The team at the Pediatric Intensive Care Unit provide a number of specialized programs.
Pediatric specialized transport has evolved since it’s inception 20 years ago, and plays an integral role in Saskatchewan’s pediatric critical care delivery. With broader geographic access and advancements in skills and technology, our pediatric specialized transport team is able to extend timely critical care into rural and remote communities.
Through extensive support from Jim Pattison’s children’s hospital foundation, Saskatchewan’s pediatric critical care transport team performs over 500 transports per year. The team safely transports children between provincial facilities, enabling assess to the appropriate level of care. With highly sophisticated ventilators, advanced cardiopulmonary monitoring and portable blood work, the team is able to initiate life sustaining therapy in a timely manner.
To deliver the highest quality care, our research for this program focuses on patient outcome metrics, and scoring systems that assess severity of illness.
Remote Presence Telehealth
Universal and timely access to pediatric specialized care is a substantial challenge. Saskatchewan’s geographical range makes provision of medical expertise in remote communities extremely difficult. Utilizing remote presence robotic devices have helped to bridge these challenges, allowing us to directly visualize and examine critically ill patients for a prompt diagnosis and accurate treatment plan. Our recently published studies reflect the safety and feasibility of this innovative technology, and how we are trying to close the access gap that permeates health care.
We currently support 3 northern communities and thanks to the ongoing commitment from the Saskatchewan ministry of health partnered with Jim Pattison Children’s Hospital Foundation, our goal is to service an additional 5 communities during 2018. We will continue expanding until all Saskatchewan children have timely access to our subspecialty support, regardless of their postal code.
Nearly 25% of children admitted to PICUs have either a new injury to their brain/spinal cord or a neurologic complication of their illness. Despite the expertise found in children’s hospitals, there remains an unmet need for these very vulnerable patients: the breadth of neurologic injuries is immense but the research supporting clinical practice is poor.
Pediatric neurocritical care has recently emerged as a subspecialty. The Jim Pattison Children’s Hospital had the vision to develop this area, and currently provides innovative care through multidisciplinary expertise from neurology, critical care, neurosurgery, psychiatry and neuroradiology. Newer developments include the utilization of non invasive ultrasound monitoring for traumatic brain imaging (transcranial dopplers and optic nerve sheath diameters), improved access to continuous electroencephalography, quick brain MRI (to minimize CT radiation exposure), early mobilization and delirium screening. Several exciting and novel initiatives are currently in the planning stages.
Critically ill pediatric patients may require advanced technologies to support failing organ systems. Over the years, we have developed the following:
- Continuous Renal Replacement Therapy (CRRT) is a form of dialysis utilized for serious kidney injuries in some of our sickest patients. The Jim Pattison Children’s Hospital Foundation was integral in supporting the initiation of this program in 2007.
- Therapeutic apheresis results in the removal of blood components that are disease or symptom causing. Children with severe infections, neuromuscular diseases, hematologic/thrombotic disorders may be overwhelmed by inflammation and clotting and require plasma exchange. Utilizing the Spectra Optia aphaeresis system (donated by the JPCHF), Saskatchewan’s PICU has performed over a 100 treatments for a variety of disease processes. Recently, leukopheresis has been introduced, to assist children with high white cells in certain cancers.
- Extracorporeal Membrane Oxygenation (ECMO) has become an essential tool in the care of children with cardiac and pulmonary failure that has not responded to conventional management. In collaboration with our pediatric cardiologists, surgeons, and perfusionists, ECMO is initiated when necessary.
Our multidisciplinary team of physicians, respiratory therapists and nurses strive for excellence in respiratory care through the use of standard and emerging therapies. Our expertise includes high flow therapy, non-invasive ventilation and non-conventional therapies such as non-invasive high frequency oscillatory ventilation (nHFOV), invasive high frequency oscillatory ventilation (HFOV) and high frequency jet ventilation (HFJV).
Through innovative technologies we are pushing conventional boundaries to provide unique and individualized respiratory care to meet the needs of our patients. The Jim Pattison Children’s Hospital Foundation has allowed us to become pediatric leaders of electrical impedance tomography (EIT) by equipping our unit with Dräger Pulmovista 500 technology. We also employ other tools including lung ultrasound and quasi-static pressure-volume measurements.
The Pediatric Simulation Program
The care of pediatric patients is becoming increasingly complex, and requires skills and knowledge sharing between multiple caregivers. Simulations are scenarios designed to closely approximate real situations – usually for the purposes of training or evaluation. Medical simulation based education and training provides an opportunity for team training without exposing patients to unnecessary harm.
With tremendous support from the Jim Pattison Children’s Hospital Foundation, we use the Laerdal SimJunior patient simulator, which can be operated remotely using a tablet-based device. SimJunior represents a 6-year-old child that simulates a wide range of conditions from a healthy, talking child to an unresponsive, critically ill patient. The Simulation Program supports orientation and skill maintenance for new and existing members of the PICU, Pediatric Inter-facility Transport Team, and pediatric providers on the ward.