Clinical Highlights and Technology
The Pediatric Critical Care Unit (PCCU) of The Children's Hospital at Montefiore (CHAM) is where all pediatric intensive care, including for those who require cardiac intensive care and/or ECMO (extracorporeal membrane oxygenation) for heart and lung support, occurs. Our team of pediatric intensive care physicians are all board certified in pediatrics and pediatric critical care medicine. Our physicians have been honored regionally and nationally for their contributions to the practice of intensive care medicine to children. In addition, our fellowship training program, one of the two original critical care fellowship programs in New York City, ensures that we not only practice the most state of the art medicine but also contribute to the future of pediatric critical care medicine. Our doctors work closely with surgeons and primary care physicians to provide the highest quality care for each child. Additionally, specialists such as heart surgeons and infectious disease, hematology and nephrology doctors make rounds everyday in the PCCU with our Intensivists, so each patient has access to physicians with an incredible wealth of expertise.
Cardiac Intensive Care
Cardiac intensive care services are dedicated to serving infants, children, and adolescents with congenital and acquired heart disease undergoing open-heart surgery, interventional cardiac catheterization procedures and management of non-surgical problems. Directed by a multidisciplinary unit of pediatric intensivists, cardiologists and cardiothoracic surgeons, the cardiac team has performed numerous cardiothoracic surgeries and shares the CHAM Excellence Award for Patient Satisfaction Survey with the entire PCCU staff. Many patients in the tri-state area and throughout the world have been referred to CHAM for cardiac services.
Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation (ECMO) provides temporary support, and in some cases, replaces the functions of the heart and lungs for children experiencing cardiac and/or respiratory failure. In newborns and premature infants it is used to treat several conditions, including: pneumonia, sepsis, Meconium Aspiration Syndrome (MAS), Persistent Pulmonary Hypertension of the Newborn (PPHN), Respiratory Distress Syndrome (RDS), and Congenital Diaphragmatic Hernia (CDH). In older children, ECMO is used to support the cardiovascular system in children with severe heart failure due to cardiomyopathy and myocarditis as well as in children who require temporary mechanical support of their circulatory system after heart surgery. ECMO is also used to provide oxygen to the body in very severe cases of lung failure. While the apparatus may look daunting, the goal of ECMO is to allow your child's lungs and/or heart to rest so they may have time to heal.
While similar to cardiopulmonary bypass (the technology used for patients undergoing heart surgery), ECMO differs in that it is designed to use for days rather than hours. The typical duration for ECMO treatment is 3-7 days. Since its inception at CHAM in 2001, we have treated dozens patients from the northeast region with ECMO.
Due to a high volume of patients with complex craniofacial and airway anomalies, CHAM has created the only multidisciplinary Airway Team in the Northeast region of the United States specifically devoted to the medical and surgical management of these specialized needs. Pulmonologists, ENT (ear, nose, and throat) physicians, cardiothoracic surgeons, plastic surgeons and pediatric intensivists bring a multidisciplinary approach to helping children with complicated congenital and acquired airway disorders. Children referred to the Airway Team are often critically ill before and after diagnostic and surgical interventions. While in the critical care unit, the Airway Team members work under the direction and coordination of the intensive care faculty. Since all of the necessary specialists are involved with the PCCU group from the start, this comprehensive approach adds an extra measure of safety in the management of respiratory stress.
CHAM's Airway Team assists children with tracheal obstructions, feeding disorders, and sleep abnormalities, as well as conditions that include: laryngo and tracheomalacia, tracheal and sub-glottic stenosis, subglottic webs, complete tracheal rings, and laryngeal papillomatosis. Surgery may be required, but in many cases, non-invasive techniques such as virtual bronchoscopy (a cutting-edge sleep study) and specialized tests of an infants' breathing capabilities may be employed. Certain apneas may be managed by utilizing Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP). Whatever treatment the Airway Team collectively decides is the most effective and least invasive, parents can rest assured that we will discuss each decision with them and support them at all phases of their child's stay.
Technology
When it comes to sophisticated state of the art electronics, the Critical Care Unit at CHAM paves the way in both innovation and implementation. The following are a few highlights of the Pediatric Critical Care Unit's technological capabilities:
- PACS (Picture Archiving Communication System): We installed this software-driven system, which is an ideal radiology management tool for viewing images in various locations. Radiologists and physicians can log onto their computers on the hospital floor or even at home to view X-Rays, CAT scans, and MRIs in real time, so they may diagnose patients and consult on them immediately. This efficient process eliminates the time lapse for messengers to deliver films and allows physicians to proceed with the next step for each patient instantaneously.
- CPOE (Computerized Physician Order Entry): The Pediatric Critical Care Unit was a pioneer in launching this top-line technology in 1999. This computerized order entry system enables doctors to immediately process prescriptions to pharmacies in order to maximize efficiency and patients' safety while minimizing human error. The Joint Commission for Accreditation for Health Care Organizations (JCAHO) mandates CPOE as a key patient safety intervention and Montefiore Medical Center and CHAM have been recognized for early and complete implementation of computerized order entry.
- CIS (Clinical Information System): Patient information such as vital signs, laboratory data and X-Rays can be electronically recorded with this integrated system. Montefiore is nationally recognized for its use of CIS and the PICU at CHAM has been an integral part of this program, which improves patients' care quality and safety.
- Central Monitoring System: This real time surveillance system allows for fast and accurate diagnosis and treatment for each patient in the PCCU. Critical information such as patients' waveforms, numerics, and alarms are transmitted over a central computer system, which is monitored around the clock. Thus, nurses and physicians are able retrieve data and perform critical tasks quickly and accurately from the moment each patient is admitted through the time of his or her discharge.
