Pediatric Critical Care (Pediatric Intensive Care Unit - PICU)

Consult our brochure for parents

The Montreal Children’s Hospital Pediatric Intensive Care Unit (PICU) offers state-of-the-art care within a patient-and family-centred philosophy for critically ill or injured newborns, children, and adolescents. This 18-bed unit is a major provincial, national and international referral centre and admits over 850 patients per year.

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Who we are

The Montreal Children’s Hospital Pediatric Intensive Care Unit (PICU) offers state-of-the-art care within a patient-and family-centred philosophy for critically ill or injured newborns, children, and adolescents. This 18-bed unit is a major provincial, national and international referral centre and admits over 850 patients per year.

Our services include complex congenital cardiovascular surgery, seizure and tumour neurosurgery, craniofacial reconstruction, complex orthopedic surgery, tracheal reconstruction surgery, level I trauma, extracorporeal life support, high frequency ventilation, long-range air transport, a nitric oxide program, and solid organ transplantation.

Our multidisciplinary team includes pediatric critical care specialists and fellows, consulting physicians, residents, pediatric critical care specialized and advanced practice nurses, respiratory therapists, pharmacists, social workers, physiotherapists, dieticians, information and administrative workers, and child life specialists.

 

Our history

The Pediatric Intensive Care Unit (PICU) at the Montreal Children’s Hospital was established in 1969. After a modest beginning, the PICU began to take on more responsibilities and became the birthplace of many exciting new programs and services. The increasingly sophisticated care provided to patients meant a greater need for specialized technology, specially-trained personnel, and additional space, which led to the establishment of the Division of Pediatric Critical Care in 1980 and the opening of our current unit in 1985.

Milestones

1969   Pediatric Intensive Care Unit established at the Montreal Children’s Hospital

1980   Pediatric Critical Care Division established

1983   Ethics research program in Critical Care established with Dr. Franco Carnevale

1985   New Pediatric Intensive Care Unit opened

1985   First successful liver transplant to the youngest recipient ever in Canada

1987   Pediatric Critical Care Training Program established

1988   Heart transplant on the youngest recipient ever in Canada

1988   Development of the first Pediatric Acute Life Support Course in Canada

1989   Neurotrauma Program established

1990   Pediatric Critical Care Training Program accredited by the Royal College of Physicians and Surgeons of Canada

1993   First Intermediate Care Unit established in Quebec

1993   MCH is designated a tertiary care Pediatric and Adolescent Trauma Centre for Quebec

2002   First successful use of a Berlin heart in Canada as a bridge to cardiac transplant on the youngest patient ever in North America

2006   Extracorporeal Life Support (ECLS) Program was unified under the direction of the Pediatric Intensive Care Unit - Dr. Sam Shemie

2012   Advanced Care Unit implemented for patients required intermediate care

Our team

The Montreal Children’s Hospital Pediatric Intensive Care Unit (PICU) works using a multidisciplinary team approach, which aims to provide the highest and best level of care to our patients.

Co-Directorship

Staff physicians

The Division of Pediatric Critical Care includes eight pediatric intensivists who have appointments in the departments of Pediatrics, Pediatric General Surgery, and Pediatric Anesthesia. Patients are admitted to the PICU under the primary care of these physicians.

Fellows and residents

Our Pediatric Critical Care Training Program has beenaccredited by the Royal College of Physicians and Surgeons of Canada since 1990. Every year, there are between four and six full-time fellows doing their pediatric critical care training in our unit. The program has trained over 50 fellows from many countires around the world including Canada, the United States, Brazil, Saudi Arabia, Oman, Kuwait, Thailand and Japan. All our fellows first completed postgraduate training in Pediatrics, Anesthesia, or Pediatric Surgery. In addition, residents from Pediatrics, Anesthesia, Adult and Pediatric Emergency, and Family Medicine also do rotations in our PICU. Medical students are also welcome for electives after completing their core rotation in pediatrics. 

