My Training Experience at Shizuoka Children’s Hospital

To enhance the perioperative management and critical care capacity for children with complex congenital heart disease (CHD) at our institution, I undertook a two-month clinical training program at Shizuoka Children’s Hospital, Japan, from July 14 to September 12, 2025. The training focused on the Pediatric Intensive Care Unit (PICU), the Department of Cardiology, and the Department of Cardiovascular Surgery.

Shizuoka Children’s Hospital is one of Japan’s leading pediatric cardiovascular centers, performing approximately 300 cardiac surgeries and 500 cardiac catheterization procedures annually, with a high proportion of complex CHD cases. During the training, I systematically studied perioperative management of critically ill neonates and infants undergoing cardiac surgery, cardiac catheterization assessment, postoperative intensive care, and family-centered communication.

In the PICU, bedside ultrasound plays a central role in hemodynamic assessment. All physicians are proficient in cardiac and vascular ultrasonography, enabling dynamic evaluation of cardiac function and fluid status. Circulatory management is highly individualized, based on pulmonary artery pressure, central venous pressure, lactate levels, and urine output. Respiratory support strategies emphasize precise oxygenation, including the combined use of high-flow nasal cannula, PRVC ventilation, and inhaled nitric oxide for pulmonary hypertension. Sedation and analgesia protocols are standardized, and strict infection control measures are implemented to ensure patient safety.

In the field of pediatric cardiology, cardiac catheterization is an essential tool throughout the entire disease course of complex CHD, including preoperative evaluation, postoperative management, and long-term follow-up. Hemodynamic data obtained from catheterization directly guide surgical decision-making. Pharmacological management of pulmonary hypertension and heart failure is comprehensive and precise, with several strategies offering valuable reference for clinical practice.

Regarding perioperative cardiac surgical management, high-risk operations are scheduled on a one-case-per-day basis to ensure optimal surgical quality. Postoperative extubation and anticoagulation strategies are individualized and dynamically adjusted, contributing to reduced complication rates. In addition, the hospital has established a high-definition surgical live-streaming and teleconsultation system, facilitating real-time learning and inter-institutional collaboration.

This training experience highlighted the critical importance of multidisciplinary collaboration and meticulous critical care management in improving outcomes for children with complex CHD. After returning to China, I plan to promote multidisciplinary case discussions in the CICU, optimize postoperative anticoagulation pathways, strengthen bedside ultrasound training, and explore multicenter collaboration to further improve the quality of care for critically ill pediatric cardiac patients.

CICU: Dr. XU Jiajun