Pediatrics & Neonatology
Volume 50, Issue 5 , Pages 184-189, October 2009

Pediatric Critical Care—A New Frontier

  • Chu-Chuan Lin
    • ,
  • Kai-Sheng Hsieh

      Affiliations

    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Veterans General Hospital, No. 386, Ta-Chung 1st Rd., Kaohsiung 813, Taiwan, R.O.C.

Department of Pediatrics, Veterans General Hospital, Kaohsiung, Taiwan

Received 11 June 2009; received in revised form 8 July 2009; accepted 15 July 2009.

Article Outline

Pediatric intensive care is now a subspecialty of pediatric medicine. Different pathologic and physiologic processes occur in pediatric patients who require intensive care. Thus, the faculty and staffing requirement differ in many aspects from those of adult intensive care units (ICUs).

In Taiwan, pediatric intensive care is relatively less developed than adult care. However, thanks to the implementation of national health insurance and increasing emphasis of children's health, the scope and quality of pediatric intensive care has widened and rapidly improved. Research has shown that full time in-ICU staffing and patient care will result in improved outcomes for critically ill pediatric patients.

In this article, we review the literature and recent advances in pediatric intensive care; we also outline the challenges arising. Special emphasis was made to the clinical context of Taiwan.

Key Words:  intensive care , medicine , pediatric

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Downes JJ . The historical evolution, current status, and prospective development of pediatric critical care . Crit Care Clin . 1992;8:1–22
  2. Gullberg N , Kalzen H , Luhr O , Gothberg S , Winso O , Markstrom A . Immediate and 5-year cumulative outcome after paediatric intensive care in Sweden . Acta Anaesthesiol Scand . 2008;52:1086–1095
  3. Randolph AG , Gonzales CA , Cortellini L , Yeh TS . Growth of pediatric intensive care units in the United States from 1995 to 2001 . J Pediatr . 2004;144:792–798
  4. American Academy of Pediatrics, Committee on Hospital Care; and Society of Critical Care Medicine, Pediatric Section: Guidelines for pediatric intensive care units . Pediatrics . 1983;72:364–372
  5. Rosenberg DI , Moss MM . Guidelines and levels of care for pediatric intensive care units . Pediatrics . 2004;114:1114–1125
  6. Pearson G , Shann F , Barry P , et al.   Should paediatric intensive care be centralised? Trent versus Victoria . The Lancet . 1997;349:1213–1217
  7. Pollack MM , Alexander SR , Clarke N , Ruttimann UE , Tesselaar HM , Bachulis AC . Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities . Crit Care Med . 1991;19:150–159
  8. Notifiable Infectious Diseases Statistics System  . Centers for Disease Control, Taiwan . Available at: http://nidss.cdc.org.tw [Date accessed: May 20, 2009]
  9. Randolph AG , Meert KL , O'Neil ME , et al.   The feasibility of conducting clinical trials in infants and children with acute respiratory failure . Am J Respir Crit Care Med . 2003;167:1334–1340
  10. Turner DA , Arnold JH . Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning . Curr Opin Crit Care . 2007;13:57–63
  11. The Acute Respiratory Distress Syndrome Network  . Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome . N Engl J Med . 2000;342:1301–1308
  12. Mehta NM , Arnold JH . Mechanical ventilation in children with acute respiratory failure . Curr Opin Crit Care . 2004;10:7–12
  13. Bartlett RH , Gazzaniga AB , Jefferies MR , Huxtable RF , Haiduc NJ , Fong SW . Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy . Trans Am Soc Artif Intern Organs . 1976;22:80–93
  14. Huang SC , Wu ET , Chen YS , et al.   Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients . Crit Care Med . 2008;36:1607–1613
  15. Alsoufi B , Al-Radi OO , Nazer RI , et al.   Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest . J Thorac Cardiovasc Surg . 2007;134:952–959
  16. Morris MC , Wernovsky G , Nadkarni VM . Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest . Pediatr Crit Care Med . 2004;5:440–446
  17. Bartlett RH , Roloff DW , Custer JR , Younger JG , Hirschl RB . Extracorporeal life support: the University of Michigan experience . JAMA . 2000;283:904–908
  18. Thiagarajan RR , Laussen PC , Rycus PT , Bartlett RH , Bratton SL . Extracorporeal Membrane Oxygenation to Aid Cardio-pulmonary Resuscitation in Infants and Children . Circulation . 2007;116:1693–1700
  19. Chan T , Thiagarajan RR , Frank D , Bratton SL . Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease . J Thorac Cardiovasc Surg . 2008;136:984–992
  20. Chang AC . Pediatric cardiac intensive care: current state of the art and beyond the millennium . Curr Opin Pediatr . 2000;12:238–246
  21. Marx CM , Rosenberg DI , Ambuel B , Hamlett KW , Blumer JL . Pediatric intensive care sedation: survey of fellowship training programs . Pediatrics . 1993;91:369–378
  22. Conlon NP , Breatnach C , O'Hare BP , Mannion DW , Lyons BJ . Health-related quality of life after prolonged pediatric intensive care unit stay . Pediatr Crit Care Med . 2009;10:41–44
  23. Marcin JP , Slonim AD , Pollack MM , Ruttimann UE . Long-stay patients in the pediatric intensive care unit . Crit Care Med . 2001;29:652–657
  24. Stambouly JJ , McLaughlin LL , Mandel FS , Boxer RA . Complications of care in a pediatric intensive care unit: a prospective study . Intensive Care Med . 1996;22:1098–1104
  25. Frey B , Argent A . Safe paediatric intensive care. Part 2: workplace organisation, critical incident monitoring and guidelines . Intensive Care Med . 2004;30:1292–1297
  26. Frey B , Argent A . Safe paediatric intensive care. Part 1: Does more medical care lead to improved outcome? . Intensive Care Med . 2004;30:1041–1046
  27. Haupt MT , Bekes CE , Brilli RJ , et al.   Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care . Crit Care Med . 2003;31:2677–2683
  28. Tenner PA , Dibrell H , Taylor RP . Improved survival with hospitalists in a pediatric intensive care unit . Crit Care Med . 2003;31:847–852
  29. Parshuram CS , Kirpalani H , Mehta S , Granton J , Cook D . In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intensive care units . Crit Care Med . 2006;34:1674–1678
  30. Odetola FO , Clark SJ , Freed GL , Bratton SL , Davis MM . A National Survey of Pediatric Critical Care Resources in the United States . Pediatrics . 2005;115:382–386
  31. Pollack MM , Cuerdon TC , Getson PR . Pediatric intensive care units: results of a national survey . Crit Care Med . 1993;21:607–614
  32. Vincent JL . Need for intensivists in intensive-care units . Lancet . 2000;356:695–696
  33. Pronovost PJ , Angus DC , Dorman T , Robinson KA , Dremsizov TT , Young TL . Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A systematic review . JAMA . 2002;288:2151–2162

PII: S1875-9572(09)60061-9

doi:10.1016/S1875-9572(09)60061-9

Pediatrics & Neonatology
Volume 50, Issue 5 , Pages 184-189, October 2009

Article Tools