Objectives: 

To assess the distribution, service delivery, and staffing of pediatric cardiac intensive care in the United States.

Design: 

Based on a 2016 national PICU survey, and verified through online searching and clinician networking, medical centers were identified with a separate cardiac ICU or mixed ICU. These centers were sent a structured web-based survey up to four times, with follow-up by mail and phone for nonresponders.

Setting: 

Cardiac ICUs were defined as specialized units, specifically for the treatment of children with life-threatening primary cardiac conditions. Mixed ICUs were defined as separate units, specifically for the treatment of children with life-threatening conditions, including primary cardiac disease.

Participants: 

Cardiac ICU or mixed ICU physician medical directors or designees.

Measurements and Main Results: 

One-hundred twenty ICUs were identified: 61 (51%) were mixed ICUs and 59 (49%) were cardiac ICUs. Seventy five percent of institutions at least sometimes used a neonatal ICU prior to surgery. The most common temporary cardiac support beyond extracorporeal membrane oxygenation was a centrifugal pump such as Centrimag. Durable cardiac support devices were far more common in separate cardiac ICUs (84% vs 20%; p < 0.0001). Significantly less availability of electrophysiology, heart failure, and cardiac anesthesia consultation was available in mixed ICUs (p = 0.0003, p < 0.0001, p = 0.042 respectively). ICU attending physicians were in-house day and night 98% of the time in mixed ICUs and 87% of the time in cardiac ICUs. Nurse practitioners were consistent front-line providers in the ICUs caring for children with primary cardiac disease staffing 88% of cardiac ICUs and 56% of mixed ICUs. Mixed ICUs were more commonly staffed with pediatric residents, and critical care fellows were found in more cardiac ICUs (83% vs 77%; p < 0.0001).

Conclusions: 

Mixed ICUs and cardiac ICUs have statistically different staffing models and available services. More evaluation is needed to understand how this may impact patient outcomes and training programs of physicians and nurses.

中文翻译：

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2018年，美国小儿心脏重症监护室的分布，服务交付和人员配备。

目标： 

评估美国小儿心脏重症监护室的分布，服务提供和人员配备。

设计： 

根据2016年全国PICU的调查，并通过在线搜索和临床医生网络进行验证，医疗中心被确定为单独的心脏ICU或混合ICU。对这些中心进行了多达四次基于网络的结构化调查，并通过邮件和电话对未答复者进行了跟踪。

设置： 

心脏ICU被定义为专门单位，专门用于治疗患有威胁生命的原发性心脏病的儿童。混合ICU被定义为单独的单元，专门用于治疗危及生命的疾病（包括原发性心脏病）的儿童。

参加者： 

心脏ICU或混合ICU医师医疗主管或指定人员。

测量和主要结果： 

鉴定出一百二十个ICU：混合ICU为61个（51％），心脏ICU为59个（49％）。百分之七十五的医疗机构至少在手术前有时使用过新生儿重症监护病房。除体外膜氧合外，最常见的临时心脏支持是离心泵，例如Centrimag。耐用的心脏支持设备在独立的心脏ICU中更为常见（84％比20％；p <0.0001）。在混合ICU中，电生理，心力衰竭和心脏麻醉咨询的可用性显着降低（p = 0.0003，p <0.0001，p分别为0.042）。在混合ICU中，有98％的时间白天和晚上在ICU主治医师，而在心脏ICU中，有87％的时间在室内。护理从业人员是ICU的一线一贯提供者，负责照料患有原发性心脏病的儿童，其中88％的心脏ICU和56％的混合ICU。混合ICU更常配备有儿科住院医师，而重症监护人则更多见于心脏ICU（83％vs 77％；p <0.0001）。

结论： 

统计上，混合ICU和心脏ICU具有不同的人员配置模型和可用服务。需要更多评估，以了解这可能如何影响患者预后以及医师和护士的培训计划。