Doing it for the kids

Caring for paediatric patients in an adult ICUDr Claire Cattigan, University Hospital

Geelong

Geelong

• Largest Regional Centre in Victoria• >16,000 paediatric presentations to ED per

year• >2500 admission to paediatric ward per year

ICU - Barriers

• Unfamiliarity• Underskilled• Equipment/resources• Centralisation of services• Fear

Adult ICU teamLeadership and

Teamwork

Resuscitation skills

Patient/Family

centred Care

Crisis Resource Management Medication

Knowledge

External Collaboration

Effective Communication

Airway Skills

Paediatrics• Hospital Mortality 3.4%• Top 5 admit dx

1. Bronchiolitis ?2. Seizures ✔3. Pneumonia/pneumonitis ✔4. Asthma ✔5. Adenoidectomy/

tonsillectomy ✔

Adult• Hospital Mortality 8.6%• Top 5 admit1. CABG surgery2. Orthopaedic surgery3. GI surgery for neoplasm4. Valvular heart surgery5. Drug overdose

http://www.anzics.com.au/Downloads/CORE%20Annual%20Report%202013-14.pdf

Differences• Diagnostic

– Congenital cardiac conditions– Trauma and management– Inborn errors of metabolism– Cancers

• Physiological– Vital sign ranges– Fixed stroke volume, reduced respiratory reserve– Transitional circulation– Thermoregulation– glucose/metabolism

• Risk – PRISM/PIM vs APACHE

• Psychology– Age appropriate interaction (4mo v 4y v 14y)– Parents/Carers

AIRWAY

Cannula (birds) to 75.0 ETT (giraffe)

http://www2.pedsanesthesia.org/newsletters/2015fall/sessVI.html

Breathing/Ventilation

VentilationSecured ETT (nasal >oral)Sedation (beware propofol)Monitoring (incl capnography), pulse oximetry, ecg telemetry. VT 6-8, RR 15-25, PEEP 5, PIP 20-25

Circulation

Medications

Resources

• Paediatric equipment (appropriate sized airway equipment, monitoring, suction, cots, breastmilk fridge)

• Paediatric resuscitation trolley• Cognitive aides• Paediatric medication chart• Paediatric Check list (ward round, intubation)• Age specific ICU chart with vital signs

Education

• Nursing– In house 3 stage program

• RCH• APLS, PLS• APICS• Beyond Paediatric Basic

Geelong ICU

Geelong Paediatricians

Geelong Paed and SCN

RCH PICUGeelong Anaesthetics

Geelong ED

Geelong/RCH Radiology Geelong

Pharmacy

Mx Cmt

SIG

Can this patient be managed at Geelong?

Pre 2011 2011 2012-2015 Future

2010 2011 2012 2013 2014 2015 20160

20406080

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ICU

MET

TF ICU

Ventilated