Development of a national daily monitoring system for demand and capacity of pediatric intensive care units during a respiratory epidemic in Uruguay.

Abstract

Background: An online tool for national monitoring of pediatric intensive care unit (PICU) bed occupancy was developed and implemented for 12 weeks in the winter of 2023 in Uruguay.

Methods: Using a daily 5-minute survey in each PICU, operational bed capacity, occupancy rates, invasive mechanical ventilation demand, and the number of children admitted for acute lower respiratory infections (ALRI) were collected. The REDCap software platform was used for data capture.

Results: Data were collected from 100% (n = 20) of Uruguayan PICUs, 68% located in Montevideo, with 2.72 PICU beds per 10,000 children under 18 years of age, and 32% in the rest of the country, with 0.86 PICU beds per 10,000 children under 18 years of age. The national average bed occupancy rate was 55.5%, with marked variability between centers (32% to 86%). During epidemiological week (SEPI) 28, the system expanded by 36% compared to the initial value of operational beds. The highest percentage of bed occupancy was observed between SEPIs 25 and 28, when the average was above 70%. This peak reached 78% during SEPI 26, coinciding with the epidemiological peak of cumulative incidence of LRTI in children under 15 years of age.

Conclusions: In Uruguay, a national ICU bed monitoring tool was implemented, which showed that occupancy rates did not reach critical levels. However, regional and inter-center differences were found that warrant further study to optimize system management.