Saving Children’s Lives

CCH Provides Pediatric Intensive Care Services
for the Central Coast


By Richard E. Lehman, MD


With advanced technology and highly trained staff, the Cottage Children’s Hospital Pediatric Intensive Care Unit offers skilled care to critically ill children.


Over the years, pediatric intensive care needs have been on the rise and, fortunately for Central Coast children, Santa Barbara Cottage Children’s Hospital is a California Children’s Services (CCS)-approved pediatric intensive care provider. The American Board of Pediatrics recognized the subspecialty of pediatric intensive care medicine in 1985 and set criteria for subspecialty certification. 


Joanne Ronaldson, RN, and Vicki Lekas, CNS, with the PiCCO-2 monitor.



The Pediatric Transport Services staff knows first hand how important it is to outside facilities to have peace of mind that the Cottage Pediatric Intensive Care Unit Transport team is coming to transport their critically ill children to a place where they will get the skilled care they need.  All Cottage Children’s Hospital transports are staffed with specially trained pediatric intensive care nurses and respiratory therapists, with a pediatric intensivist guiding interventions.


The Pediatric Intensive Care Unit (PICU) is on the cutting edge of technology with an advanced hemodynamic monitor, the PiCCO-2 (Pulsion, Inc) that gives staff the ability to monitor cardiac output (CO).


This allows the PICU to maintain consistency with the latest guidelines for septic shock published by the American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock (Brierley et al, CCM-2009). 


Medical education teaches that CO, determined by stroke volume and heart rate, is the key to life.  So, having a tool that measures CO can be extremely useful to support critically ill patients.  Anecdotally, the Cottage PICU team has been able to adjust vasoactive agents and diuretics with the help of the PiCCO monitor to have a positive effect on ventilator days, ICU days and ultimately better outcomes.  Staff is looking retrospectively at the use of the PiCCO monitor and will publish its findings.  The American Critical Care Medicine 2007 update on septic shock recommends the use of a CO monitor if other therapies have not reversed shock, thus the Cottage PICU practice is in accordance with these guidelines.


Many children who are sick require intravenous (IV) access to help with treatment.  The Pediatric department’s newly purchased mobile, easy-to-use ultrasound makes IV access in difficult patients more successful.  In the Cottage PICU, most central lines in critical care are placed using ultrasound guidance. Growing literature supports the use of ultrasound for central line placement to decrease the number of attempts and sites used while obtaining central access. 


The Pediatric Intensive Care Unit team at Cottage Children’s Hospital is proud of the work it does saving lives, one child at a time.


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