The Division of Pediatric Pharmacology and Critical Care

The Division of Pediatric Critical Care at University Hospitals Rainbow Babies & Children’s Hospital/Case Western Reserve University trains nationally recognized specialists in the field who are accomplished clinicians, educators and researchers. Our specialists in the Pediatric Intensive Care Unit (PICU) at UH Rainbow Babies & Children’s Hospital use their expertise in conventional and evolving ventilatory strategies, renal replacement therapies, nitric oxide and ECMO to provide care for our patients. Very active programs in neurosurgery, bone marrow transplantation, trauma, epileptology, craniofacial reconstruction, otolaryngology, sedation, pediatric pain services and palliative care are some of the full complement of pediatric subspecialists and pediatric surgeons available for our patients. Our unit design and award-winning nursing staff help us to provide the highest standard of family centered care to our patients.


Our faculty includes twelve Pediatric Intensivists that mentor our Fellows. Close relationships with faculty from other Divisions provide additional scholarly oversight to our Fellows. Rainbow is one of the most well-funded research institutes in the country (ranked #7 in 2016 among medical school-based Pediatrics Departments), and our Division is active in many areas of research. Research and clinical interests of our faculty include acute respiratory failure, global health, conventional and evolving ventilatory strategies, post-intensive care outcomes, health disparities, head trauma, medical education, infectious disease, disaster management, administration, and ECMO.

Selected Publications

Shein SL, Rotta AT, Speicher R, Slain KN, Gaston B. Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma. Hosp Pediatr. 2017 Jun 15.

Allareddy V, Rampa S, Rotta AT, Allareddy V. The impact of septicemia occurring during hospitalization for renal transplantation procedures on outcomes in adults in United States. PLoS One. 2017 Jun 13;12(6):e0179466.

Shein SL, Slain K, Martinez Schlurmann N, Speicher R, Rotta AT. Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions. Hosp Pediatr. 2017 May;7(5):263-270.

Slain KN, Martinez-Schlurmann N, Shein SL, Stormorken A. Nutrition and High-Flow Nasal Cannula Respiratory Support in Children With Bronchiolitis. Hosp Pediatr. 2017 May;7(5):256-262.

Shein SL, Rotta AT. Sedation and subglottic stenosis in critically ill children. J Pediatr (Rio J). 2017 Mar 19.

Cocoros NM, Priebe GP, Logan LK, Coffin S, Larsen G, Toltzis P, Sandora TJ, Harper M, Sammons JS, Gray JE, Goldmann D, Horan K, Burton M, Checchia PA, Lakoma M, Sims S, Klompas M, Lee GM. A Pediatric Approach to Ventilator-Associated Events Surveillance. Infect Control Hosp Epidemiol. 2017 Mar;38(3):327-333.

Alves PM, Nerwich N, Rotta AT. In-Flight Injuries Involving Children on Commercial Airline Flights. Pediatr Emerg Care. 2016 Dec 9.

Bradley JS, Armstrong J, Arrieta A, Bishai R, Das S, Delair S, Edeki T, Holmes WC, Li J, Moffett KS, Mukundan D, Perez N, Romero JR, Speicher D, Sullivan JE, Zhou D. Phase I Study Assessing the Pharmacokinetic Profile, Safety, and Tolerability of a Single Dose of Ceftazidime-Avibactam in Hospitalized Pediatric Patients. Antimicrob Agents Chemother. 2016 Sep 23;60(10):6252-9.

Gall C, Wetzel R, Kolker A, Kanter RK, Toltzis P. Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds. Crit Care Med. 2016 Sep;44(9):1762-8.

Fleming GM, Brook MM, Herman BE, Kennedy C, McGann KA, Mason KE, Weiss P, Myers AL. Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey. Acad Pediatr. 2016 Jul;16(5):415-8.

Allareddy V, Martinez-Schlurmann N, Rampa S, Nalliah RP, Lidsky KB, Allareddy V, Rotta AT. Predictors of Complications of Tonsillectomy With or Without Adenoidectomy in Hospitalized Children and Adolescents in the United States, 2001-2010: A Population-Based Study. Clin Pediatr (Phila). 2016 Jun;55(7):593-602.

Shein SL, Speicher RH, Filho JO, Gaston B, Rotta AT. Contemporary treatment of children with critical and near-fatal asthma. Rev Bras Ter Intensiva. 2016 Jun;28(2):167-78.

Shein SL, Gallagher JT, Deakins KM, Weinert DM. Prophylactic Use of Nebulized Hypertonic Saline in Mechanically Ventilated Children: A Randomized Blinded Pilot Study. Respir Care. 2016 May;61(5):586-92.

Miller Ferguson N, Shein SL, Kochanek PM, Luther J, Wisniewski SR, Clark RS, Tyler-Kabara EC, Adelson PD, Bell MJ. Intracranial Hypertension and Cerebral Hypoperfusion in Children With Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults. Pediatr Crit Care Med. 2016 May;17(5):444-50.

