Are you having an RSV crisis?

AliRae · Jan 7, 2007

I'd be interested to know what your RSV situation is like and whereabouts in the world you are.

I'm in central Jersey in a 20-bed unit. We actually haven't been too bad yet (as I knock on every piece of wood within arm's reach...). It's been unseasonably warm here ... today was 73 degrees! ... and I think that's had something to do with it. We've had more flu and adenovirus thus far. Lost one kiddo to that combo, but the rest pulled through. Right now we have 3 RSV, one on bubble CPAP but none intubated. I'm not sure how many they have on the floor, but they can't be bad, because they send them to us at the drop of a hat. (Or the drop of a sat. Tee hee!)

Pediatric Critical Care Columnist · Jan 7, 2007

I'm not sure how many they have on the floor, but they can't be bad, because they send them to us at the drop of a hat. (Or the drop of a sat. Tee hee!)

CUTE!!! May I use that one?

We too have been unseasonably warm for the last while although we had a really cold snap in Novemeber where we had temperatures around the -20 F mark. But lately it's been closer to the freezing mark instead of 10 degrees colder. I don't know if that's having much effect. A lot of our really sick kids have come to us from the far north, Nunavut and the Northwest Territories. Except for the one from Saskatchewan and the other one from Manitoba...

Redneckmedic63 · Jan 7, 2007

We seem to have started RSV season a little late this year as well - weather likely a factor here, too. However, we're now pretty much ramped into another full season - ours usually lasts til end of March. Most are the typical critical RSV, but seems like we're seeing alot of concurrent flu and strept infections as well. Good luck - RSV season is the Daytona of PI! My favorite time of the year - really!

AliRae · Jan 7, 2007

A lot of our really sick kids have come to us from the far north, Nunavut and the Northwest Territories. Except for the one from Saskatchewan and the other one from Manitoba...

Holy cow ... how far do your kids come to you from? Where are you, if I may ask? (Obviously somewhere in the great white North.) I guess things are different for us - there are loads of hospitals in Jersey.

Pediatric Critical Care Columnist · Jan 7, 2007

AliRae, I work at the Stollery Children's Hospital at the University of Alberta in Edmonton, Alberta, Canada. To make it a little clearer, we're 655 miles due north of Butte, Montana. Between London, Ontario (just northeast of Detroit) to the Pacific Ocean, there are five PICUs covering a landmass of 53.2 million square miles and serving a population of about 12 million. The PICU at the Winnipeg Children's Hospital in Manitoba has 8 beds, soon to be expanded to 10. The PICU at Royal University Hospital, Saskatoon, Saskatchewan also has 8 beds. The newly opened Alberta Children's Hospital in Calgary has 20 PICU beds. And British Columbia Women's and Children's has 10 beds. There used to be a PICU at the Victoria General Hospital in Victoria, BC, but I can't find any information about its continued existence. We in Edmonton have as many beds as our medical director decides we have... in reality we have 15 actual bed spaces, including 7 isolation rooms, but we have at times had as many as 19 kids in that same space by cohorting kids in the isolation rooms. We have an average of 900 admissions per year. Our patients come from as far away as Inuvik, Northwest Territories which is some 2000 miles from here, although they usually will go to Yellowknife, NT first for stabilization. That's only 931 miles away.

Our unit is the referral centre for all pediatric cardiac surgery for western Canada. BC Children's does some low-risk surgeries, fewer than 150 per year; we do all the rest, between 500 and 600 per year. In 2005 we did 17 heart transplants. We also will admit kids from eastern Canada for heart surgery, and have had kids from every province and territory in the unit in the last two years. Recently we were named the North American training facility for the Berlin Heart, a four-chambered, pulsatile external artificial heart. We also do all the liver transplants for Saskatchewan, Alberta and most of BC. We have one of four pediatric ECLS programs in Canada and are the most active of the two in western Canada, with an average of 250 in-unit pump days per year. We have a dedicated pediatric transport team that travels to wherever a sick child is (by road, fixed wing propeller, fixed wing jet or helicopter) and brings them to our hospital for care. The majority of the patients they transport end up in PICU. Some of the nurses and RRTs are qualified to transport physicianless, but due to staff turnover that number is dwindling. We have successfully transported two children on ECLS from Winnipeg (a distance of 880 miles) via military transport plane, both of whom survived neurologically intact.

