Related Experiment Video
Updated: Jan 6, 2026
An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Pediatric Bed Capacity, Bed Strain, and Load Imbalance During the 2022 Respiratory Viral Season
Nadir Ijaz1,2, Constantin Radu3, Craig Rothenberg4
1National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut.
Insights
Pediatric bed strain and load imbalance were common during the 2022 respiratory viral season. However, declines in pediatric bed capacity since 2010 were not associated with these issues.
Area of Science:
- Pediatric healthcare capacity
- Hospital resource management
- Public health surveillance
Background:
- Anecdotal evidence suggested a link between pediatric bed capacity changes and hospital strain during the 2022 respiratory viral surge.
- Understanding pediatric bed strain and load imbalance is crucial for healthcare preparedness.
Purpose of the Study:
- To determine the prevalence of pediatric bed strain and load imbalance across US hospital referral regions (HRRs).
- To evaluate the association between changes in pediatric bed capacity from 2010-2021 and bed strain/load imbalance during the 2022 respiratory viral season.
Main Methods:
- Cross-sectional analysis of weekly pediatric bed strain and load imbalance data (September 2022 - January 2023).
- Longitudinal analysis of pediatric bed capacity data (2010-2021).
- Utilized US Department of Health and Human Services and American Hospital Association data for 254 HRRs.
Main Results:
- A mean of 44.1% of HRRs experienced pediatric bed strain weekly.
- A mean of 66.7% of HRRs experienced pediatric load imbalance weekly.
- Pediatric beds per 10,000 children decreased by 12.0% from 2010 to 2021.
- No association found between prior bed capacity changes and 2022 strain or imbalance.
Conclusions:
- Pediatric bed strain and load imbalance were prevalent during the 2022 respiratory viral season.
- Declines in pediatric bed capacity were not associated with the observed strain or imbalance.
- Regionalization strategies may be key to preventing future capacity overload.
Importance:
During the 2022 respiratory viral surge, anecdotal evidence suggested that pediatric bed strain and load imbalance (hospitals in the same region experiencing disparate occupancy rates) may be linked to pediatric bed capacity changes during the preceding decade.
Objectives:
To determine the prevalence of pediatric bed strain and load imbalance by hospital referral region (HRR) and to evaluate the association between 2010-2021 pediatric bed capacity changes and bed strain and load imbalance during the 2022 respiratory viral season.
Design, Setting, And Participants:
This cross-sectional analysis of weekly mean bed strain and load imbalance from September 30, 2022, through January 5, 2023, used US Department of Health and Human Services data; longitudinal analysis of 2010-2021 pediatric bed capacity used American Hospital Association survey data. A total of 254 HRRs throughout the US were included. For bed strain analyses, inclusion criteria consisted of having at least 1 pediatric acute care bed; for load imbalance analyses, at least 2 hospitals, each with at least 1 pediatric acute care bed. Hospitals with missing data for at least 2 consecutive weeks in the study period were excluded. Data were analyzed from February 7, 2023, to July 2, 2025.
Main Outcomes And Measures:
Bed strain, defined as more than 85% of pediatric acute care beds in the HRR occupied, and load imbalance, defined as at least 1 hospital with at least 85% pediatric beds occupied, at least 1 hospital with less than 85% pediatric beds occupied, and a difference of at least 20% in pediatric bed occupancy between hospitals with the highest and lowest occupancies in the HRR.
Results:
Of 254 HRRs included in the analysis, a mean of 112 (44.1%) experienced pediatric bed strain per week. Of 123 HRRs with at least 2 hospitals with pediatric beds, a mean of 82 (66.7%) experienced pediatric load imbalance per week. In the 254 HRRs included in the analysis of pediatric bed strain, the number of pediatric beds per 10 000 children decreased from 4.57 in 2010 to 4.02 beds (12.0% decrease) in 2021. There was no association between 2010-2021 HRR-level pediatric bed capacity changes and 2022 pediatric bed strain or load imbalance.
Conclusions And Relevance:
In this cross-sectional analysis of the 2022 respiratory viral season, bed strain and load imbalance were common but not associated with declines in pediatric bed capacity since 2010. Regionalization efforts may prevent capacity overload and load imbalance during future surges.
More Related Videos
Related Concept Videos
01:22Respiratory Volumes and Capacities
01:26Respiratory Volumes and Capacities I
01:24Respiratory Capacities
One key metric is the Inspiratory Capacity (IC), which represents the maximum amount of air that can be inhaled with full effort. IC is calculated by summing the tidal volume and inspiratory reserve volume, typically ranging from 2.4 to 3.6 liters.
The Functional Residual Capacity (FRC) represents the air in the...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:31Common Respiratory Disorders
Upper respiratory disorders impact the airways above the vocal cords, encompassing areas like the nose, sinuses, and throat. Various conditions fall under this category, including the common cold and allergic rhinitis. These disorders can stem from several causes,...