The beginnings of intensive care in Košice
The activity of the Children’s Hospital as an independent institution providing complete care for children (including the premises of a polyclinic) on Kuzmányho – Moyzesová Street dates back to January 1, 1966, when the Regional Children’s Hospital was established. Regardless of the changes in society and the needs of the time, when it changed its name, management and dealt with the current operation after the emigration of capable workers abroad after 1968, it was necessary – also in the sense of socialist slogans – to fulfill its mission. And so in the seventies, on the 2nd floor of the children’s clinic, the Premature Infants’ Department (A 3) was separated. It provided oxygen therapy, ensured nutrition, thermostability (only in incubators) and the big hearts of doctors and nurses capable of doing everything humanly possible. Among the first doctors were Dr. Zimová, Dr. Schvardyová and nurses, who were the only and most useful monitors for fragile babies. The equipment was gradually supplemented with incubators (Medicor), injection dispensers made in the GDR (German Democratic Republic) and the first possibilities of respiratory support. These were devices such as the Pulmarca from Dräger (1976) and non-invasive artificial pulmonary ventilation – nasal CPAP (Benett), which was developed by the head physician, MUDr. Mária Tomaškovičová. The pediatric department then worked under the primary care of MUDr. Dušan Kahanc, CSc. Despite the restrictions in the eighties, the primary care physician obtained knowledge from various sources on how to best provide health care. Infant mortality was high in the then Czechoslovakia and its reduction was an indicator of improved health care for children. He came up with the initiative to mark the beds of seriously ill children with a big red I (as an intensive care patient), which meant that the child had to have at least three visits per day and during the institutional emergency service he had to have a visit from the 2nd service. Since there were no monitors, this was the only way to check the patient’s health more often and detect changes. During his time, the infant department acquired the first cardiac monitors (made in the GDR), which only a few doctors and nurses knew how to use correctly anyway, and “intensive” medicine was performed by everyone who could take better care of the child. It is to his credit that he caught the trends in providing resuscitation (mouth-to-mouth breathing, intracardiac administration of drugs) and tried to educate future generations in this spirit.
Faculty Hospital with Polyclinic on Trieda SNP 1 in Košice
The only workplace for children in Košice that received completely new premises was the Children’s Clinic in the new building of the Faculty Hospital with a polyclinic on Trieda SNP. It was built as a ridge structure next to a monoblock, had 3 floors for patients and an outpatient clinic. The first to start its activities in 1982 was the infant department on the 2nd floor (otherwise in the close vicinity of the then ICU for adults, while they shared a corridor). The head of the Children’s Clinic was Prof. MUDr. Oľga Pavkovčeková, CSc., who planned to build an Intensive Care Unit here, following the example of workplaces in the USA and abroad (!). Therefore, a little improvisation was resorted to (as many times before) and the boxes at the end of the corridor were reconstructed so that 6 beds were created, 5 of which were monitoring beds. The opening of the first ICU DKL was on August 15, 1983, it served children from the newborn period to 3 years. The first monitors were Hellige, they were classic cardiorespiratory monitors, without the ability to measure blood pressure, but like adults, they had pacemakers and “some” ability to detect oxygen saturation percutaneously. Artificial pulmonary ventilation was provided by the Chirolog 3 device, without a humidifier and the ability to cooperate with the patient, soon 1 Dräger 7150 incubator with Pulmarca and 1 Babylog 1 ventilator were added. The ICU was staffed by 1 doctor – MUDr. Mária Pisarčíková (who was on duty during the service), station nurse Magdaléna Zavillová, 6 nurses and 1 orderly. From the very beginning, they were helped by