What We Do:

The Johns Hopkins Pediatric Intensive Care Unit (PICU) is a 40-bed unit dedicated to providing state-of-the-art care to children and young adults with life-threatening acute illnesses and those recovering from major surgery. Critical medical illnesses include acute respiratory failure, complex congenital and acquired cardiac failure, renal and hepatic failure, shock, overwhelming infections and metabolic diseases, severe asthma, seizures, cardiac arrest, traumatic brain injury, and diabetic coma. Patients recovering from cardiac surgery, major neurosurgery, orthopedic surgery, or ear nose and throat surgery also receive their postoperative care in the unit. The PICU is the Level I pediatric trauma center and burn unit for the care of critically children in the state of Maryland.

The PICU is staffed by a multidisciplinary team of skilled and dedicated physicians, nurses, respiratory therapists, nutritionists, pharmacists, social workers, child life workers, occupational and physiotherapists, and clergy, expert in the care and support of critically ill and injured children and their families. This complex care is coordinated by specialty trained critical care physicians and nurses. Renowned specialists in pediatric oncology, bone marrow and solid organ transplantation, cardiology, endocrinology, neurology, pulmonary disease, infectious diseases, genetics, metabolic diseases, and the surgical subspecialties are available for consultation in the care of patients in the PICU.

PICU intensivists are expert in and frequently utilize the most advanced critical-care medical technology, including new modes of mechanical ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation (ECMO), artificial heart support, renal dialysis, intracranial pressure monitoring, continuous electroencephalograph (EEG) monitoring, plasmapheresis, dialysis, and continuous veno-venous ultrafiltration. Compassion, caring, and a supportive, family-focused ethic are core values emphasized in the care of all of our patients.

The Pediatric Cardiac Critical Care program provides high quality state-of-the-art care to optimize outcomes for children with heart disease. We achieve this with an integrated, multidisciplinary team of experts, including pediatric specialists from Critical Care, Anesthesiology, Cardiology, Cardiothoracic Surgery, Maternal Fetal Medicine, and Rehabilitation. We carefully track overall pediatric heart surgery outcomes, which help us to identify areas for improvement and to answer families’ questions regarding the particular procedure their child will undergo. Families are able to maintain cardiac care for their child from initial diagnosis throughout their lives, beginning with our fetal program through the adult congenital heart disease program, all under one roof.

Community Outreach
The Pediatric Cardiac Critical Care Team leads the efforts in community education programs, including identification and management of single ventricle anatomy and physiology, heart failure, ventricular assist device VAD and transplant programs.

Research
Cardiac critical care research promotes cutting-edge cardiac critical care by initiating collaborative, multispecialty programs in basic science and clinical research that tap into the strengths of the Johns Hopkins cardiovascular community, from fetal life to the elderly population.

Questions
Please email Kristen Nelson, MD (knelso23@jhmi.edu) or Kristen Brown, CRNP (kstanic1@jhmi.edu) with any questions regarding our programs, including community outreach.

The Pediatric Neurocritical Care program provides high quality state-of-the-art care to prevent neurologic injury, and improve neurologic outcomes for critically ill and injured infants and children, enabling normal development and function. We achieve this with an integrated, multidisciplinary team of experts, including pediatric specialists from Critical Care, Anesthesiology, Neurology, Neurosurgery, Neuroradiology, Trauma Surgery, and Rehabilitation.

Our specialized team provides care for children with neurocritical care issues including traumatic brain injury, stroke, encephalitis/meningitis, status epilepticus, brain and spinal cord tumors, neuromuscular disorders, encephalopathy, and neurovascular disorders.

Pediatric Neurocritical Care Fellowship
We offer a unique fellowship that enables a pediatric critical care or pediatric neurology trained physician to spend an additional year focusing on pediatric neurocritical care. Upon completion of this training, we anticipate that trainees will be qualified to develop and lead pediatric neurocritical care programs in an academic setting. Learn more about the Pediatric Critical Care Fellowship.

Pediatric Neurocritical Care Research
Our neurocritical care research involves collaborative, multispecialty programs in basic science and clinical research that tap into the strengths of the Johns Hopkins neuroscience community. Because both injury and response to injury in the pediatric age group can be influenced by perinatal events and have effects at older ages, our program focuses on integrating the pathology throughout life, from the fetus to old age. Learn more about Research.

For questions please contact Sujatha Kannan, MD (skannan3@jhmi.edu), Courtney Robertson, MD (crober48@jhmi.edu), Rebecca Riggs, MD (rriggs6@jhmi.edu), or Theresa Ruddy, CRNP (truddy1@jhmi.edu).

The Johns Hopkins Pediatric Intensive Care Unit (PICU) is a leader in the field of early mobilization for critically ill children. The PICU Up! ™ Early Mobilization Program is an interdisciplinary initiative designed to improve PICU outcomes through a systematic approach to mobility and exercise, including developmentally appropriate play and activities for even the most critically ill children. Physicians, nurse practitioners, nurses, physical therapists, occupational therapists, respiratory therapists, and child life specialists in the Johns Hopkins PICU work together to foster a culture of mobility which improves a child’s sleep-wake cycles and decreases sedation needs and delirium. The ultimate goal is to improve both short and long-term neuropsychological outcomes for critically ill children and increase family engagement.

