What kind of kids do you see in your PICU?

[sergel02, BSN]

Another pediatric question I was thinking about. I know every PICU is different and at a different level, but I was wondering what kind of kids you see in your unit. All I know is most PICU's have vented patients and open heart post-ops. I know at the 3 PICU's in my area, once a kid doesn't need the vent, they tend to get taken down to med surg.

Also, something I've been really curious about, is the age range you see. Mostly toddlers, under 8, adolescents, etc.? I have a friend precepting in a PICU and they get a lot of heart kids since there is a CVICU for peds, but since the hospital is also a major trauma center they get a lot of teens doing things they probably shouldn't have.

Thanks for any help :)

[guest769224]

Here's what I see in our current PICU census. Maybe it'll help you get a feel.

Near drowning - 16 months

AMS- 15 yrs

OD- 14 yrs

Colon obstruction- 16 months

Resp distress- 4 months

Bronchiolitis- 2 months

Renal failure- 3 years

MVA- 5 years

Head injury- 44 days

Neuromuscular scoliosis- 12 years

Complex craniosynostosis- 6 months

Bronchiolitis- 7 months

Larnygomalacia- 2 months

Hypoxia- 3 months

Fever- 13 months

[oliegirllvn]

What's is AMS and MVA?

[IgotDimples]

MVA - motor vehicle accidents

Other one no idea

[oliegirllvn]

Thanks :)

[guest769224]

MVA - motor vehicle accidents

Other one no idea

Altered mental status

[IgotDimples]

Thanks, good to know

[meanmaryjean, DNP, RN]

We currently have:

13 yo heroin OD

3 RSV bronchiolitis/ 2 vented 1 on cuirass: all infants

2 acute renal failure / 1 on PD (age six)one on HD (age 14) :

unrepaired, unbalanced AV canal with downs/ vented 4 months

two teenage scoli repair (they typically spend the night of surgery only with us)

1 newborn HLHS post Norwood

acute CVA/ AMS Age 7

[sergel02, BSN]

Thanks for the examples. ICUman, a lot of your kids are under 2 years old. The age range is interesting.

If anyone has more examples that'd be nice to see too.

One thing I was wondering, what causes renal failure in kids? I never actually heard of it happening, but I don't have much experience. I had a patient with end stage renal disease, but he's 80 and had other issues.

[meanmaryjean, DNP, RN]

Our younger patient has HUS (hemolytic uremic syndrome) and our older one has some rare infectious glomerulonephritis which has been apparently untreated for months prior to admit)

I would say that nearly 75% of our patient population is under age five, probably half under age two.

[NotReady4PrimeTime, RN]

For most units it depends on the time of the year. Where I live, RSV season, which runs from late October to May here, means small people. But our census as of yesterday looked more like this:

1 MVC/polytrauma (16 years)

2 post-op liver transplants (4 months and 10 months)

1 neuromuscular disorder (1 month)

1 ARDS with acute-on-chronic renal failure on CRRT (15 years)

1 mediastinal mass (5 years)

1 ex-prem with increased ICP and EVD (12 years)

1 HLHS post Fontan/post cardiac arrest (3 years)

1 neurodevelopmentally delayed kiddo post G-Tube/fundoplication (2 years)

1 end-stage pulmonary failure on ECLS (16 years)

1 GAS pneumonitis on ECLS (11 months)

1 post-op spinal instrumentation (5 years)

1 severe global developmentally delayed kidlet with respiratory failure (3 years)

1 cardiomyopathy on VAD (3 years)

1 pulmonary atresia/hypoplastic lungs/AVSD with central shunt (2 weeks)

1 arterial switch (10 days)

1 severe TOF/pulmonary vein stenosis (5 months)

1 Shone's complex with trach and G-Tube (1 year)

1 complex cardiac post CVA (2 years)

Once May long weekend rolls around our trauma season will get rolling and we'll have an average of 1 older kid a week coming in with TBIs, multiple fractures, spinal cord injuries, traumatic amputations and so on. This lasts up to Labour Day. Fun times!

[NotReady4PrimeTime, RN]

Oh yeah... I meant to answer your question about renal failure and got caught up with counting noses instead.

Besides HUS and infectious glomerulonephritis, there are many cases of CRF in children. Kids can be born with renal agenesis. They can develop acute renal failure as a result of severe hypotension. They may have polycystic kidneys. If they have biliary atresia or some other liver anomaly they could develop hepatorenal syndrome where both liver and kidneys fail. They could have vesicoureteral reflux caused by strictures of the urethra that damages the kidneys. They may have received nephrotoxic drugs. They may develop nephrotic syndrome, sometimes an autoimmune disorder. They could have sickle cell related renal injury. Kids aren't exempt from lupus, Alport's syndrome, Goodpasture's syndrome, insulin-dependent diabetes or neurogenic bladder. And the vast majority of Wilm's tumours occur in kids.