Can Pediatric Intermediate Care Optimize PICU Utilization? Outcomes from a Single-Center Study

Background Pediatric Intermediate Care Units (PIMCUs) provide an intermediate level of care for children whose needs exceed those of general wards but do not require Pediatric Intensive Care Unit (PICU) admission. Most PICU-escalated children quickly recover without intubation. Although intensive care overcrowding is documented, the safety of non-invasive ventilation (NIV) outside intensive care in pediatrics remains uncertain. This study aims to analyze admissions to PIMCU, to characterize patients requiring PICU transfer and identify a subgroup who might have been safely managed in the PIMCU. Methods this is a retrospective analysis of admissions to a newly established PIMCU (Nov 2023–Jun 2025). Data collected were demographics, Pediatric Early Warning Score (PEWS), and outcomes. A subgroup analysis defined a “Low-risk NIV Group” (NIV ≤ 5 days, simple interfaces, no or dexmedetomidine-only sedation). A cost simulation compared intensive care costs with projected PIMCU costs for this group. Results a total of 365 children were admitted to PIMCU; 26 (7%) required intensive escalation, mainly for respiratory failure (80%); transferred patients had higher PEWS (median 2 vs. 1, p < 0.001) and shorter PIMCU stays (2 vs. 6 days, p < 0.001). Respiratory disease was an independent predictor of pediatric intensive care transfer (adjusted OR 2.79, 95% CI 1.10–7.06). In intensive care, 81% were managed with NIV; 9 fulfilled “Low-risk NIV” criteria. A cost simulation estimated potential savings of >€50,000 annually. Conclusions most intensive escalations were due to respiratory failure. In low-risk patients, short and mild NIV support was successful. This suggests that, under appropriate conditions, NIV could be safely extended to PIMCUs.