doctors from the ARO department of the FNsP (MUDr. Emilián Gramata, MUDr. František Slaninka, MUDr. Monika Grochová and many others, and valuable advice was provided by nurses). Professional literature was scarce, knowledge was difficult to obtain, we had to improvise and rely on experience when working. A three-week study stay at the children’s ARO in the Motolská hospital in Prague offered MUDr. Pisarčíková a glimpse of what an ICU should look like… In 1988, on February 1, 4 beds for children under 15 years of age were added on the 1st floor of the Children’s Clinic (toddler department), which increased the capacity of the ICU DKL to 10 beds. MUDr. Ivona Gramatová worked in the department, and Danka Krafčíková was the head nurse. However, the premises were unsuitable in terms of location and size for a passageway, did not allow for isolation of patients, made proper operation impossible when hospitalized elderly patients (on large beds), and restricted access to the bed. The staff worked inefficiently when working on 2 floors, and problems with medications and SZM increased. Gradually, equipment (thanks to sponsors) including pulse oximeters, more modern vital signs monitors, incubator, thermobeds, UPV devices, dosing pumps, injection machines. After the reconstruction on the 2nd floor in 1997, we combined both ICUs, and 10 beds were available for children under 18 in 5 rooms (2 isolation rooms, 3 rooms for 8 patients). The head of the ICU was Prof. MUDr. Miroslav Šašinka, DrSc., the head physician was MUDr. Jozef Filka, CSc., the head physician was MUDr. Mária Pisarčíková, the ICU was strengthened by doctors – MUDr. Milan Kurák, MUDr. Martin Uher and later MUDr. Anetta Némethová, who, as a certified anesthesiologist, performed bedside work (analgosedation, local and general anesthesia, and others). Danka Krafčíková was appointed as the station nurse, and the number of nurses was still insufficient. Professor Šašinka allowed the activities of this department to be fulfilled by separate services (although these were still doctors in the 2nd service – mostly pediatricians). The spectrum of diagnoses with which patients were hospitalized expanded. In addition to the treatment of severe infections, respiratory failure, shock states, intoxications and many others, these were primarily craniocerebral injuries, polytraumas and multiorgan failures. Close cooperation with the ARO, the dialysis department, surgical departments including traumatology and many others were the basis for further growth. Anesthesia during operations was provided exclusively by doctors from the 1st KAIM of the FNsP. We could also rely on their valuable advice and consultations in the treatment of critically ill children (MUDr. Jozef Firment, MUDr. Grochová, MUDr. Mochnáč, MUDr. Korenek, MUDr. Boris Bočev and others).
KDN at Moyzesová Street No. 9 in Košice
In 1986, on the occasion of the 20th anniversary of the establishment of KDN, an integrated Intensive Care Unit was opened. When it opened, it had 4 beds and 1 incubator. The ICU was part of the Internal Department and the first to work there were MUDr. Marcel Dolobáč and station nurse Marta Halušková. The equipment was gradually improved (artificial pulmonary ventilation – Chirolog alfa, Babylog 8000, incubator, injection and infusion pumps, Packard and Siemens vital function monitors) and in 1995 the ICU premises were renovated (with 6 + 1 beds). Hospitalized here were mainly patients with life-threatening infectious diseases (continuation of the Children’s Infectious Diseases Department) but also other serious conditions. The department was successively worked by doctors MUDr. Eva Bálintová, MUDr. Iveta Marinová, MUDr. Július Štefan and MUDr. Juraj Bazár and station nurses Hedviga Tirpáková from 15.5.1995 to 30.6.2002 and Oľga Reváková from 1.7.2002 to 28.2.2005. We would like to separately emphasize the work of MUDr. Erika Dosedlová, who was the first certified anesthesiologist in the KDN and provided anesthesia for the ENT department in solving urgent conditions (aspiration of foreign bodies, inflammatory diseases of the ENT area) and planned procedures (especially the development of microsurgery and endoscopic methods). The anesthesia nurses were Mária Oravcová and Oľga Reváková.
