Pediatric critical care capacity in Canada

Abstract

Objectives: Pediatric intensive care unit (PICU) capacity is a current and future health system challenge. Despite experiencing two pandemics in as many decades and surges every winter, we have little to no information on PICU capacity in Canada. Our objective was to characterize the bed capacity of Canadian PICUs and their ability to accommodate surges in demand.

Methods: We conducted a cross-sectional survey to gather information from Canadian PICUs regarding funded/physical beds, unit characteristics, medical staffing, therapies provided, and challenges related to surge management. The survey was completed by a representative from each PICU and validated by PICU Directors. Quantitative survey results were summarized as counts and proportions, while the free-text response was summarized using inductive content analysis.

Results: Representatives from all 19 Canadian PICUs located in 17 hospitals completed the survey and reported having 275 (217 level 3 and 58 level 2) funded beds and 298 physical bed spaces. Of these, 47 beds (35 level 3 and 12 level 2) are in two specialized cardiac PICUs. Roughly 13,385, 13,419, 11,430, and 12,315 children were admitted in the years 2018, 2019, 2020, and 2021, respectively. During a surge, PICUs reported being able to add 5.9 ± 3.4 beds per unit totaling up to 108 temporary surge beds. Several barriers for the successful implementation of surge plans were identified.

Conclusions: Canadian pediatric critical care capacity is comparable to that in many other high-income countries, though our ability to respond to a pandemic/epidemic with significant pediatric critical illness may be limited.

Keywords: Critical care capacity; Healthcare resources; ICU Resources; Intensive care beds; Pandemic preparedness; Surge capacity.

Figure 1.

Onion peel model of a “funded” pediatric intensive care unit bed. CRRT Continuous renal replacement therapy; ECMO Extra-corporeal membrane oxygenation; HFOV High frequency oscillatory ventilation

Figure 2.

Map location of the 17 Canadian children’s hospitals housing the 19 Pediatric Intensive Care Units (created on batchgeo.com®). Montreal children’s hospital and CHU Sainte-Justine children’s hospital are located close to each other and are not distinguishable on this map

Figure 3.

Pediatric intensive care unit bed density. (A) Canadian PICU bed density per 100,000 population; (B) Canadian PICU bed density per 100,000 children aged 0–14 years; (C) global PICU bed density per 100,000 children. European data (survey yr. 2000) derived from Nipshagen et al. (28); Nepal data (yr. 2016) based on Khanal et al. (32); Pakistan data (survey yr. 2009) from Haque et al. (33); South Korea data (survey yr. 2015) based on Yoon JS et al. (23); United States of America data based on Horak RV et al (22). United Kingdom data from the PICANet report (34) (https://www.picanet.org.uk/wp-content/uploads/sites/25/2022/01/PICANet-2021-Annual-Report_v1.0-13Jan2022-2.pdf). Canadian PICU bed density has been calculated based on population of 0–14-year-old children (not 0–18). ANZ data based on that reported in the 2019-20-CCR-Activity-Report (30) (Source: https://www.anzics.com.au/wp-content/uploads/2021/06/2019_20-CCR-Activity-Report.pdf). Nepal PICU bed density based on population of 27.26 million (2016) and children aged 0–14 years old contributing to 32% of Nepalese population in 2016 (Source: https://www.statista.com/statistics/678090/nepal-children-as-a-percentage-of-the-population/)

Figure 4.

Number of annual admissions and annual admissions per funded bed across Canadian PICUs (2018–2021)