Program Code: SCF-DBI-PICU-ADMIT-0001
Operational Window: Admission → First 6 Hours of PICU Care
Primary Objective: Establish physiologic stabilization, biologic intelligence baseline mapping, ANMS enrollment, and activation of RHENOVA pediatric critical care procedures.
SECTION 2.1
PICU ADMISSION ACTIVATION CRITERIA
Direct PICU Admission
Respiratory Failure
- Mechanical ventilation
- Escalating respiratory support
- Pediatric ARDS
- Severe asthma
- Airway compromise
Hemodynamic Instability
- Shock
- Vasopressor requirement
- Lactate elevation
- Myocarditis
- Severe dehydration
Neurologic Emergencies
- Status epilepticus
- Severe TBI
- Altered mental status
- Encephalitis
- Stroke
Severe Infection
- Sepsis
- Septic shock
- Toxic shock
- Severe pneumonia
Trauma
- Polytrauma
- Hemorrhagic shock
- Burns
- Drowning
- Crush injuries
Postoperative Critical Care
- Cardiac surgery
- Neurosurgery
- Major abdominal surgery
- Organ transplantation
SECTION 2.2
ED TO PICU HANDOFF SOP
Objective
Ensure continuity of biologic intelligence surveillance.
Required Handoff Elements
Clinical Diagnosis
Primary reason for PICU admission.
Timeline of Illness
Symptom onset
Interventions performed
Response to treatment
Physiologic Status
Airway
Breathing
Circulation
Neurologic status
Urine output
Critical Laboratory Review
Lactate
Blood gas
CBC
Electrolytes
Cultures
Imaging Review
Radiology
Ultrasound
Echocardiography
CT/MRI (if performed)
SCF Handoff Elements
ANMS Pre-Baseline
If available
Shock Risk Profile
Neurodevelopmental Risk Profile
Recovery Risk Assessment
SECTION 2.3
SCF-DBI INITIAL BIOLOGICAL INTELLIGENCE ASSESSMENT
Assessment Window
Within:
First 60 Minutes of PICU Admission
DOMAIN A
Neuroimmune Intelligence
Evaluate:
Infection burden
Inflammatory burden
Hyperimmune activation
Immunosuppression risk
DOMAIN B
Neurocardiac Intelligence
Evaluate:
Perfusion
Lactate
Cardiac function
Hemodynamic reserve
DOMAIN C
Neurovascular Intelligence
Evaluate:
Endothelial function
Perfusion quality
Tissue oxygen delivery
Cerebral oxygenation
DOMAIN D
Neurometabolic Intelligence
Evaluate:
Glucose
Lactate
Nutritional reserve
Metabolic adaptation
DOMAIN E
Neuroendocrine Intelligence
Evaluate:
Stress burden
Adaptive reserve
Recovery capacity
DOMAIN F
Regenerative Intelligence
Evaluate:
Functional reserve
Recovery potential
Growth trajectory
Rehabilitation potential
SECTION 2.4
RHENOVA PEDIATRIC RISK STRATIFICATION
Tier I
Low Risk
Minimal biologic disruption
Tier II
Moderate Risk
Early adaptive stress
Tier III
High Risk
Threatened adaptation
Tier IV
Critical Risk
High multi-system failure potential
Tier V
Catastrophic Risk
Active biologic intelligence collapse
SECTION 2.5
PEDIATRIC ANMS BASELINE ESTABLISHMENT
Purpose
Generate baseline adaptive profile.
