what is the layout of your unit

Yeah, that's a lot of sedation. Most of our kids are on between 50 and 100 mcg/kg/hr of morphine, but there are those who we just escalate and escalate. We do have some prolonged intubations, one little one was over a year! (Parents refused a trach. Self-extubated and so far so good though.) One thing that really bothers me is that we have these kids on mega-sedation and then when the docs want to wean for extubation, we shut everything off then restart it at a much lower dose hours later. One of our docs gauges readiness for extubation on whether the kid is sitting up watching TV or not! He wants them awake, calm and interactive. Okay, let's give you enough morphine and midazolam to stop a bull moose in its tracks for a week then shut it all off and see how calm and cooperative YOU are. I'm really glad that we're getting more and more of our kids back from the OR already extubated.

It is, but we're sometimes actually having to send kids home while still on their wean because they don't need to be in hospital for any other reason any more.

We don't use swans for anybody. I've only seen on in six years, in a 16 year old post explantation of Berlin heart. None of our staff are trained in caring for swans except the really "old" ones who remember it from the old days or when we worked somewhere else. The evidence doesn't support using them in most patients anyway.

Agreed, most instutions are moving away from swans even in the adult icu world (i work there to) but this is the only hospital I have ever worked at that using them at all in children at least. We use them pretty consistently. I think it is just a CV surg preference at this point. On some of the dilated cardiomyopathy kids it's good to shoot CO at times. otherwise we just use it for PA pressures and SVO2.

Our PICU sounds very similar to the OP's new unit. We have 15 beds, 13 rooms with 2 that can be doubled for sibs or times of high census. Before our renovation we were a 19 bed unit and yes, we do miss those 4 beds.

There are charting stations inbetween every 2 rooms with a computer and windows to the rooms. We haven't had any change in accidental extubations, though we do try to keep the vented kids closer to the main nursing station and avoid the far end rooms if possible.

We try to maintain a nice level of sedation where they aren't sitting up, but they will breathe on their own, unless they're requiring high ventilatory support. Our first drugs of choice are Versed and Fentanyl drips, for those very difficult to sedate kids we'll add in prns of many different drugs. We have definitely seen a great deal more Precedex use in the last few years. It is rare to have kids paralyzed, when we do it's Vecuronium.

Hope this helps!