A Cardiac ICU for Children

pcicu

Darren Klugman, second from left, leading morning rounds in the PCICU.

September 11, 2020

This dedicated intensive care unit is the latest addition to the recently opened Blalock-Taussig-Thomas Pediatric and Congenital Heart Center at Johns Hopkins.

In 1944, Johns Hopkins surgeons performed the first landmark operation on an infant whose heart was unable to pump blood to the lungs to provide enough oxygen to the body. Surgeon Alfred Blalock, with technician Vivien Thomas guiding him, implanted a shunt developed by Blalock and pediatric cardiologist Helen Taussig to increase blood flow to the lungs. The so-called Blue Baby procedure saved the lives of thousands of chil­dren and played a major role in launching the field of modern cardiac surgery. The breakthrough also had the effect of attracting world-class pediatric heart specialists, including cardiac surgeon Bret Mettler and cardiologist Shelby Kutty, to Johns Hopkins to build a new heart center for children. Most recently, it has brought pediatric cardiologist and critical care specialist Darren Klugman to direct the first dedicated pediatric cardiac intensive care unit (PCICU) at Johns Hopkins Children’s Center.

“What attracted me was this institution’s rich history of almost 80 years as the foundation of congenital heart surgery,” says Klugman. “Building this cardiac critical care program is an opportunity, when coupled with the systems and programs and — importantly — the people at Johns Hopkins, that will allow us to provide a level of evidence-based care and a patient-family experience that is truly unique in this region and the country.”

While one-year survival for infants with critical congenital heart defects has been improving over time, mortality remains high. Advanced surgical approaches allowing early intervention, Klugman explains, along with specialized cardiac critical care of these children, has translated into better outcomes. Research shows PCICU care has many advantages over traditional ICU cardiac care, including shorter ventilator stays, improved continuity of care and more seamless coordinated multidisciplinary care, which is a necessity to ensure high-quality outcomes.

Developing such a model multidisciplinary pediatric cardiac ICU to achieve those benefits, however, is not without its challenges. There are a limited number of trained pediatric cardiac intensivists, especially ones such as Klugman who is board certified in pediatrics, pediatric cardiology and critical care medicine. The unit he is building will be composed of cardiac critical care specialists with specialized training, nurse practitioners with training in cardiac critical care, and dedicated PCICU nurses. An internationally known researcher in congenital heart disease quality and outcomes, Klugman will be leading efforts to advance outcomes in the PCICU and optimize practice through scientific inquiry and quality improvement.

“One of the things that attracted me to Johns Hopkins was the enormous research infrastructure and resources that exist within our system,” says Klugman. “All of the dedicated subspecialty care, research and education here will allow us to ask important questions, to understand the differences between our patients, and participate in research and clinical care advances to improve our outcomes. Without question, our singular goal is to continue to advance the care we provide through research, science and practice to improve outcomes beyond where they are today.”

In addition to the evidence-based medicine research approach, Klugman notes there will be a strong focus on the family experience and parents as partners in care.

“These are patients and families whose lives have been demonstrably changed forever with the diagnosis they received, so in caring for them holistically we will provide them with opportunities to change how they live those lives in a rich and full way,” says Klugman. “We will engage them in a way that allows them to be part of the healing and care decisions for their child. Without them, we can only do so much.”

Pointing to the people, the resources and culture at Johns Hopkins, Klugman is optimistic that the PCICU will exceed his expectations.

“There are exceptional people here, a rich environment of collaboration, a thirst for knowledge, a willingness to learn and an intense desire to advance our care,” says Klugman. “We are facing the opportunity now with the development of this cardiac intensive care program to really rethink and reinvigorate our focus and our ability to provide these patients and families with a comprehensive care program that will optimize the rest of their child’s life.”