TABLE 2

PICU Resources by Level of Care

Resources by Organ SystemQuaternary or Specialized FacilityTertiaryCommunity
Cardiovascular
 Hemodynamic monitoring
  NoninvasiveEssentialEssentialEssential
  InvasiveEssentialEssentialEssential
 Inotropic supportEssentialEssentialEssential
 Echocardiogram (24-h availability)EssentialEssentialEssential
 ECMO or ECLSEssentialOptionalNE
 VADsEssentialOptionalNE
 Transplant: heartDesirableOptionalNE
Gastrointestinal
 Upper and lower endoscopyEssentialEssentialDesirable
 Transplant: liverDesirableOptionalNE
Hematologic
 Plasmapheresis or leukapheresisEssentialEssentialDesirable
 Transplant: bone marrowEssentialOptionalNE
Neurologic
 Intracranial pressure monitoringEssentialEssentialDesirable
 External ventricular drainEssentialEssentialDesirable
 Lumbar drainEssentialEssentialDesirable
 Continuous EEGEssentialEssentialOptional
 Video EEGEssentialEssentialOptional
Respiratory
 Noninvasive ventilation (HFNC, CPAP, BIPAP, NPV)EssentialEssentialEssential
 Conventional mechanical ventilationEssentialEssentialEssential
 Advanced mechanical ventilation (HIFV, HFOV)EssentialEssentialDesirable
 Conventional inhalation therapies (heliox or continuous albuterol)EssentialEssentialEssential
 Nitric oxideEssentialEssentialDesirable
 Advanced inhalation gases (flolan or anesthetic agents)EssentialDesirableOptional
 BronchoscopyEssentialEssentialDesirable
 Transplant: lungsDesirableOptionalNE
Renal
 Continuous renal replacement therapyEssentialEssentialOptional
 HemodialysisEssentialEssentialOptional
 Peritoneal dialysisEssentialEssentialOptional
 Charcoal hemofiltrationEssentialEssentialDesirable
 Transplant: kidneyEssentialOptionalNE
Radiology
 Diagnostic imaging, including CT (24-h availability)EssentialEssentialEssential
 Advanced Diagnostic Imaging, including MRI (with sedation)EssentialEssentialDesirable
 Interventional neuroradiologyEssentialDesirableOptional
 Interventional cardiologyEssentialDesirableOptional
 Cardiac MRIEssentialDesirableOptional
  • BIPAP, biphasic positive airway pressure; CPAP, continuous positive airway pressure; CT, computed tomography; ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygenation; HFNC, high-flow nasal cannula; HFOV, high-frequency oscillatory ventilation; HIFV, high-inspiratory flow ventilation; NE, not expected; NPV, negative pressure ventilation; VAD, ventricular assist device.