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Critical Care

Charles Schleien, MD

The intensive care units of Morgan Stanley Children's Hospital provide care around the clock to infants, children, and adolescents with life-threatening illnesses and injuries, as well as those recovering from major or high-risk surgery. The Critical Care Division oversees all of the clinical care in our 27-bed Pediatric Intensive Care Unit (PICU) and the 14-bed Cardiac Intensive Care Unit (CICU), treating more than 1,800 patients annually. The staff is committed to the principles of family-centered care. Parents are key participants on their childs health care team and we encourage them to spend as much time as possible at the bedside in the ICU with their child. Accommodations are available at every bedside for parents.

Pediatric Intensive Care Unit (PICU)

The Pediatric Intensive Care Unit provides care for children with conditions that include:

• complex congenital heart disease
• acute respiratory failure
• cardiac arrest and brain resuscitation
• diabetic ketoacidosis (the result of severe insulin deficiency that leads to dehydration and a chemical imbalance)
• infections, including meningitis and encephalitis
• neurological illness, including seizures
• severe asthma
• transplants including heart, liver, small intestine, kidney, and lung
• multiorgan and head trauma

Patients requiring intensive care following surgery for complex congenital heart disease, neurosurgery, ear, nose and throat surgery, orthopedic procedures, and ophthalmology procedures account for almost half of our admissions to the PICU and CICU.

The PICU and CICU are staffed by a dedicated interdisciplinary team of physicians, nurses, respiratory therapists, pharmacists, social workers, child life workers, occupational and physical therapists and other allied health care professionals. Care of patients is delivered under the direction of an experienced pediatric critical care attending physician. Patients also benefit from the availability of world-class surgical and medical pediatric subspecialty services, such as diagnostic and interventional radiology, neurology and neurosurgery, pediatric surgery, oncology and bone marrow transplant teams.

The PICU and CICU staff are expert in the management of the most advanced support technology, including ECMO (see below), high-frequency oscillatory ventilation, inhaled nitric oxide, continuous renal replacement therapies such as CVVH (continuos veno-venous hemofiltration), neurologic monitoring including continuous EEG, and ventricular assist devices, one of the few institutions in the world offering such technology to the smallest children. We also manage the perioperative care of patients undergoing organ transplantation including liver, small bowel, kidney, heart and lung transplants. In addition, we have particular expertise in intensive care for patients with critical injuries, including head and multiorgan trauma.

Cardiac Intensive Care Unit (CICU)

Morgan Stanley Childrens Hospitals cardiovascular program is one of the largest and most prestigious in the nation, performing more than 500 cardiac operations annually. The Hospital has the largest pediatric heart transplant program in the United States, performing over 25 heart transplants each year. Additionally, NewYork-Presbyterian Hospital/Columbia University Medical Center is a nationally regarded center of excellence for the management of pulmonary hypertension.

The CICU serves pediatric patients with complex congenital and acquired heart disease. The care of patients in the CICU is directed by both pediatric critical care physician and pediatric cardiologists, with surgical patients managed in close consultation with our cardiothoracic surgical staff. Patients benefit from a wealth of experience and expertise in the management of cardiac extracorporeal membrane oxygenation (ECMO) and ventricular assist devices.

Extracorporeal Membrane Oxygenation (ECMO)

ECMO is a device that supports or replaces the functions of the heart and lungs when these organs are failing. It may be used in cases of overwhelming respiratory or cardiac failure that has not responded to other treatments. It is similar to cardiopulmonary bypassthe technology commonly used for patients undergoing heart operationshowever, ECMO technology is designed to be used for days and even weeks rather than hours. The Center was the third in the world to successfully support a newborn, and more than 2,500 infants and children have been referred to our Center as potential ECMO patients from institutions throughout the tri-state and mid-Atlantic region.

Transport Center

Morgan Stanley Childrens Hospital serves as a major referral center and regional resource for other hospitals that need the level of expertise of our pediatric intensive care units. Seriously ill or injured children are transferred by the Hospitals Pediatric Critical Care Transport team. The dedicated transport teamsattended by PICU-trained paramedics and Critical Care fellows as needed, as well as nurses and other health care professionalswork closely with staff at the referring hospital to move children quickly and safely. The Transport Program transfers some 400 patients annually to the PICU from member hospitals of the NewYork-Presbyterian Healthcare System as well as from other hospitals in the tri-state area and beyond. The service provides advanced capabilities, including the use of inhaled nitric oxide and ECMO.