The Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Instensive Care Unit (PCICU) at Duke Children’s Hospital provide comprehensive services for a wide variety of critically ill medical and surgical pediatric patients with acute, life-threatening disease and injury. Duke is a Level I Trauma Center and a regional, national, and international referral facility. Areas of subspecialty expertise include congenital heart disease, cardiovascular surgery, respiratory failure, neurosurgery, stem cell transplantation, immunodeficiencies, hematologic and oncologic emergencies, sepsis, and multiorgan system dysfunction. Available advanced treatment modalities include Extracorporeal Life Support (neonatal, pediatric, and cardiac ECMO), high frequency ventilation, nitric oxide therapy, non-invasive ventilation, ventricular assist devices (VADs), and hyperbaric oxygen therapy.  

The 16-bed PICU and 13-bed PCICU are state-of-the-art critical care units designed to meet the needs of our patients, families, and staff team members. Care is also provided in a nine-bed Pediatric Progressive Care Unit. The Pediatric Critical Care Medicine Division and the Pediatric Intensive Care Unit are actively growing to better serve the needs of our patients and our community.  

Additional inpatient services at Duke Children’s Hospital include 55 intermediate care beds, a 16-bed stem cell transplant unit, and a 48-bed Neonatal Intensive Care Unit and Transitional Care Nursery. The Pediatric Radiology Division offers the highest quality imagery techniques including magnetic resonance imaging, positron emission tomography, ultrasound, and nuclear medicine. The Emergency Department, a Level I Trauma Center, includes a specialized pediatric emergency center staffed by board-certified Emergency Medicine physicians. A new Pediatric Emergency Department facility was completed in 2007. The Duke Hyperbaric Center is a well-established facility involved in both patient care and research which is used for PICU and PCICU patients primarily for the management of carbon monoxide poisoning or air embolism.  

The PICU and PCICU attendings coordinate the transport of critically ill infants, children, and adolescents to Duke through the Life Flight / Life Care program which provides air and ground transport by highly-trained pediatric transport nurses. Fellows participate in the coordination of transports during their second and third years of training.  

Problems commonly managed in the PICU and PCICU include: 

• Medical and surgical management of neonatal and pediatric congenital heart disease
• Acute respiratory failure from multiple causes including status asthmaticus, pneumonia, bronchiolitis, and airway obstruction
• Septic shock
• Pre- and post-operative management for all surgical subspecialties (neurosurgery, cardiothoracic surgery, general pediatric surgery, orthopedics, otolaryngology, ophthalmology, and plastic surgery)
• Diabetic ketoacidosis and other severe endocrine disorders
• Status epilepticus
• Brain tumors (pre- and post-operative management)
• Trauma including closed head injury
• Stem cell and solid organ transplantation
• Poisonings including ingestions and carbon monoxide inhalation
• Primary immunodeficiencies including DiGeorge Syndrome and Severe Common Immunodeficiency Syndrome (SCIDS)

Specialized services in the PICU and PCICU include:

• Advanced respiratory support including conventional mechanical ventilation, high frequency oscillatory ventilation, high frequency jet ventilation, and inhaled nitric oxide
• Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric patients with refractory respiratory and/or cardiac failure
• Continuous veno-venous hemofiltration, hemodialysis, and peritoneal dialysis
• Non-invasive and invasive state-of-the-art cardiovascular and neurological monitoring
• Continuous bedside monitoring of respiratory mechanics and capnography
• Advance diagnostic imaging support
  
  

The PICU and PCICU team is comprised of a broad range of healthcare professionals including board certified / eligible pediatric intensivists and cardiac intensivists, pediatric critical care fellows, highly skilled and specially trained critical care nurses and respiratory care practitioners, residents, medical students, social workers, physical and occupational therapists, chaplains, discharge planners, clinical nutritionists, and clinical pharmacists. All medical and surgical subspecialties are readily available to provide consultation as needed. The PICU and PCICU care delivery model supports this entire team’s commitment to utilizing their specialized skills to meet our patients' needs in a family-centered care environment.