Shein SL, Ferguson NM, Kochanek PM, Bayir H, Clark RS, Fink EL, Tyler-Kabara EC, Wisniewski SR, Tian Y, Balasubramani GK, Bell MJ. Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury--Results From an Automated Data Collection System Time-Synched to Drug Administration. Pediatr Crit Care Med. 2016 Mar;17(3):236-45.

Das A, Anderson IM, Speicher DG, Speicher RH, Shein SL, Rotta AT. Validation of a pediatric bedside tool to predict time to death after withdrawal of life support. World J Clin Pediatr. 2016 Feb 8;5(1):89-94.

Shein SL, Li H, Gaston B. Blood eosinophilia is associated with unfavorable hospitalization outcomes in children with bronchiolitis. Pediatr Pulmonol. 2016 Jan;51(1):77-83.

Cocoros NM, Kleinman K, Priebe GP, Gray JE, Logan LK, Larsen G, Sammons J, Toltzis P, Miroshnik I, Horan K, Burton M, Sims S, Harper M, Coffin S, Sandora TJ, Hocevar SN, Checchia PA, Klompas M, Lee GM; Pediatric Ventilator-Associated Conditions Study Team. Ventilator-Associated Events in Neonates and Children--A New Paradigm. Crit Care Med. 2016 Jan;44(1):14-22.

Martinez-Schlurmann NI, Rampa S, Speicher DG, Allareddy V, Rotta AT, Allareddy V. Prevalence, predictors and outcomes of cardiopulmonary resuscitation in hospitalized adult stem cell transplant recipients in the United States: not just opening the black box but exploring an opportunity to optimize! Bone Marrow Transplant. 2015 Dec;50(12):1578-81.

Shein SL, Maul TM, Li H, Kurland G. Surfactant Administration During Pediatric Extracorporeal Membrane Oxygenation. ASAIO J. 2015 Nov-Dec;61(6):682-7.

Biber JL, Allareddy V, Allareddy V, Gallagher SM, Couloures KG, Speicher DG, Cravero JP, Stormorken AG. Prevalence and Predictors of Adverse Events during Procedural Sedation Anesthesia-Outside the Operating Room for Esophagogastroduodenoscopy and Colonoscopy in Children: Age Is an Independent Predictor of Outcomes. Pediatr Crit Care Med. 2015 Oct;16(8):e251-9.

Toltzis P, Soto-Campos G, Shelton C, Kuhn EM, Hahn R, Kanter RK, Wetzel RC. Evidence-Based Pediatric Outcome Predictors to Guide the Allocation of Critical Care Resources in a Mass Casualty Event. Pediatr Crit Care Med. 2015 Sep;16(7):e207-16.

Allareddy V, Das A, Lee MK, Nalliah RP, Rampa S, Allareddy V, Rotta AT. Prevalence, predictors, and outcomes of methicillin-resistant Staphylococcus aureus infections in patients undergoing major surgical procedures in the United States: a population-based study. Am J Surg. 2015 Jul;210(1):59-67.

Rotta AT, Piva JP, Andreolio C, de Carvalho WB, Garcia PC. Progress and perspectives in pediatric acute respiratory distress syndrome. Rev Bras Ter Intensiva. 2015 Jul-Sep;27(3):266-73.

Rotta AT, Piva JP. Pediatric acute respiratory distress syndrome: much more than little acute respiratory distress syndrome. Pediatr Crit Care Med. 2015 Jun;16(5):483-4.

Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015; 372:1898-1908.

Rampa S, Allareddy V, Asad R, Nalliah RP, Allareddy V, Rotta AT. Outcomes of invasive mechanical ventilation in children and adolescents hospitalized due to status asthmaticus in United States: a population based study. J Asthma. 2015 May;52(4):423-30.

Toltzis P, Sprung CL. The value of early administration of antibiotics in children with presumed severe sepsis and septic shock. Crit Care Med. 2014 Nov;42(11):2455-6.

Toltzis P, O'Riordan M, Cunningham DJ, Ryckman FC, Bracke TM, Olivea J, Lyren A. A statewide collaborative to reduce pediatric surgical site infections. Pediatrics. 2014 Oct;134(4):e1174-80.

Rotta AT, Alves PM, Mason KE, Nerwich N, Speicher RH, Allareddy V, Allareddy V. Fatalities above 30,000 feet: characterizing pediatric deaths on commercial airline flights worldwide. Pediatr Crit Care Med. 2014 Oct;15(8):e360-3.

Shein SL, Shellington DK, Exo JL, Jackson TC, Wisniewski SR, Jackson EK, Vagni VA, Bayır H, Clark RS, Dixon CE, Janesko-Feldman KL, Kochanek PM. Hemorrhagic shock shifts the serum cytokine profile from pro- to anti-inflammatory after experimental traumatic brain injury in mice. J Neurotrauma. 2014 Aug 15;31(16):1386-95.

