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 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Canadian Critical Care Trials Group (CCCTG) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Office of Human Research Ethics determined that this study did not require oversight by Western University research ethics board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.