Pediatric Critical Care

Stony Brook Medicine

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    OverviewQuality pediatric critical care is at the heart of Stony Brook Children's. In our 12-bed, pediatric intensive care unit (PICU), we provide the region's most advanced, family-centered critical care to Suffolk County's most seriously ill and injured children. The PICU is led by Margaret Parker, MD, MCCM, who was recently named a Master of Critical Care Medicine (MCCM) by the Society of Critical Care Medicine. This honor recognizes long-standing achievements in critical care medicine, leadership, research and education on a national and international level, as well as exemplary character. To have a Stony Brook Children’s physician selected into this elite group elevates the program and gives the children of Suffolk County access to world class care.

    Approximately 800 patients — many of whom are transferred to us from other hospitals — are admitted to Stony Brook Children’s PICU each year. Problems that may need critical care include complicated pre- and post-surgical care, injuries from accidents, serious infections and severe breathing problems. Patients can range in age from infants to early twenties.

    While in the PICU, all patients receive close, constant attention from a team of specially trained health professionals overseen by attending pediatric intensivists — physicians specializing in the delivery of critical care to children. These pediatric intensivists are at Stony Brook 24/7. Among the sophisticated services we deliver are: continuous renal replacement therapy (dialysis), high frequency oscillatory ventilation (breathing machine), inhaled nitric oxide therapy, and moderate or deep sedation for children undergoing painful procedures, both on an inpatient and outpatient basis.

    In addition, the Division of Pediatric Critical Care is extensively involved in research, education and family advocacy. 

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    Our Team Pediatric critical care is a complex and highly sophisticated branch of medicine. To deliver it well requires a strong multidisciplinary team: pediatric specialists; pediatric subspecialists; nurses; respiratory therapists and other therapists (speech, occupational and physical); pharmacists; child life specialists; and social workers. In total, the department — led by Dr. Margaret Parker, a recently named Master of Critical Care Medicine — has about 40 specially trained staff nurses caring for patients. Physicians throughout Stony Brook Children's interact and collaborate with the PICU.

    As a closed unit, the PICU's physicians, known as pediatric intensivists, oversee and coordinate all the members of each child's care team.

    Our intensivists include:
    Margaret Parker, MD, FCCM - Division Chief
    Laura Czulada, DO
    Kimberly Fenton, MD
    Ilana Harwayne-Gidansky, MD
    Laura Monahan, MD
    Rahul Panesar, MD
    Daniel Sloniewsky, MD

    Our Nurse Practitioner: Kathleen Culver, DNP, RN, CPNP 

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    Services Critical care today typically involves high technology support including continuous dialysis; ventilator care including the availability of a high frequency ventilator; administration of nitric oxide; and support for kidney transplants and bone marrow transplants. Continuous, state-of-the-art monitoring is standard practice.

    At Stony Brook Children's, pediatric intensivists support both the inpatient and outpatient facilities when sedation is required for a child undergoing painful procedures, such as bone marrow aspiration and biopsy, spinal taps, liver or kidney biopsies, and bronchoscopies.

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    Patient Resources Family-centered care is especially important in the PICU. To help alleviate the parent's anxiety during a highly stressful time, the Division of Critical Care launched a Family Advocacy Board several years ago. The board's membership includes parents of former and current patients who work with the unit's leadership to provide programs and services that make life easier for parents. For example, these include a list of "Things Parents Need to Know" hanging in the patients' rooms and on the unit door; a coffee hour with parents of current and former patients; and support and information visits between current and former parents of kids with similar experiences.

    Parents are permitted and encouraged to stay with their children in the PICU 24 hours a day. Reclining chairs are in the patient rooms and a parent respite room is equipped with showers, vending machines and basic services.

    Communication is the core of family-centered care and the PICU invites parents to join physician rounds to learn more about the care plan and their child's progress. Parents are welcome to talk with their child's attending physicians, nurses and other health professionals at any time.

    Child Life services also are available to PICU patients and families.
    Learn more.

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    Research and Education Current research in the Division of Critical Care focuses on improving education through laboratory simulations (see Advances and Recognitions below), and improving tracheotomy practices. We are participating in two tracheotomy research studies, including the Physician Opinion Related to Early Tracheotomy in Trauma (POETT) Study.

    Critical Care faculty are involved both in resident and medical student education. Typically, four physician residents work in the unit per month, a combination of second- or third-year pediatric residents and second-year emergency medicine residents. Third- and fourth-year medical students also experience learning opportunities in the PICU.

    Critical care faculty members also teach their colleagues and other professionals Pediatric Advanced Life Support (PALS).

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    Advances and Recognitions Critical Care faculty provide real-time, hands-on, Pediatric Advanced Life Support (PALS) training for pediatric residents, colleagues and staff. To improve performance and outcomes, a Pediatric Simulation Program is offered in the School of Medicine's Clinical Skills Center. The program creates mock pediatric emergencies requiring resuscitations of computerized patient mannequins. Student and resident doctor reactions can be recorded, measured and evaluated using advanced equipment.

    In 2014, Division Chief Margaret Parker, MD, was named a Master of Critical Care Medicine (MCCM) by the Society of Critical Care Medicine (SCCM), the largest multi-professional organization dedicated to ensuring excellence in critical care. The organization, which has nearly 16,000 members in more than 100 countries, also promotes research, education and patient advocacy. According to the SCCM, fellows selected for the prestigious MCCM designation have high personal character, eminence in clinical practice, and provide exemplary contributions to the Society and College and the field of critical care in its broadest sense.

    In 2008, the Family Advisory Board received the Permanent Journal Service Quality Award from the Institute for Healthcare Improvement’s 20th Annual National Forum on Quality Improvement in Healthcare.

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    Definitions Bronchoscopy - A procedure involving a light and tiny camera threaded through the nose or mouth to look inside the lungs' airways, treat bleeding or remove stuck objects.

    Critical Care - Also called intensive care, critical care is provided when patients have life-threatening injuries or illnesses. It usually takes place in a dedicated Intensive Care Unit, Critical Care Unit or trauma center. Units may specialize in a particular type of critical care or patient-for example, Neonatal Intensive Care (for babies immediately following birth); Pediatric Intensive Care (for newborns who have been discharged and then return to the hospital, up through adolescence and even young adults if congenital issues are involved); Coronary Critical Care (following heart surgery or heart attack), or a Surgical Intensive Care Unit (following surgery). Monitors, IV tubes, catheters, ventilators and other equipment are commonly used in intensive or critical care units.

    Dialysis - When the kidneys fail, dialysis helps do their job of filtering of the blood to rid the body of harmful wastes, extra salt, and water.

    Feeding tube - When a person cannot eat or has difficulties swallowing because of an illness, injury or surgery, enteral nutrition or tube feeding may be helpful. A special liquid food mixture is provided through a tube than may be placed through the nose or directly through the skin into the stomach or bowel.

    Intensivist - A physician with subspecialty training in critical care.

    IV tube - A tiny intravenous tube is placed by needle into a vein or artery to deliver medications, fluids or pain controlling drugs.

    Nitric oxide therapy - Nitric oxide is a gas added to the oxygen in a ventilator to help blood vessels in the lungs dilate and allow more blood flow and oxygen to the lungs.

    Pediatric intensivist - A physician with subspecialty training in pediatrics and in critical care.

    Ventilator - Also known as a respirator, a ventilator is a machine that helps people breathe.

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