Early mobilization and delirium prevention are a core component of daily bedside rounds, and each child has an individually tailored PICU Up! © Plan. The PICU Up! ™ Early Mobilization Program is led by Beth Wieczorek, CRNP and Sapna Kudchadkar, MD. For more information, please go to https://www.johnshopkinssolutions.com/solution/picu-up/.

The Pediatric Extracorporeal Membrane Oxygenation (ECMO) Program provides ECMO services to infants and children with severe, intractable, cardiorespiratory failure. Our center built one of the first ECMO programs in the country and has been in existence since 1987. Over time, we developed a significant amount of collective experience and expertise as a multidisciplinary team to provide excellent care for our sickest patients.

Our ECMO program has been granted the Award of Excellence in Life Support continuously since 2010, by the international Extracorporeal Life Support Organization (ELSO). This award is recognizes improved patient outcomes that stem from advanced education of extracorporeal life support staff, and utilization of highest-standard equipment, policies and procedures.

ECMO Transport
The Johns Hopkins Pediatric ECMO Transport program was developed in 2010. We provide both ground and air-based transport of children already cannulated onto ECMO at other centers, and we have also created teams that can deploy to community hospitals to assist the local team in conducting the ECMO cannulation safely, then transport the patient to a referral center in stabilized condition.*

Education
Staff members of our ECMO team serve as educators in regional, national and international ECMO courses that train personnel from hospitals that are starting new ECMO programs. Additionally, our faculty teach courses in ECMO management nationally and internationally and provide workshops at national conferences for the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care.

The Johns Hopkins PICU also take a proactive approach to emergent situations by performing ECMO/ECPR simulations. These multidisciplinary simulations occur every other month and have helped identify process and care provision improvements that ultimately support improved survival and neurological outcomes.

Research
Our ECMO team plays an active role in single- as well as multi-center observational research studies that promote better understanding of the physiology of extracorporeal support and of outcomes following extracorporeal life support.

Questions
Please email Melania Bembea, MD, PhD (mbembea1@jhmi.edu) or John Young, RRT (jyoung85@jhmi.edu) with any questions regarding our program.

The Johns Hopkins Charlotte R. Bloomberg Children’s Center provides comprehensive pediatric burn services for the state of Maryland. The PICU burn services within the Johns Hopkins Pediatric Burn Center aid in coordinating excellent and efficient care for children critically injured with burns and related illnesses. The PICU is equipped with four specially outfitted rooms that are environmentally optimized and designed for treatment and recovery of burn patients. The PICU is also located next to the operating room areas that are designated for burn care, enabling patients to travel easily between the two for procedures.

Care in the PICU incorporates a multidisciplinary team of burn surgeons, intensivists, pediatric pain service, physical and occupational therapists, social workers, nutritionists, and child life specialists, among others, to ensure that all burn patients receive comprehensive and timely care.

The burn program also supports education of PICU providers with American Burn Association standards of management and provides regular didactics on burn care education.

The Pediatric Transport Service is a major source of admissions to the Charlotte R. Bloomberg Children’s Center. We transport approximately 2,700 patients annually to the Children’s Center. The transport team receives requests from more than 55 regional healthcare facilities as well as from other national and international locations.

Our core team consists of a dedicated group of highly trained emergency medical technicians, paramedics, and PICU nurses. Our team also dispatches a respiratory therapist and/or a pediatric critical care fellow for transport of critically ill children. Pediatric critical care and emergency medicine physicians provide medical management for all patients during transport. Our pediatric transport team has experience with ground, helicopter, and fixed-wing transports of children who require advanced modes of respiratory support (including noninvasive positive pressure with high-flow nasal cannula or Bilevel Positive Pressure Airway, conventional mechanical ventilation, inhaled nitric oxide and high-frequency oscillation) and extensive hemodynamic support, including patients on ECMO (extracorporeal membrane oxygenation).

Claire Beers, Philomena Costabile, Eric Henderson, Bruce Klein, and Corina Noje supervise the pediatric transport service.

Please contact us for more information.

Philomena Costabile, BSN, RN
Assistant Nurse Manager, Pediatric Transport
pcostab1@jhmi.edu

Corina Noje, MD
Medical Director, Pediatric Transport
cnicule1@jhmi.edu

Bruce Klein, MD
Director, Pediatric Transport
bklein2@jhmi.edu

The critical care ultrasound program at the Johns Hopkins Charlotte R. Bloomberg Children’s Center PICU augments the delivery of care to critically ill children with state-of-the art ultrasound in a multitude of ways. Though ultrasound has been in use for years by medical professionals, only recently have technological advancements put high-end ultrasound in the hands of clinicians who are directly caring for children.

Ultrasound is now being used to help guide procedures at the bedside, decreasing the risk of complications and improving patient safety. Ultrasound is also helping clinicians to make important care decisions for children in the PICU. It can speed up time to diagnosis by enabling clinicians see inside patients without causing pain or injury. The critical care ultrasound program educates clinicians in use of the technology, conducts quality assurance efforts within the program, and maintains the available technology.

Currently, the education mission of the program entails training all PICU personnel, including medical students, residents, fellows, nurses, nurse practitioners, and staff physicians. Training sessions include didactic and practical teaching experiences and are held both ad hoc and in dedicated ultrasound courses. A number of ultrasound educators within the program have also played a prominent role in national ultrasound courses for professional societies and other academic institutions.

The ultrasound program has an active research initiative. Current projects are investigating questions related to both general and cardiac imaging. We collaborate with several sub-specialties across JHU for these projects.