So there you have it: the state of pediatric intensive care in western Canada. Glad you asked?

Trauma Columnist · Jan 7, 2007

My little grandson just got out of the hospital yesterday after five days in the hospital with RSV. We were told that December was far worse for RSV than Jan has been. I live in central IL.

Pediatric Critical Care Columnist · Jan 7, 2007

So glad your little darlin' is home and safe! The hospital is really no place for a sick baby! :wink2: Have you stocked up on Purelle yet?

Trauma Columnist · Jan 7, 2007

Oh yes and we are very careful.

AliRae · Jan 7, 2007

So there you have it: the state of pediatric intensive care in western Canada. Glad you asked?

Very glad, actually! I myself am a Canadian (at least at heart ... lived in the states my whole life, but since my mum and dad are Canadian, I'm a dual citizen), and considered coming up north to work when I graduated. (My grampa was late in his Alzheimer's course, and I was going to help care for him. He passed away the day before I graduated, so I stayed down here.) I have family all in the east though- Toronto, London, and Nova Scotia. My uncle is actually a family physician in Halifax. He was recently named one of the top 10 family MDs in Canada!

To get back to the purpose of the thread ... how often do you get RSV kiddos sick enough to go on ECMO? We don't do it, I don't know if I've ever seen one in our unit that we would have liked to pursue it. Usually the ones who get that sick are the ones with underlying issues (NICU grads, birth injuries, etc).

Pediatric Critical Care Columnist · Jan 7, 2007

So sorry about your grandpa, but congrats to your uncle! We Canadians are a special breed!!

As for RSV on ECMO, we've done it a few times in the last while. I'm not saying that we should be doing it, only that we do. Because we can. The kiddie we have on now is a previous coarct who came in with respiratory distress at 0620, arrested at 0710, had a 29 minute resus with five rounds of drugs, failed conventional ventilation, failed HFOV and has now been on ECMO at full flows for oh... four weeks. He got a chest tube the other day to drain his pleural effusion... The one before that was an infant who if I correctly recall was previously healthy and only needed a few days of support. And last spring we had a previously healthy gal who came in with adeno who was on for 8 weeks, a full 56 days, then taken off for celestial transfer. Horrible! We aren't allowed to let kids die in our unit. Until they've started to decompose. I hate that part of it.

km5v6r, EdD, RN · Jan 8, 2007

We aren't allowed to let kids die in our unit. Until they've started to decompose. I hate that part of it.

That is the part of PICU I am having the most difficulty with right not. We recently had a 4 yr old with a history of liver/small bowel transplant develop severe rejection. The child walked in to the PICU but quickly ended up on the vent. From there it was the HFOV then CRRT with the catheter placed transhepatic because there were no other vessals. 4 chest tubes, 3 different pressors, massive fluid overload, skin on the extremities and pressure points like the ears breaking down despite everything, massive pneumoperitonium and discussion of ECMO. We don't do ECMO in our PICU. The transplant surgeons even said they would have a CV surgeon "crack the chest" to place the needed access. Thank God the CV surgeon said NO. The hardest part was when Mom asked the transplant coordinator "how do you know when to quit?" The coordinator responded with "Oh don't worry. The kids always seem to have a way of letting us know when to stop. Until then we will do everything possible but when he lets us know it is time to stop we will." The parents actually trusted that these medical professionals would recognize the ending point and let them know it was time to let go. The child was coded. The coordinator was right. The kids do tell us it is time to stop. The coordinator didn't say we would listen.