Neuroimmune Domain
CRP
Procalcitonin
CBC
Clinical inflammation burden
Neurocardiac Domain
Lactate
Perfusion
BP
Cardiac function
Neurovascular Domain
Endothelial status
Cerebral oxygenation
Microvascular perfusion
Neurometabolic Domain
Glucose
Acid-base status
Nutritional status
Neuroendocrine Domain
Stress burden
Sedation burden
Illness severity
Baseline ANMS Classification
Green
ANMS >80
Yellow
ANMS 60–79
Orange
ANMS 40–59
Red
ANMS 20–39
Black
ANMS <20
SECTION 2.6
RHENOVA PROCEDURE ACTIVATION WORKFLOW
Activation Window
0–6 Hours
RHENOVA PROCEDURE 1
Neuroprotection & Cognitive Preservation Bundle
Activate for:
Mechanical ventilation
Neurologic illness
Sepsis
Shock
Trauma
Immediate Actions
Delirium prevention
Sleep preservation
Cerebral oxygenation monitoring
Neuroinflammation surveillance
RHENOVA PROCEDURE 2
Endothelial Preservation & Microvascular Stability Bundle
Activate for:
Shock
Sepsis
ARDS
Trauma
ECMO
Immediate Actions
Perfusion optimization
Lactate surveillance
Fluid stewardship
Endothelial monitoring
RHENOVA PROCEDURE 3
Pediatric Regenerative Recovery Platform
Activate for:
ICU LOS >48 hours anticipated
Trauma
Surgery
Sepsis
ECMO
Immediate Actions
Early nutrition planning
Mobility planning
Recovery trajectory mapping
RHENOVA PROCEDURE 4
Pediatric Self-Tolerance Preservation Program
Activate for:
Sepsis
Septic shock
Hyperinflammatory syndromes
Autoimmune disease
Immediate Actions
Cytokine surveillance
Immune regulation monitoring
STRI baseline generation
RHENOVA PROCEDURE 5
Recovery Intelligence Transfer Package
Pre-activate upon admission.
Objective
Begin discharge planning on Day 1.
SECTION 2.7
PICU COMMAND CENTER ENROLLMENT
Every PICU Patient Enrolled
Into:
ANMS
STRI
EII
MAS
Recovery Readiness Index
Command Dashboard Assignment
Status Categories
Stable
Watch
Escalation
Rescue
Recovery
SECTION 2.8
FIRST SIX-HOUR CLINICAL OBJECTIVES
Airway
Stabilized
Breathing
Oxygenation optimized
Circulation
Perfusion optimized
Neurologic
Baseline established
Infection
Assessment completed
Nutrition
Recovery plan initiated
Family
Integrated into care planning
SECTION 2.9
ESCALATION TRIGGERS DURING INITIAL ADMISSION
Immediate Escalation
Any of the following:
Lactate increasing
Perfusion worsening
Escalating respiratory support
Declining mental status
ANMS decline >20%
EII decline >20%
STRI decline >20%
SECTION 2.10
ADMISSION ENDPOINTS
Clinical
Stabilization achieved
Diagnostic pathway established
Monitoring initiated
SCF
ANMS baseline complete
STRI baseline complete
EII baseline complete
MAS baseline complete
RHENOVA
All applicable procedures activated
Recovery pathway initiated
PAGE 2 COMPLETION
Next Page (Page 3):
Pediatric Respiratory Failure SOP
Pediatric ARDS Workflow
Severe Asthma Critical Care SOP
Mechanical Ventilation Intelligence Program
RHENOVA Lung Protection & Recovery Bundle
Respiratory ANMS Escalation Framework
Ventilator Liberation Strategy
MASTER REGISTRY INDEX
SCF-DBI-PICU-ADMIT-0001 — PICU Admission Workflow
SCF-DBI-PICU-HANDOFF-0001 — ED-to-PICU Handoff SOP
SCF-DBI-PICU-BIA-0001 — Biological Intelligence Assessment
SCF-ANMS-PICU-BASE-0001 — Pediatric ANMS Baseline Framework
SCF-RHENOVA-PICU-ACT-0001 — RHENOVA Activation Protocol
SCF-DBI-PICU-COMMAND-0001 — PICU Command Center Enrollment
SCF-DBI-PCR-PICU-ADMIT-0001 — Preventative-Curative-Restorative Admission Architecture
SCF-RHENOVA-PICU-0001 — Project RHENOVA Pediatric Critical Care Platform