Guidelines for Pediatric Intermediate Care

Many children admitted to the hospital need a higher level of care than general inpatient pediatric critical care. Therefore, an intermediate care level for children has been developed in some hospitals. “Admission and Discharge Guidelines for the Pediatric Patient Requiring Intermediate Care” is available online athttp://pediatrics.aappublications.org/cgi/content/full/113/5/1430.

Admission is guided by physiologic parameters, depending on the type of care needed. Children with respiratory, cardiovascular, endocrine, renal, and gastrointestinal disease who need multidisciplinary intervention and frequent monitoring may be admitted. Patients with non–life-threatening neurologic disease who need multidisciplinary intervention, frequent monitoring, and neurologic assessment every two hours or more also may be admitted, as well as children with potentially unstable hematologic or oncologic disease or non–life-threatening bleeding. Patients who have undergone surgery and require monitoring may be admitted if they do not have hemodynamic or respiratory instability.

Patients will be evaluated and considered for transfer to general or special-care units when the disease process has reversed or the physiologic problem that prompted the admission has resolved. The criteria on which the decision to transfer or discharge the patient will be made include the following: the patient has stable hemodynamic parameters for at least six to 12 hours; respiratory status is stable and the patient has been extubated with evidence of acceptable gas exchange for four or more hours; the patient has minimal oxygen requirements; cardiac arrhythmias have been controlled for at least 24 hours; seizures have been controlled for a reasonable amount of time; and all invasive hemodynamic monitoring devices have been removed.

Other criteria include the following: intravenous inotropic support, vasodilators, and antiarrhythmic drugs are no longer needed; patients who needed mechanical ventilation have returned to baseline clinical status; and the patient is able to receive peritoneal dialysis or hemodialysis on an outpatient basis.