Staff members

Nursing staff

We have a dynamic team of over 70 nurses working in the PICU, all committed to providing family-centred care in a safe, professional environment.

Nurses undergo an extensive two-year preceptorship and education process as they become involved in caring for patients with more complex conditions. During this time, they share specialized knowledge through an advanced CVT course, and an advanced PICU concepts course. We offer a myriad of ongoing educational activities to continue their professional journey, and pride ourselves in offering specific opportunities to support the growth of newer graduates. Our education programs reflect the diversity of the children and families that we care for, and the full spectrum of health challenges that our patients face.

Nurses working at the patient’s bedside are supported by a nurse manager, assistant nurse manager, fulltime nurse educator and three advanced practice nurses.

  • Margaret Ruddy, BSc Nursing, M. Mgmt, Nurse Manager
  • Marie Antonacci, N, BScN, Assistant Nurse Manager

Advanced practice nurses

  • Maryse Dagenais, APN, CNS
  • Linda Massé, APN, CNS

Nurse educator

  • Margaret Powell N, BSN, MEd

Registered respiratory therapists

Registered Respiratory Therapists (RRT) are an integral part of the Critical Care team. They provide cardio-respiratory care to acutely ill patients. RRTs have specialized knowledge and skills in airway management including treating difficult airways, using invasive and non-invasive mechanical ventilation, administering oxygen and specialized gases, and administering alternate modes of ventilation such as high frequency oscillation and high frequency jet ventilation.  Respiratory Therapists are also part of the extracorporeal membrane oxygenation (ECMO) team.

An RRT is assigned to the PICU 24 hours a day, 365 days a year. There is also an RRT assigned to the Resuscitation Team and Trauma Team to respond to acute emergencies anywhere in the hospital.

Chief respiratory therapist 

  • Pina Diana, RRT, Manager, Respiratory and Anesthesia Services, Pediatric Mission

Assistant chief respiratory therapist

  • Marisa Leone, RRT

Respiratory therapy technical coordinator

  • Johanne Boyer, RRT

Dietician

  • Donna Drury, PDt, MSc

Pharmacists

Social Worker

  • Matthew Park, BSW

Psychologist

  • Judith Legallais

Child Life Specialist

  • Lise Gagnon

Spiritual Care

  • Paul Geraghty

Administrative support

  • Lyse Dorion, Administrative Assistant
  • Kerry Phillips, Administrative Assistant
  • Constantina Akrivos,  Administrative Assistant
Programs and services

The Montreal Children’s Hospital Pediatric Intensive Care Unit (PICU) is a multidisciplinary unit recognized for its excellent patient outcomes. We provide comprehensive care for over 850 patients per year with complex diagnosis, such as cardiac and respiratory diseases, trauma, burns, cancer, and patients who need post-operative care after complex airway, spine, cardiac and neurosurgery.

As leaders in the care of complex patients, the Pediatric Intensive Care Unit (PICU) at the Montreal Children’s Hospital offers many specialized programs:

Extracorporeal Life Support (ECLS)

The ECLS Program started at the Montreal Children's Hospital in 1991. Initially, extracorporeal membrane oxygenation (ECMO) was provided in the Neonatal Intensive Care Unit. In 2006, the program was unified under the direction of the Pediatric Intensive Care Unit to provide all forms of mechanical support for heart and lung failure including ECMO and Ventricular Assist Devices (VAD). The Montreal Children's Hospital is the only provincial referral centre for neonatal respiratory ECMO. While the majority of ECLS care is provided to newborns, we provide support for children of all ages with lung or cardiac failure. The Program is a member of the Extracorporeal Life Support Organization (ELSO), a world-wide consortium of healthcare centres that report their ECLS data to a central registry.

Continuous Renal Replacement Therapy (CRRT)

A team of nurses receive specialized ongoing education to administer Continuous Renal Replacement Therapy.