Toltzis P, Goldmann D. Rethinking infection prevention research. Lancet. 2013 Mar 30;381(9872):1078-9.

Sammons JS, Toltzis P. Recent trends in the epidemiology and treatment of C. difficile infection in children. Curr Opin Pediatr. 2013 Feb;25(1):116-21.

Shein SL, Bell MJ, Su E, Kochanek PM, Exo J. Intracranial monitoring and continuous data collection. Crit Care Med. 2012 Nov;40(11):3115-6; author reply 3116.

Shein SL, Bell MJ, Kochanek PM, Tyler-Kabara EC, Wisniewski SR, Feldman K, Makoroff K, Scribano PV, Berger RP. Risk factors for mortality in children with abusive head trauma. J Pediatr. 2012 Oct;161(4):716-722.e1.

Shein SL, Reynolds TQ, Gedela S, Kochanek PM, Bell MJ. Therapeutic hypothermia for refractory status epilepticus in a child with malignant migrating partial seizures of infancy and SCN1A mutation: a case report. Ther Hypothermia Temp Manag. 2012 Sep;2(3):144-9.

Viau RA, Hujer AM, Marshall SH, Perez F, Hujer KM, Briceño DF, Dul M, Jacobs MR, Grossberg R, Toltzis P, Bonomo RA. "Silent" dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clin Infect Dis. 2012 May;54(9):1314-21.

Shein SL, Bell MJ. Hyperosmolar therapies for severe brain injuries in children: where are we in pediatric neurotrauma? Crit Care Med. 2012 Jan;40(1):336-7.

Toltzis P, Nerandzic MM, Saade E, O'Riordan MA, Smathers S, Zaoutis T, Kim J, Donskey CJ. High proportion of false-positive Clostridium difficile enzyme immunoassays for toxin A and B in pediatric patients. Infect Control Hosp Epidemiol. 2012 Feb;33(2):175-9.

Kim J, Shaklee JF, Smathers S, Prasad P, Asti L, Zoltanski J, Dul M, Nerandzic M, Coffin SE, Toltzis P, Zaoutis T. Risk factors and outcomes associated with severe clostridium difficile infection in children. Pediatr Infect Dis J. 2012 Feb;31(2):134-8.

Ulate KP, Raj S, Rotta AT. Critical illness hyperglycemia in pediatric cardiac surgery. J Diabetes Sci Technol. 2012 Jan 1;6(1):29-36. Review.

Mason KE, Urbansky H, Crocker L, Connor M, Anderson MR, Kissoon N; Task Force for Pediatric Emergency Mass Critical Care. Pediatric emergency mass critical care: focus on family-centered care. Pediatr Crit Care Med. 2011 Nov;12(6 Suppl):S157-62.

Pediatric Intensive Care Unit

Our Pediatric Intensive Care Unit provides highly specialized, state of the art care to approximately 1,700 patients annually. We are located in a nationally ranked pediatric hospital that serves as the quaternary referral center for the region. University Hospitals Rainbow Babies & Children's Hospital also has the only accredited Pediatric Trauma Center in the region.

Our sedation unit is a patient and family oriented unit that provides outpatient and inpatient services to over 2,000 patients annually. Our Intensivists deliver care to patients needing gastrointestinal services, bronchoscopies, minor surgical procedures, invasive procedures required for management of patients with malignancies and a full range of radiologic studies, among others. Utilization and satisfaction ratings are extremely high for this program. Active research programs make the sedation unit a rich source of scholarly activity.

UH Rainbow Babies and Children’s Hospital

University Hospitals Rainbow Babies & Children’s Hospital is a modern 244-bed dedicated children’s hospital with a nationally renowned faculty. UH Rainbow Babies & Children’s Hospital’s eight-story patient care tower, which opened in 1997, is one of the most advanced, family-centered pediatric hospital sites in the nation. Approximately 10,000 newborns, children, and adolescents are admitted annually to UH Rainbow Babies & Children’s Hospital, where they receive first-rate care in a warm, supportive environment conducive to healing.

Pediatric Library

The Samuel J. Horwitz, MD Pediatric Learning Center (PLC) is a clinically oriented library focused on Pediatrics and geared to support Resident and Fellow education as well as assist in continued learning for all Rainbow faculty and staff. The facility houses a printed reference collection, a number of computer-equipped work stations, and provides access to printing, scanning, and photocopy equipment.

The center is staffed by a full-time librarian and is open 24/7 with a door key code. Along with printed books and journals, the library subscribes to a number of electronic resources, available from the PLC website, and provides a number of specialized research guides and tools. Library services include reference and mediated literature searching, database training, and interlibrary loan assistance.

Pediatric Learning Center

Tel: 216-844-3265
Fax: 216-844-1724

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