Pediatric critical care capacity in Canada: a national cross-sectional study

Background: Pediatric intensive care unit (PICU) capacity is a current and future health system challenge in Canada. Despite experiencing two pandemics over the last 15 years and surges in PICU admissions every winter, the bed capacity of Canadian PICUs and their ability to accommodate surges in demand are largely unknown. Methods: We conducted an internet based cross sectional survey to gather information from Canadian PICUs regarding PICU characteristics, medical staffing, therapies provided, and anticipated challenges related to surge management. The survey was completed by a representative of each PICU and validated by PICU Directors. Quantitative survey results were summarized as counts, proportions, and ratios while qualitative response was analyzed using inductive content analysis. Results: Representatives from all 19 PICUs located in 17 hospitals completed the survey and reported having 275 (217 level 3 & 58 level 2) funded beds with 298 physical bed spaces. Two PICUs representing 47 beds (35 Level 3 & 12 Level 2) are specialized cardiac ICUs. Roughly 13385, 13419, 11430 and 12315 Canadian children were admitted to these PICUs in the years 2018, 2019, 2020 & 2021 respectively. During a surge, PICUs reported being able to add 5.9 {+/-} 3.4 (range: 0 - 14) beds per unit and a total of 108 temporary surge beds. Several barriers for the successful implementation of surge plans were identified. Interpretation: Canadian pediatric critical care capacity is comparable to other high-income countries, though our ability to respond to a pandemic/epidemic surge with significant pediatric critical illness may be limited.