Advanced modes of ventilation

There are incidences when ventilating (supplying air to the lungs) through conventional methods is not enough to properly support the child’s cardio-respiratory system. The PICU and the RRTs are always at the forefront of searching for alternate technologies to achieve successful life saving cardio-respiratory care while minimizing detrimental side effects to the child. The PICU offers advanced modes of ventilation such as high frequency oscillatory ventilation and high frequency jet ventilation.

Trauma Program

The Montreal Children's Hospital (MCH) of the McGill University Health Centre is a provincially designated Pediatric and Adolescent Trauma Centre, a Neurotrauma Centre of Expertise, and an important player in the provincial trauma network.

Each year, more than 16,000 children and teens from throughout Quebec are treated at the MCH Emergency Department for trauma-related injuries. Upwards of 400 of these patients sustain injuries that are serious enough to require hospitalization.

On an annual basis, the MCH receives approximately 150 trauma patients from regional centres throughout the province who are in need of tertiary trauma expertise. The hospital's trauma experts become involved with all these patients as well as hundreds more who are referred as outpatients by community physicians and regional centres for consultation and a variety of specialized interventions.

Organ and Tissue Donation

In 1998, the McGill University Health Centre (MUHC) was the first Québec hospital organization to have a dedicated nurse to support and explain the organ and tissue donation process to potential donor families. This important end-of-life care option compliments the holistic and humanistic support offered at the Montreal Children’s Hospital and across the MUHC.

At the Montreal Children’s Hospital, organs and tissues can be donated following a diagnosis of neurological death. In addition, tissues can be donated following a cardiac death. For each type of donation an evaluation process is carried out to determine the eligibility of the donor.

Our service understands that the death of a child is a traumatic event for parents. Whether or not a family chooses to donate, our team offers bereavement support and resources to help cope with the death. We take time to explain the donation process, encourage questions, and provide time to ensure the choice that best reflects family values and beliefs. The Organ and Tissue Donation team is available 24 hours a day, 7 days a week and can be reached at (514) 412-4400, x 36590.

Nursing education and training

Nursing Orientation Program

The Pediatric Intensive Care Unit (PICU) Nursing Orientation consists of three phases:

Phase I: The objective of the theory phase (10 days) is to introduce the new nurse to scientific knowledge and develop critical thinking skills relevant to nursing children and families in the PICU.

Phase II: The objective of the clinical phase is to provide the new nurse with the opportunity to incorporate scientific knowledge into practice, foster critical thinking, develop clinical skills and integrate into the PICU interdisciplinary team. Each new nurse has the opportunity to work with a senior PICU nurse preceptor for six consecutive weeks (eight weeks for a new graduate).

Phase III: The objective for the follow-up phase is to ensure the new nurse has patient assignments and learning opportunities that are appropriate for his/her level of practice. Knowledge acquisition, critical thinking, skill development and integration into the PICU team are assessed throughout the first three to six months following the completion of phase II of the orientation.

Nursing Genesis Program

The PICU Nursing Genesis Program is offered to new graduate nurses following the completion of phase II of the PICU orientation program. This program supports and fosters professional development among new graduate nurses as they transition into the role of staff nurse in the PICU.  Five eight-hour seminars are scheduled during the first year following completion of phase II of the orientation program.

Cardiovascular Nursing Course - Nursing the Child Undergoing Cardiac Surgery

This three and one-half day course is designed to provide PICU nurses with theoretical and clinical educational support that will enable them to provide advanced nursing care to children who undergo complex cardiac surgery. There are three days of theory followed by a half-day that integrates the theory into clinical scenarios in a high-fidelity simulation lab.  It is offered within the first eight to 12 months following the completion of the orientation program.

Cardiovascular Nursing Course Topics
Anatamy & physiology
Cardiac pacing
Congenital heart defects
Cardiovascular pharmacology
Cardiac transplantation
Surgical procedures & cardiopulmonary bypass
Post-operative complications
Family concerns

PICU Nursing Course - Nursing the Critically Ill Child: Advanced Concepts

This 10-day course is designed to promote an advanced understanding of scientific knowledge required to nurse critically ill children in the PICU.  It is offered 12 to 18 months following the completion of the orientation program. This course may also serve to prepare nurses who wish to obtain the Canadian Nurses Association (CNA) specialty certification in pediatric critical care.

