiac ICU or mixed ICU. These centers were sent a structured web-based survey up to four times, with follow-up by mail and phone for nonresponders.
Cardiac ICUs were defined as specialized units, specifically for the treatment of children with life-threatening primary cardiac conditions. Mixed ICUs were defined as separate units, specifically for the treatment of children with life-threatening conditions, including primary cardiac disease.
Cardiac ICU or mixed ICU physician medical directors or designees.
One-hundred twenty ICUs were identified: 61 (51%) were mixed ICUs and 59 (49%) were cardiac ICUs. Seventy five percent of institutions at least sometimes used a neonatal ICU prior to surgery. The most common temporary cardiac support beyond extracorporeal membrane oxygenation was a centrifugal pump such as Centrimag. Durable cardiac support devices were far more common in separate cardiac ICUs (84% vs 20%; p < 0.0001). Significantly less availability of electrophysiology, heart failure, and cardiac anesthesia consultation was available in mixed ICUs (p = 0.0003, p < 0.0001, p = 0.042 respectively). ICU attending physicians were in-house day and night 98% of the time in mixed ICUs and 87% of the time in cardiac ICUs. Nurse practitioners were consistent front-line providers in the ICUs caring for children with primary cardiac disease staffing 88% of cardiac ICUs and 56% of mixed ICUs. Mixed ICUs were more commonly staffed with pediatric residents, and critical care fellows were found in more cardiac ICUs (83% vs 77%; p < 0.0001).
Mixed ICUs and cardiac ICUs have statistically different staffing models and available services. More evaluation is needed to understand how this may impact patient outcomes and training programs of physicians and nurses.
评估美国儿科心脏重症监护病房的分布、服务提供和人员配备情况。
基于 2016 年全国 PICU 调查，并通过在线搜索和临床医生网络验证，确定了设有独立心脏 ICU 或混合 ICU 的医疗中心。这些中心收到了四次在线调查，对未回复者进行了邮件和电话跟进。
心脏 ICU 被定义为专门治疗危及生命的原发性心脏疾病的儿童的重症监护病房。混合 ICU 被定义为专门治疗危及生命的儿童的独立病房，包括原发性心脏疾病。
心脏 ICU 或混合 ICU 医师医疗主任或指定人员。
共确定了 120 个 ICU：61 个（51%）为混合 ICU，59 个（49%）为心脏 ICU。75%的机构在手术前至少使用过新生儿 ICU。除体外膜肺氧合外，最常见的临时心脏支持是离心式泵，如 Centrimag。在独立的心脏 ICU 中，更常见使用耐用的心脏支持设备（84%比 20%；p < 0.0001）。在混合 ICU 中，电生理、心力衰竭和心脏麻醉咨询的可用性明显较低（p = 0.0003，p < 0.0001，p = 0.042）。混合 ICU 中 ICU 主治医生白天和晚上 98%的时间都在病房，而心脏 ICU 中只有 87%的时间。在 ICU 中护理患有原发性心脏疾病的儿童的护士从业者是一致的一线提供者，在 88%的心脏 ICU 和 56%的混合 ICU 中都有他们的身影。混合 ICU 更常见的是儿科住院医师，而更多的心脏 ICU 配备了重症监护研究员（83%比 77%；p < 0.0001）。
混合 ICU 和心脏 ICU 具有统计学上不同的人员配备模式和可用服务。需要进一步评估以了解这可能如何影响患者的结局和医生和护士的培训计划。
