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t m c » p u l s e | a p r i l 2 0 1 9 26 Maternal ICU Opens at Texas Children's Hospital New unit offers four beds for mothers in need of critical care B y A l e x a n d r a B e c k e r E arlier this year, Jacqueline Elizondo was diagnosed with the flu. She was 35 weeks pregnant. By the fourth day of her illness, she could barely move and her breathing had grown labored and painful. She called her doctor, who sent her to Texas Children's Pavilion for Women to get a lung X-ray. As Elizondo watched the worried technicians conferring with nurses, she could tell something was terribly wrong. Almost immediately, she was admitted to the hospital. Technicians could barely find a vein for her IV because she was so dehy- drated. Soon, a nurse took her hand and told her she would be going to a brand-new unit, one created espe- cially for pregnant women in need of critical care. In her room with shiny, state-of- the-art equipment, Elizondo found herself surrounded by "an army of doctors." They tried breathing treatments, to no avail. Finally, they explained that she would be under- going an emergency C-section—that in order for her to get better, she needed to first have her baby. That army soon delivered a healthy little boy. A week later, after recovering from bacterial pneumonia and sepsis in that very same room, Elizondo finally took him home. Her life was saved in an inten- sive care unit (ICU) unlike any other in Texas. Dedicated space Located in the labor and delivery unit of Texas Children's Pavilion for Women, the new four-bed mater- nal intensive care unit opened in January. Dedicated to obstetric (OB) intensive care, the unit offers a specialized, private space for high-risk expectant and postpartum mothers. Staffed 24/7 by a pulmo- nary critical care team, a maternal- fetal specialist team and nurses certified in intensive care and advanced cardiovascular life sup- port, the space has all the capabil- ities of a typical ICU as well as the most advanced obstetric equipment and fetal monitoring systems. The new unit accommodates women who have been diagnosed aside for these clinical cases. "Even in most advanced aca- demic centers, pregnant patients are usually placed with a general adult ICU population, and then they call in the OB doctors to help them manage, but there are very few standalone OB critical care units that are dedicated just to taking care of mom and baby," explained David Muigai, MBChB, an intensivist trained in both pulmo- nary and critical care medicine who serves as the medical director for the maternal ICU. Placing a pregnant or postpar- tum woman in a traditional ICU can be problematic if the care team is not familiar with the nuances and complications associated with obstetrics. "Women during pregnancy have varied, unique changes to their physiology related to how the heart works, how it pumps, the amount of blood volume they have in their body, when that volume will shift—you need to know obstetrics and you need to know intensive care," said Lynda Tyer-Viola, Ph.D., vice president of Women's Services and Professional Development and Research at Texas Children's Pavilion for Women. "We see the sickest of the sick, and I think having that compre- hensive team of experts right here makes a huge difference in timing and in implementing life-sustaining therapies," added Liz Bolds, one of the nurse specialists staffing the new unit. Although the focus is on highly specialized clinical care, the hospital also wants the maternal ICU to be a place for families. "We expect and encourage families to stay with the patients," Tyer-Viola said. Already, the team has observed benefits to carving out this dedicated with certain high-risk pregnancies or severe postpartum complications, including placenta accreta, sepsis, cancer, congenital heart defects or hypertensive disorders. Although Texas Children's Hospital has been offering these services since opening the Pavilion in 2012, this is the first time dedicated space has been set Above: Jacqueline Elizondo, who was a patient in the new maternal ICU at Texas Children's Pavilion for Women, holds her son, Atlas. Facing page: Lynda Tyer-Viola, Ph.D., vice president of Women's Services and Professional Development and Research at Texas Children's Pavilion for Women, and David Muigai, MBChB, medical director for the maternal ICU, stand in the new unit.