question about picu and vented

Pediatric Critical Care Columnist · Sep 30, 2014

Generally speaking, it's the need for mechanical ventilation that causes most PICU patients to be admitted, particularly in the fall and winter, when respiratory viruses are at their peaks. The internal diameter of your airway is the same as the external diameter of your pinky finger, so it doesn't take much to compromise a child's airway. And in keeping with those details, one of the criteria for transfer out of the PICU is no longer requiring invasive mechanical ventilation. If you want to be able to play with your patients all the time, then PICU isn't for you. We do get to play with our patients toward the end of their PICU admission but at least on my unit (when and if there are inpatient beds available) we extubate on one day and transfer out the next.

careo180 · Oct 5, 2014

I work in a PICU in a smaller hospital in new england. The majority of our admissions are not vented, but more in the winter. BUT I do sorely miss the interaction with pediatric patients who act more like children...who are not neurologically compromised or sedated, so I am currently searching for a pediatric unit position...

Nepenthe Sea · Oct 17, 2014

I work in a small PICU, and our patient acuity is not as high as the other hospital in town. We do get vented patients, sometimes multiple ones, but it's also not uncommon to have no vents or to have some floor overflow, when they are getting slammed and we have beds available. So, not all of our patients are sedated. The good thing about my unit is that we tend to keep them through discharge, unless we need their room for a patient, so you will see a vented patient come off the vent, get better, and start acting like a regular kid. It's nice to see that progression.

jrt4 · Oct 20, 2014

I agree with the posts above. I used to work in a small community hospital PICU...most of our patients were not intubated. I now work at a large academic medical center. The PICU has 2 sections...one for critically ill and one that is a more intermediate area. In general, most patients on the critical end are intubated.

sergel02, BSN · Apr 7, 2015

I was kind of wondering this myself as I think about fields to go into. PICU seems interesting, but I too was worried about not getting to really interact with the patients that much, compared to the floor.

Course others say that since you have less patients, you can have more patient interaction. They said that for adult ICU though, and I'm not sure that carries over the same in PICU.

Pediatric Critical Care Columnist · Apr 7, 2015

You will interact with your PICU patient many, many times in the course of a shift but your patient probably won't interact nearly as much with you - if you know what I mean. The kids who come to the PICU for overnight monitoring post-operatively are the ones who have the most potential for being interactive, although usually it's to beg for water then vomit it back up on your shoes, to refuse to be repositioned and to carry on about having to do their incentive spirometry. As well, the kids who are nearing transfer to the ward will be more interactive. But you can't count on having a patient assignment that gives you the opportunity to play with the kids.

sergel02, BSN · Apr 7, 2015

Yeah that's a bit unfortunate, but it makes sense. If they could talk to you tons then that could mean they are healthy enough for the floor.

I live in California and I think pediatric nurses have a max of 3 patients, though I can't confirm that. That is encouraging compared to higher ratios for adults, though it can take longer to do things for kids. There is a good PICU that takes lots of trauma and cardiac kids that I heard has a 2 nurse to 1 patient ratio. I'm not positive myself, but that sounds amazing.

Course, I guess I'll have to see if I like pediatrics(or even ICU). I still got 10 months or so before I start my peds clinicals.