Department of Pediatrics

Clinical Learning Environment


Lester and Sue Smith Legacy Tower

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Lester and Sue Smith Legacy Tower

The critical care units span seven floors, house 132 ICU beds, and include dedicated spaces for subspecialty cohorting of patients in both the Pediatric and Cardiac Intensive Care units, making us a unique pediatric critical care center worldwide. Cohorts in the PICU include the Neuro-ICU with integrated epilepsy monitoring, the Surgical ICU, the Hematology/Oncology ICU, the Pulmonary ICU, a general Medical ICU and a Transitional ICU. Cohorts in the CICU include the Heart Failure ICU, the Neonatal CICU, and a general medical/surgical CICU. Legacy Tower is also equipped with a helipad dedicated to the transport of critically ill and injured patients. Our critical care teams include physicians, fellows, nurse practitioners, physician assistants, residents, as well as, nursing, respiratory care, and other ancillary staff.

In addition to the Medical Center Campus located in the Texas Medical Center, Texas Children’s Hospital has two community-based PICUs comprised of our 16-bed West Campus facility in Katy, Texas (west of Houston) and our 10-bed PICU in The Woodlands, Texas (north of Houston). The West Campus facility is also home to Texas Children’s Hospital Special Isolations Unit. The SIU is an eight-bed unit specifically designed for children with highly contagious infectious diseases, such as Ebola and MERS, and has been vital to Texas Children’s Hospital’s response to the COVID-19 pandemic. 

Patient flow to and from the various ICUs is coordinated through Texas Children’s Hospital Mission Control, a comprehensive transport and triage hub. During November 2018, Texas Children’s Hospital opened its helipad and has had over 150 landings between the Medical Center campus and our community campuses. The coordination of care that takes place in Mission Control helps to ensure that patients are delivered to the right place in a timely fashion for optimal care.

The PICU has over 3000 admissions per year, with more than two-thirds requiring assisted ventilation or other advanced support, such as oscillatory ventilation, nitric oxide administration, extra-corporeal membrane oxygenation (ECMO), extra-corporeal liver support, and other extracorporeal therapies. It is a multi-disciplinary ICU, which supports the primary through quaternary patient population of southeast Texas with patients admitted from all major medical and surgical subspecialties. Our PICU was recently awarded the Society of Critical Care Medicine’s ICU Design Citation Award at the 50th Annual Critical Care Congress. This citation is awarded to the ICU that best resolves both functional and humanitarian issues in a unique and complementary manner.

The CICU, in affiliation with the Texas Children’s Heart Center, is fully dedicated to critically ill children and young adults with congenital or acquired cardiac disease with approximately 1000 admissions per year. Our team of heart surgeons perform over 800 cardiac surgeries annually, including cardiac and lung transplantation, and extracorporeal circulatory support. We have one of the busiest ventricular-assist device programs in the country having placed 20 VADs over the last year, and we opened the first dedicated Heart Failure ICU in the nation in 2015. Texas Children’s Heart Center was ranked number #1 by U.S. News and World report 2020.

The TICU has approximately 1000 admissions per year and is specifically designed for children who require long-term technological support, those with residual PICU morbidities requiring transition to home, and the management of children who require more intensive physician and nursing support.


Transport and Referrals


In addition to helping the children of Houston and southeast Texas, we receive referrals from across the United States and worldwide.

Our Kangaroo Crew is a dedicated pediatric critical care transport team that participates in over 1,400 pediatric transports per year. Although the majority of transports are performed by a dedicated transport team consisting of nurses and respiratory therapists, Critical Care Fellows participate in the transport of the most critically ill patients. In addition to standard medical transport, we also initiate ECMO at referring hospitals If deemed necessary for a safer transport as well as transport patients on ECMO who have refractory cardiac and/or respiratory disease.

All Kangaroo Crew transports are medically managed by Critical Care physicians through Texas Children's state-of-the-art communications hub, Mission Control, which houses representatives from Room Management, Transport Services, and Critical Care. Mission Control performs real-time tracking of ground and flight crews, weather, and traffic. Mission Control manages all interfacility transports including initial intake, recommendations from our physicians, dispatch of the Kangaroo Crew, stabilization of the patient, and transport to one of our Texas Children facilities. Additionally, Mission control utilizes a new electronic health record, RescueNet, that integrates transport data and documentation into the standard medical record when the patient arrives. Fellows spend time in Mission Control, while on their transport rotation, assisting and learning the “art” of triage medicine.