Dedicated Neuroscience ICU

Innovative Care | October 24, 2018 | cookchildrens

The three primary diagnostic categories of patients discharged from Cook Children's Pediatric ICU (January 1, 2009 through December 31, 2010) were: respiratory (892 patients/24.18% of total discharges), cardiovascular (758/20.55%) and neurologic (617/16.73%). In 2011, Cook Children's set out to develop its own Neuro Critical Care Program with a vision to improve patient care and outcomes through quality improvement, research collaboration and a family-centered multidisciplinary pediatric neurological critical care team.

The Neuro-PICU team is composed of highly trained neurosurgeons, neurologists, critical care physicians, advanced practice nurses, critical care nurses, neuro-radiologists and hematologists that round on patients as a team daily improving communication between specialists, nurses and the family – ultimately leading to improved care and shorter hospitalizations. The team is supported by educators, nutritionists, neuro-pharmacists, a chaplain, social workers as well as respiratory, speech, occupational and physical therapists providing the full complement of services needed for these critically ill patients. Our Neuro-PICU team model has been an example of collaboration for other institutions trying to create or enhance their Neuro Critical Care Program. We have joined the Pediatric Neuro Critical Research Group, a national group specifically developing research for pediatric critical neurological disorders and, as a member of Children's Hospital Association, we have participated in research addressing nutritional needs in patients with traumatic brain injury and delirium in the intensive care environment.

Over the past six years, 4,562 patients have been admitted to the Neuro-PICU. Of these, 35% (1,607) were seen for primary neurological disorders, 45% (2,064) for primary neurosurgical disorders and 20% (891) for combined neurological and neurosurgical disorders. While the average daily census has increased, the average length of stay per patient has decreased from 4.32 in 2011 to 3.15 days in 2017, underscoring the success of this dedicated collaborative team approach. In November of 2017, we expanded our ICU an additional 10 beds focusing on and cohorting Neuro-PICU patients in a single unit. This new unit provides essential monitoring such as continuous video electroencephalography for patients at risk for seizures, as well as cerebral oxygen saturation, intracranial pressure, and continuous hemodynamic monitoring for brain injuries. We offer advanced ventilatory support including negative pressure ventilation for patients with neuromuscular disorders. We also have protocols in place to achieve normal temperature rapidly and prevent variations in temperature using Arctic Sun, a device that controls the temperature using external pads applied to the patient's skin. We are improving our own care through established guidelines for the care of traumatic brain injury, establishment of a normothermia protocol for patients that suffer cardio-respiratory arrest and a hypothermia protocol for refractory status epilepticus. For patients with acute ischemic stroke, we have developed a rapid response model to provide fast and effective therapy, critical to saving the brain. The response model begins the moment we receive a call from a referring institution, or the patient arrives to our emergency room.

We will continue to provide a focused practice that enhances the care of patients. “This was the next logical step for our Neurosciences Program at Cook Children's. We believe that we will be another strong part of the Neurosciences Program, and, in turn, attract more talent to the team. Also, we will serve as a referral center for patients in need of highly specialized neurocritical care. Finally, this is what I would want for my sons if they had the need for neurocritical care,” said Javier Gelvez, M.D., Medical Director, Neuro Pediatric Intensive Care Unit.

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Javier Gelvez, MD

Pediatric Intensive Care Unit (PICU)

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