Editorial
Guidelines of admission, discharge and organization of the pediatric intensive care
Criterios de ingreso y alta y organización de los cuidados intensivos pediátricos
a Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
c Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
d Red de Salud Maternoinfantil y del Desarrollo (Red SAMID) RD16/0022/0007, Madrid, Spain
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Rather, pediatric intensive care affords integral management for children with some medical and/or surgical disorder affecting one or–more frequently–several organs, and which poses a threat to the life of the patient.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The development of medicine allows the treatment of an ever-increasing number of individuals with complex disease processes requiring strict vigilance and continuous management. The treatment of these patients demands a specifically designed unit (the PICU) staffed by medical and nursing professionals with specific training in pediatric intensive care, with a view to guaranteeing adequate treatment 24<span class="elsevierStyleHsp" style=""></span>h a day, every day of the year.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> The PICU therefore allows the treatment of seriously ill pediatric patients, regardless of whether the underlying disorder is of a medical or surgical nature, and of whether the course of the condition is acute or requires prolonged admission.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The two fundamental criteria for pediatric patient admission to the PICU are the need for close vigilance and/or care, and the existence of a potentially reversible disease process.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Furthermore, and depending on the circumstances and the hospital, the PICU can also take charge of palliative care and the intermediate care of children that do not require intensive treatment but which do need more care and monitoring than can be afforded in conventional hospital wards.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The PICU must provide support for the rest of the hospital departments and facilitate their activities and progress in a coordinated manner. The supervising health authorities therefore must procure sufficient admission capacity for the unit, with due adaptation of its architectural structure and with sufficient material means and staff to cover its healthcare duties and the activities of the rest of the hospital departments–providing integral quality care for the patients and their families.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Quality of care in the PICU moreover relies on specific capacitation in pediatric intensive care on the part of the medical and nursing staff, in order to ensure that the therapeutic measures inherent to pediatric patients are adopted, with the incorporation and integration of new technologies.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5,6</span></a> However, the activity of the PICU cannot be confined to its own physical space but must also comprise support for specialists in other areas, with the performing of specific techniques, sedation, organization and guidance of the in-hospital rapid response system, the transfer of critically ill children, follow-up of patients with special diseases or who are dependent upon complex technological support, palliative care and telemedicine.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The PICU requires an important number of specially trained healthcare professionals and abundant resources. Since such Units are costly, their size and number should not be incremented indiscriminately.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> It is therefore necessary to clearly define what type of patients can benefit from admission to the PICU. It is neither possible nor necessary for all Spanish hospitals to have a PICU, provided all children can be guaranteed adequate intensive care when needed.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a> The health authorities are therefore responsible for ensuring a sufficient number of PICU beds and for organizing the function of such units in an open and flexible manner, with different levels of complexity, in order to adapt to the real present and future needs of the population. It is essential for each hospital to define the level of care it can offer, in all cases guaranteeing initial stabilization of the seriously ill pediatric patient. Furthermore, the adoption of a specifically pediatric transport system at both Spanish Autonomous Community and national level should constitute a priority concern, since unfortunately no such systems are available in most of the country.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As commented by the authors, these guidelines seek to “facilitate decision making referred to pediatric patient admission to and discharge from PICUs in Spain, with a view to ensuring that these patients receive the best possible care adjusted to their clinical condition”.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> These guidelines offer clear criteria for PICU admission and discharge in children with alterations and diseases of each organ system, with multisystem disease processes, or subjected to surgery or invasive procedures.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The aim is to optimize PICU use, guarantee adequate care adjusted to patient severity, and ensure the safety of the patients.