PICU Nursing Course Topics
Acid-base balance
Extra corporeal membrane oxygenation
Oxygenation
Shock
Pulmonary hypertension
Renal function & diseases
Ventilation
Neurological evaluation 
Myocardial mechanics
Trauma
Cardiac electrophysiology
Transplants (renal and cardiac)
Infectious diseases
Nutrition
Oncological diseases
Ethics

Resuscitation Team

PICU nurses attend a workshop designed to prepare them to be part of the PICU resuscitation team (Code Pink Team). Interdisciplinary Mock Code Pink teachings sessions are held weekly to help team members maintain their knowledge and skills.

Certification Courses

PICU nurses attend a Basic Life Support (BLS) certification course during orientation and are re-certified on a regular basis.  Nurses attend the Pediatric Advanced Life Support (PALS) and the Advanced Cardiovascular Life Support (ACLS) courses within the first 12 to 18 months following the completion of the orientation program.

Preceptor

Nurses who express an interest in precepting new nurses attend a workshop to provide them with knowledge and skills necessary to assume the role of a preceptor.

Specialized Training

Nurses who are members of the PICU Continuous Renal Replacement Therapy (CRRT) and Extra Corporeal Life Support (ECLS) teams attend an introductory course that offers scientific knowledge and skills specific to CRRT or ECLS. Throughout the year nurses attend on-going educational activities to maintain their knowledge and skills related to these specialized treatment modalities.

For more information, please contact:

Margaret Powell, Nurse Educator

1001 boulevard Décarie, room B06.3557, Montreal, QC H4A 3J1, Canada
Phone: 514-412-4400, x. 23100
E-mail: margaret.powell@muhc.mcgill.ca

Medical education and training

Pediatric Critical Care Training Program

Our Pediatric Critical Care Training Program was developed in 1987 and became an accredited training program of the Royal College of Physicians and Surgeons of Canada in 1990. Our goal is to prepare our fellows to assume leadership roles in pediatric critical care in academic institutions worldwide.  Trainees include highly qualified Canadian and foreign candidates who have already completed at least three years of accredited base specialty training. Upon completion of this two-year program, candidates will be eligible for certification in Pediatric Critical Care by the Royal College, Board of Pediatrics certifications. This training will also count toward America.

Our multidisciplinary PICU allows for the acquisition of advanced skills such as (but not limited to) neurocritical monitoring and care, all modes of invasive and non-invasive respiratory support, cardiovascular support (including ECLS and assist-devices) and renal support (CRRT). Fellows are trained to care for patients requiring critical care services through our many specialized programs; congenital cardiac surgery, trauma (level 1 centre), craniofacial reconstruction program, airway reconstruction, complex scoliosis repair, seizure surgery, and solid organ transplant (kidney and heat). Fellows gain first hand experience to organ support through ECLS (ECMO and VAD) and CRRT.

Additional clinical training includes electives in anesthesiology, echocardiography, neuroradiology, trauma, and ICU. Fellows receive training in bedside ultrasound applied to critical care. Furthermore, our training program includes a formal pediatric critical care teaching program (protected half day a week) with teaching provided by pediatric critical care staff and experts in other specialties, use of simulation for educational purposes, and research training. Fellows are mentored to prepare and deliver educational sessions as well. 

Trainees are mentored by the multidisciplinary faculty of the Division of Pediatric Critical Care Medicine. Our faculty have appointments in Pediatrics, Pediatric General Surgery, Pediatric Anesthesia, Epidemiology, Nursing, and Bioethics. Our fellows are implicated in all aspects of PICU functioning to train them in leadership, consultant, and teacher roles. All trainees will be expected to share on-call duties in the PICU. Trainees will also be expected to pursue a scholarly project under the mentorship of one of the research faculty members; this project may be in the areas of clinical research, health professions education, quality improvement, knowledge translation, etc. Finally, all trainees  participate in clinical conferences, multidisciplinary rounds, quality improvement initiatives and weekly meetings of other subspecialty services, e.g., cardiology, cardiovascular surgery, and radiology.

