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Potential pediatric intensive care unit demand/capacity mismatch due to novel pH1N1 in Canada

Stiff, David PhD; Kumar, Anand MD; Kissoon, Niranjan MD; Fowler, Robert MD, CM, MS; Jouvet, Philippe MD, PhD; Skippen, Peter MD; Smetanin, Paul MQF; Kesselman, Murray MD; Veroukis, Stasa MD

Pediatric Critical Care Medicine: March 2011 - Volume 12 - Issue 2 - pp e51-e57
doi: 10.1097/PCC.0b013e3181e2a4fe
Online Clinical Investigations

Objective: To investigate the possibility of pediatric intensive care unit shortfalls, using pandemic models for a range of attack rates and durations. The emergence of the swine origin pH1N1 virus has led to concerns about shortfalls in our ability to provide pediatric ventilation and critical care support.

Design: Modeling of pediatric intensive care demand based on pH1N1 predictions using simulation techniques.

Setting: Simulation laboratory.

Patients: None.

Interventions: None.

Measurements and Main Results: Data collected during the first wave of the pH1N1 in children in Canada were applied to several second wave pandemic models to explore potential pediatric intensive care unit ventilatory demands for Canada and to investigate the impact of vaccination upon these demands. In almost all cases studied, even for relatively low attack rates of 15%, significant pediatric intensive care unit shortages would be expected to occur. Vaccination strategies targeting 50% of the population significantly reduced demand, but shortages may still be expected. Although shortfalls can occur in all provinces, Ontario and British Columbia may experience the greatest supply-demand difference, even at low attack rates.

Conclusion: Reducing the attack rate among children, whether through vaccination or additional measures, such as social distancing, will be critical to ensure sufficient pediatric intensive care unit capacity for continued pediatric care.

From the Risk Analytica Research (DS, PS), Toronto, ON Canada; Section of Critical Care Medicine (AK), Health Sciences Centre, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics (NK, PS), University of British Columbia, Division of Critical Care, BC Children's Hospital, Vancouver, BC, Canada; Interdepartmental Division of Critical Care Medicine (RF), Sunnybrooke, University of Toronto, Toronto, ON, Canada; Research Centre CHU Sainte-Justine (PJ), University of Montreal, Montreal, QC, Canada; and the Section of Pediatric Critical Care (MK, SV), Children's Hospital of Winnipeg, University of Manitoba, Winnipeg, MB, Canada.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: nkissoon@cw.bc.ca

©2011The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies