Creating a Healing Environment in the PICU
Why We Need to Change the Standard of Care in Pediatric ICUs
Traditional pediatric ICU care has meant keeping young patients immobilized by sedation, which allows them to rest and ease their pain and suffering. However, for patients who recover, this practice can often leave them physiologically dependent on opioids and benzodiazepines, with disturbed sleep, increased delirium, and physical atrophy. And this practice fails to allow dying patients meaningful interaction with their loved ones.
PICU Up! was developed at the Johns Hopkins Children's Center over a 2-year period of methodical protocol implementation and review, including pre- and post-launch testing by caregivers in every clinical discipline across the PICU. Study results demonstrated that a bundled intervention to create a healing environment in the PICU with structured activity is safe, feasible, and may have benefits for short- and long-term outcomes of critically ill children.
It has since been successfully adapted at 200+ hospitals globally and implemented directly at 25+ children's hospitals nationwide.
Dr. Sapna Kudchadkar Introduces PICU Up!
Illness shouldn't mean stillness: Let's "PICU Up!" | Dr. Sapna Kudchadkar TEDx Talk
Program Components
How PICU Up! Works
PICU Up! is an interdisciplinary, multi-component program designed to help providers improve outcomes for critically ill children. Its aims for improvements in:
- Pain treatment and management
- Mechanical ventilation optimization
- Sleep/wake cycle optimization
- Delirium prevention and treatment
- Early mobilization
Program Components
PICU Up!
Resources and Program Information
PICU Up!
Articles and Press Releases
About the Program Innovator
She completed residencies in pediatrics and anesthesiology followed by fellowships in both pediatric critical care and pediatric anesthesiology at Johns Hopkins. After clinical training, she completed a doctoral degree in clinical investigation at the Johns Hopkins Bloomberg School of Public Health where she was awarded the Sommer Scholar Award for doctoral candidates who "exemplify scientific excellence, energy, ambition, political acumen, and a determination to change the world" through public health research.
Dr. Kudchadkar's clinical and research focus is on functional outcomes after pediatric critical illness and major surgery and the interplay of sedation optimization, sleep promotion, delirium prevention and early mobilization in pediatric ICU care. She is the founder and director of the Johns Hopkins PICU Up! program, which has been implemented in pediatric ICUs internationally, and she is the Lead PI for PARK-PICU study (Prevalence of Acute Rehabilitation for Kids in the PICU), which includes more than 200 sites across North America, Europe, Australia/New Zealand and Brazil. The PICU Up! program is currently part of a 10-center NIH trial including community and academic PICUs across the US.