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The mentioned guidelines are only general recommendations that must be dynamic<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,9</span></a> and should be adapted by the professionals to the characteristics of the patient, the capacity of the PICU, and the peculiarities and physical and professional capacities of the rest of the hospital departments.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Classification and assessment (“triage”, as used by the authors) of each patient is essential for deciding whether admission or discharge can be of benefit, conditioned to the monitoring and intensive care needs. Patient benefit should not only be seen in terms of survival but also in terms of quality of life.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,10</span></a> The healthcare professionals of the PICU, together with those of the rest of the departments implicated in the management of the patient, should take part in this process.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Lastly, and as commented by the authors, posterior evaluation based on a multicenter study is required in order to confirm the validity of these criteria.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, these guidelines are an important help for professionals in deciding patient admission and discharge in Spanish PICUs, and should serve as a basis for reorganizing pediatric intensive care in this country.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">RETIC funded by PN I<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>D<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>i 2008–2011, <span class="elsevierStyleGrantSponsor" id="gs1">ISCIII-<span class="elsevierStyleItalic">Subdirección General de Evaluación y Fomento de la Investigación</span></span> and the <span class="elsevierStyleGrantSponsor" id="gs2">European Regional Development Fund (ERDF)</span>, Ref. <span class="elsevierStyleGrantNumber" refid="gs2">RD16/0022/0007</span>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-17" "fechaAceptado" => "2017-12-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Herce J, Carrillo Álvarez A. Criterios de ingreso y alta y organización de los cuidados intensivos pediátricos. Med Intensiva. 2018;42:203–204.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guías de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. De la Oliva" 1 => "F.J. Cambra-Lasaosa" 2 => "M. Quintana-Díaz" 3 => "C. Rey-Galán" 4 => "J.I. Sánchez-Díaz" 5 => "M.C. Martín Delgado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.10.015" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "volumen" => "42" "paginaInicial" => "235" "paginaFinal" => "250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29699643" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organización de las unidades de cuidados intensivos pediátricos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Martinón-Sánchez" 1 => "S. Trabazo-Rodríguez" 2 => "F. Marques" 3 => "A. Rodríguez-Núñez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Manual de cuidados intensivos pediátricos" "paginaInicial" => "37" "paginaFinal" => "40" "edicion" => "4th ed." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 17 | 23 |
| 2024 October | 72 | 58 | 130 |
| 2024 September | 93 | 49 | 142 |
| 2024 August | 131 | 63 | 194 |
| 2024 July | 157 | 31 | 188 |
| 2024 June | 157 | 54 | 211 |
| 2024 May | 95 | 32 | 127 |
| 2024 April | 93 | 54 | 147 |
| 2024 March | 82 | 37 | 119 |
| 2024 February | 95 | 39 | 134 |
| 2024 January | 118 | 36 | 154 |
| 2023 December | 143 | 39 | 182 |
| 2023 November | 139 | 52 | 191 |
| 2023 October | 84 | 35 | 119 |
| 2023 September | 67 | 45 | 112 |
| 2023 August | 69 | 22 | 91 |
| 2023 July | 79 | 27 | 106 |
| 2023 June | 78 | 23 | 101 |
| 2023 May | 99 | 37 | 136 |
| 2023 April | 83 | 20 | 103 |
| 2023 March | 130 | 46 | 176 |
| 2023 February | 124 | 44 | 168 |
| 2023 January | 143 | 32 | 175 |
| 2022 December | 92 | 47 | 139 |
| 2022 November | 79 | 39 | 118 |
| 2022 October | 101 | 49 | 150 |
| 2022 September | 75 | 41 | 116 |
| 2022 August | 63 | 44 | 107 |
| 2022 July | 40 | 39 | 79 |
| 2022 June | 40 | 19 | 59 |
| 2022 May | 64 | 42 | 106 |
| 2022 April | 64 | 33 | 97 |
| 2022 March | 84 | 43 | 127 |
| 2022 February | 70 | 54 | 124 |
| 2022 January | 129 | 44 | 173 |
| 2021 December | 96 | 76 | 172 |
| 2021 November | 84 | 51 | 135 |
| 2021 October | 109 | 89 | 198 |
| 2021 September | 79 | 54 | 133 |
| 2021 August | 113 | 47 | 160 |
| 2021 July | 86 | 36 | 122 |
| 2021 June | 78 | 31 | 109 |
| 2021 May | 74 | 64 | 138 |
| 2021 April | 266 | 102 | 368 |
| 2021 March | 194 | 33 | 227 |
| 2021 February | 149 | 41 | 190 |
| 2021 January | 128 | 40 | 168 |
| 2020 December | 133 | 35 | 168 |
| 2020 November | 90 | 26 | 116 |
| 2020 October | 86 | 36 | 122 |
| 2020 September | 111 | 15 | 126 |
| 2020 August | 58 | 19 | 77 |
| 2020 July | 66 | 24 | 90 |
| 2020 June | 112 | 18 | 130 |
| 2020 May | 63 | 24 | 87 |
| 2020 April | 80 | 26 | 106 |
| 2020 March | 73 | 9 | 82 |
| 2020 February | 196 | 60 | 256 |
| 2020 January | 84 | 33 | 117 |
| 2019 December | 54 | 23 | 77 |
| 2019 November | 312 | 54 | 366 |
| 2019 October | 384 | 78 | 462 |
| 2019 September | 109 | 50 | 159 |
| 2019 August | 114 | 32 | 146 |
| 2019 July | 99 | 41 | 140 |
| 2019 June | 85 | 29 | 114 |
| 2019 May | 129 | 48 | 177 |
| 2019 April | 119 | 47 | 166 |
| 2019 March | 128 | 47 | 175 |
| 2019 February | 64 | 42 | 106 |
| 2019 January | 68 | 43 | 111 |
| 2018 December | 51 | 27 | 78 |
| 2018 November | 34 | 47 | 81 |
| 2018 October | 34 | 20 | 54 |
| 2018 June | 0 | 1 | 1 |
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