Guidelines for pediatric intensive care units.

The second half of the 20th century has produced an explosion of knowledge applied to the critically ill. The pathophysiology of life-threatening processes such as shock, respiratory failure, and increased intracranial pressure has been explored extensively. Advances in electronic patient monitoring, pharmacology, and improvement in transport systems are but a few of the factors that have drastically changed the nature of critical care. Simultaneous with the scientific and technical advances has been the evolution of the pediatric intensive care unit (PICU). Children have special medical needs, and it is appropriate, therefore, to provide their critical care in units of excellence dedicated exclusively to children, where care is provided by pediatric specialists. There is also increasing recognition of the degree of sophistication implicit in the term “intensive care,” which has culminated in the acceptance by the American Board of Medical Specialists of the joint application by the American Boards of Anesthesiology, Internal Medicine, Pediatrics, and Surgery for a Certificate of Special Competency in Critical Care Medicine. Thus, a new subspecialty has been born which reflects the developments in this field. The purpose of this paper is to provide guidelines for pediatric intensive care units which will serve as a reference for those wishing to develop new units or to modify existing ones. The contributors to this set of guidelines have included pediatricians, anesthesiologists, intensivists, emergentologists, surgeons, engineers, nurses, and child life specialists who focus on the care of children in hospitals. The following should be interpreted as guidelines only. Because of continuing ongoing developments in this field, periodic revisions of these guidelines will be necessary. The relative importance of various items is suggested in the Table. For the purposes of this paper, the PICU shall be considered to be a hospital unit that provides treatment to children with a wide variety of illnesses of a life-threatening nature, including children with highly unstable conditions and those requiring sophisticated medical and surgical intervention. For example, this type of unit would be able to provide care for patients with severe multipie trauma and patients requiring open heart surgery. Referral to this unit is usually the decision of the primary physician. All critically ill children up to approximately 16 years of age (excluding premature infants) referred for pediatric intensive care regardless of subspecialty category should be placed in units dedicated exclusively to children whenever possible. There is no attempt here to set guidelines for units limiting care to less ill children or for neonatal intensive care units.