Saving the brain through the right critical care at the right time

Regardless of the primary diagnosis, neurological outcome profoundly influences quality of life for children and their families. The Pediatric Neurocritical Care Program (PNCP) at St. Louis Children’s Hospital was established in 2008 to provide timely specialized care to critically ill children with neurological disorders. Using evidence-based protocols developed through multidisciplinary collaboration and deployed through implementation science, the PNCP has transformed functional outcome trajectories for critical illness survivors, limiting disability to a degree previously not thought possible, particularly for trauma victims. Several aspects of our model of care have been adopted at institutions in the U.S. and abroad.

Supporting a highly specialized team

The PNCP provides outstanding clinical care 24/7/365 to approximately 800 critically ill children and their families every year. We continue to support services provided by pediatric neurosurgery, neurology, neuroradiology and trauma surgery. We also assure coordination with rehabilitation services and resources through multidisciplinary communication, development of transfer of care pathways and long-term neurodevelopmental follow up. Our skilled critical-care team provides timely, precise interventions necessary to protect vulnerable brains of children during the course of any critical illness.

Training future leaders in pediatric neurocritical care

Adequate infrastructure and advanced technology are important, but skilled physicians, bedside nurses and investigators are the true driving force behind the best clinical care and the discovery of new therapies. The PNCP has a track record of training undergraduate students, medical students and post-doctoral trainees. We provide ongoing educational sessions that target the hospital’s pediatric nurse practitioners, medical residents and fellows. At the regional, national and international levels, the PNCP has contributed to educational symposia, manuscripts, editorials, book chapters and educational seminars, including educational programs sponsored by the Brain Trauma Foundation, the National Institutes of Health and other leading organizations.

Funding translational research 

Improving outcome following neurological injury impacts quality of life for both children and their families. Supporting sustained research efforts by the PNCP will result in improved care and novel therapies. We have chosen to focus PNCP efforts on the best means to pragmatically and reliably implement new knowledge and therapies into the complex ICU environment, a surprisingly difficult task. Failure in this task has repeatedly undermined successful translation of promising therapies from controlled experimental models/conditions to the challenging “real world” clinical environment. Our remarkable success and established track record in this area of special focus are distinguishing features of our program. Uniquely, to achieve this aim, we have formed a partnership with the world-class Implementation Science and Knowledge Transfer Team at the Washington University Institute of Public Health. Moreover, our research infrastructure includes a unique informatics platform that allows capture and presentation of highly complex data streams in real-time as well as computational analysis for discovery of predictive physiologic signatures that drive decisions about timing of therapeutic interventions to improve outcomes. The PNCP’s research team is available 24/7/365 so that no opportunities to advance the field are missed. This infrastructure supports our participation in NIH multi-center clinical trials and applications for extramural funding.

The PNCP adds to the already well established reputation for excellence in neuroscience at St. Louis Children’s Hospital and Washington University, contributing to high national rankings for Neurology and Neurosurgery.