Advanced Pediatric Critical Care Fellowship

The McGill University Pediatric Critical Care Medicine program offers a one-year advanced clinical/research fellowship to qualified candidates who have already completed their base Pediatric Critical Care specialty training.  This additional year is geared towards developing excellence in advanced multi-organ support modalities while enhancing leadership and academic skills. In addition, this fellowship includes a formal pediatric critical care teaching program (protected academic half day), use of simulation for educational purposes, and research training. Regarding the latter, research opportunities are numerous in the fields of applied physiology, clinical trials, bioethics, psychology, quality improvement, healthcare delivery and medical education. The year will be tailored to the individual’s career goals by determining the balance between clinical and academic activities. Graduates of this program are prepared to assume leadership roles in academic institutions.

Fellows are mentored by the multidisciplinary faculty of the Division of Pediatric Critical Care Medicine. Our faculty have appointments in Pediatrics, Pediatric General Surgery, Pediatric Anesthesia, Epidemiology, Nursing, and Bioethics. Our fellow are implicated in all aspects of PICU functioning to train them in leadership, consultant and teacher roles. All trainees will be expected to share on-call duties in the PICU. Trainees will also be expected to pursue a scholarly project under the mentorship of one of the research faculty members; this project may be in the areas of clinical research, health professions education, quality improvement, knowledge translation, etc. Finally, all fellows participate in clinical conferences, multidisciplinary rounds, quality imrpovement activities and weekly meetings of other subspecialty services, e.g., cardiology, cardiovascular surgery, and radiology.

Pediatric Critical Care Training Program Application Process
EligibilityCandidates must have completed core residency training in Pediatrics,
 Anesthesia, Internal Medicine, Surgery, or Emergency Medicine
 
Advanced Fellowship: base training in Pediatric Clinical Care
Duration24 months (2 years)
Advanced Pediatric Critical Care Fellowship: 1 year
Program descriptionProgram academic year: July to June 
12-18 months of Pediatric Critical Care 
2-6 months of additional clinical training in specialties relevant to Critical Care 
4-6 months dedicated to research
Number of positions available per yearPediatric Critical Care Training Program: 2 positions/year

Division of Pediatric Critical Care, Montreal Children's Hospital

Dr. Samara Zavalkoff, Program Director

1001 boul Décarie, room B06.3557, Montreal, QC, H4A 3J1 Canada
Phone: 1 514 412-4400, extension 22696
E-mail: samara.zavalkoff@mcgill.ca

Research

The Division of Pediatric Critical Care is committed to developing and supporting high-quality research projects that ultimately aim to improve the quality of care provided to critically ill pediatric patients.

Research team

Our staff members are involved in a variety of basic, clinical, and educational research projects, reflecting their different interests and expertise. Our team includes basic scientists, an epidemiologist, an ethicist, and experts in education, quality improvement, infection control, organ donation, and pharmacology.

In addition, the nurses in the PICU who are dedicated to research have an essential role in the coordination of research projects taking place in our PICU. Their responsibilities include screening of eligible patients and recruiting them for research, as well as ongoing data collection.

Faculty members and their research areas

Ronald Gottesman MD, FRCPC, FAAP, FCCM: Technology-enhanced-instruction; medical simulation; leadership skills training and faculty development.

Sam Shemie MD, FRCPC: Development and implementation of intensive care unit–based organ donation strategies; health policy research related to organ donation; transplantation; technological support of end-stage organ failure.

Davinia Withington MD, FRCA, MRCP (UK): Sedation; pharmacokinetics and pharmacogenomics of sedation in pediatric patients; sedation and neurodevelopment.

Saleem Razack MD, FRCP(C): Selection for medical school (best practices in admissions); diversity, equity, and social accountability in health professions education, qualitative methodologies (discourse analysis, critical social/language theories (Foucault, Bourdieu, Bakhtin), mixed methods research).