Finally together
By decision of the Ministry of Health of the Slovak Republic, the pediatric departments on Trieda SNP No. 1 and on Moyzesova Street were merged and the Children’s Faculty Hospital on Trieda SNP No. 1 was established on June 1, 2003. The administrative merger was followed by the physical relocation of the department from Moyzesova Street and a joint Department of Intensive Care Medicine began operating on March 1, 2004. The number of functional beds was 10 (6 closed due to subsequent reconstruction), 6-9 doctors, 23 nurses and 5 orderlies worked here. This highly specialized DFN department provided and provides comprehensive health care to children who are at risk of failure or have failed the function of one or more organ systems due to a wide range of serious illnesses or injuries, the age range from 0 to 19 years. MUDr. was appointed to the position of primary care physician. Mária Pisarčíková, PhD., and head nurse Oľga Reváková. With the arrival of MUDr. Ľubica Králiková, an anesthesiologist enters the department with a difficult task – providing anesthesia for DFN patients, anesthesia consultations and pre-anesthesia examinations. After MUDr. Némethová left for maternity leave, she was the contact physician for the I.KAIM FNsP in coordinating and providing the operating program (for the Department of Pediatric Surgery, ENT Department) during the day. The availability of the anesthesiologist during inpatient emergency services was solved in the form of children’s services (a doctor and a nurse with a predominance of I.KAIM FNsP employees). In addition to the independent work of the anesthesiologist, she also had to solve issues of an administrative and professional nature, i.e. teach pediatricians to look at the child from the perspective of the pitfalls and risks of procedures under general and local anesthesia. She was a professional guarantor for anesthesia at the DFN.
After the reconstruction was completed, the department moved to new premises in the 2nd ridge building on February 10, 2005, with full operation. Head nurse Juliana Fialková had the difficult task of making the department functional and combining the work of personnel from two different groups. It was a year of great and new changes. During the year, the system and organization changed work, the number of open beds increased to 12, additional staff – doctors (anesthesiologist MUDr. Vladimír Filka) and nurses, many devices and finally the name was changed to the Department of Anesthesiology and Intensive Medicine. In 2006, in cooperation with the Rescue Service, we began to perform air and ground secondary transports of critically ill patients (based on their requirements and for a transitional period). From September 1, 2006, an outpatient clinic for pre-anesthetic examinations began to work independently at 0.2 hours. Work in the operating room gradually expanded, but the department had one operating room available (rented within the FNsP since 2005, there was sometimes a second room for emergencies). We prepared standards, used the intervention room in the department for small procedures and hired doctors and nurses with the prospect of working primarily for anesthesia. As of February 1, 2008, the original OAIM III was established. Department of Pediatric Anesthesiology and Intensive Care Medicine of the University of Bratislava and the Department of Pediatric Anesthesiology of Košice as a teaching workplace of the Faculty of Pediatric Anesthesiology of the University of Bratislava. MUDr. Mária Pisarčíková, PhD., was appointed as the head nurse, and Mgr. Renáta Popiková as the head nurse. After the staff was replenished in 2009, the inpatient part of the clinic (head doctor MUDr. Milan Kurák) and the department of anesthesiology (acting head doctor MUDr. Vladimír Filka) began to work separately. Since then, we have had 2 operating rooms, the staff provides anesthesia and pre-anesthesia management for patients of the Department of Pediatric Anesthesiology 24 hours a day exclusively by regular employees of the Department of Pediatric Anesthesiology. We have started to perform anesthesia as part of one-day surgery (for patients of the ENT department so far).
In 2010, the changes in personnel continued with the merger of the functions of the heads to 1 employee, who is assigned to MUDr. Vladimír Filka, the position of day shift manager was created, we solved the 24-hour presence of an anesthesiology nurse at the workplace, the anesthesiology outpatient clinic works daily (workload 1.6), the number of certified anesthesiologists increased to 4 and another 5 are in preparation for this certification. The total number of doctors is 15, nurses 37 and medical assistants 7.
The progress we have made in almost 30 years has established us as a recognized workplace in the region and the Slovak Republic. Our thanks go to everyone who selflessly advised us, believed in us and supported us in every way.
The current head of the Department of Pediatric Anesthesiology and Intensive Care Medicine is MUDr. Milan Kurák and the primary head is MUDr. Pavol Fedor.