Pramod Puligandla MD, MSc in Physiology, FRCSC, FACS: Evaluation of clinical outcomes; feeding practices for children needing ventilatory support; post-operative hyperglycemia; pulmonary infections.

Farhan Bhanji MD, MSc in Education, FRCPC, FAHA: Simulation-based education; optimizing the instruction of pediatric resuscitation; use of technology enhanced instruction to improve clinical training, CanMEDS education.

Samara Zavalkoff MD, FRCPC, FAAP: Quality improvement; process of care; infection control in PICU, point of care ultrasound.

Patricia Fontela MD, PhD in Epidemiology: Healthcare-associated infections (HAI) acquired in ICUs; central line-associated bloodstream infections; HAI surveillance in ICUs; antimicrobial stewardship; procalcitonin; healthcare-associated urinary tract infections.

Franco Carnevale RN, PhD candidate in Philosophy, PhD in Psychology: Pediatric ethics; the experience of critically ill children and their families; childhood disability.

Janet Rennick RN, MSc in Nursing, PhD in Nursing: Psychological impact of critical illness and exposure to highly invasive, technological care on the child and family; innovations in care to enhance child comfort and parent involvement during PICU hospitalization, and promote healthy recovery post-PICU; measurement development.

Collaboration

In addition to undertaking locally developed projects, the Division of Pediatric Critical Care collaborates with different groups involved in critical care research:

Pediatric Critical Care Research Training Program

We have developed a research program for our fellows, which aims to:

  • Expose trainees to the steps required for the development and completion of a research project;
  • Promote the development of skills to critically evaluate evidence presented in the health sciences literature;
  • Teach the principles of epidemiology necessary for the design and performance of clinical research projects.

This program includes monthly critical appraisal sessions and research seminars in which fellows learn basic principles of epidemiology and biostatistics. In addition, we also offer sessions about protocol development with the objective of training fellows in different aspects of research, such as how to do a systematic review, formulate a research question, design surveys and research plans, analyze methods, and interpret results.

We also encourage our fellows to take basic epidemiology and biostatistics courses during the summer session of the Department of Epidemiology at McGill University.

Publications

 

  • Publications in 2015
  • Publications in 2014
  • Publications in 2013
  • Publications in 2012
  • Publications in 2011
Information for families

Consult our brochure for parents

 

If your child is currently hospitalized and you would like to learn more about our unit, consult the following weblink: Caring together: information on the Pediatric Intensive Care Unit for families

Contact us

Pediatric Critical Care Training Program

 

Dr. Samara Zavalkoff, Program Director

Division of Pediatric Critical Care, Montreal Children's Hospital
1001 boul Décarie, room B06.3557, Montreal, QC, H4A 3J1 Canada
Phone: 1 514 412-4400, extension 22696

Fax: 1 514-412-4205
E-mail: samara.zavalkoff@mcgill.ca

Nursing

 

Margaret Ruddy, Head Nurse

Montreal Children's Hospital
1001 boul Décarie, room B06.3549, Montreal, QC, H4A 3J1 Canada
Phone: 1 514 412-4400, extension 22140

E-mail: margaret.ruddy@muhc.mcgill.ca

Respiratory therapy

 

Pina Diana, Manager Respiratory and Anaesthesia Services, pediatric mission

Montreal Children's Hospital
1001 boul Décarie, room BRC.5000, Montreal, QC, H4A 3J1 Canada
Phone: 1 514 412-4400, extension 24422

E-mail: pina.diana@muhc.mcgill.ca

Pediatric Intesive Care Unit

 

Montreal Children's Hospital
1001 boul Décarie, B wing, 6th floor, Montreal, QC, H4A 3J1 Canada
Phone: 1 514 412-4400, extension 22855

Fax: 1 514 412 4205

Refer a patient 

Room: B 06.3718, Glen site

Phone : 514-412-4400 ext. 22696
To reach the unit: 514-412-4238 (PICU) 24/7
Fax : 514-412-4205