Pediatric Critical Care Medicine

The arrival of a critically ill child in a hospital setting stimulates a cascade of well-coordinated actions crafted to first stabilize the child and second, almost simultaneously, initiate the steps needed to diagnose and treat the child. The staff of virtually all children’s hospitals and the vast majority of general hospitals are well rehearsed in these steps so that regardless of when or where the child may be within that setting, he or she receives immediate and appropriate care. Once stabilized, the child is transferred to a setting devoted to children suffering from immediate life-threatening conditions, where they are treated by highly skilled and committed staff who specialize in the care of these sickest of children; this transfer process is now a routine component of modern children’s hospitals. Attendings and residents throughout the hospital take great comfort from the knowledge that if, despite their best efforts on the general floors, a child’s health deteriorates, critical care support is immediately accessible.

This finely orchestrated response is of recent origin, coinciding with the birth of the subspecialty of pediatric critical care. In earlier decades, reaction to a critically ill child was longer in coming, less likely to be scripted, and often did not best address the child’s immediate life-threatening condition. Even when stabilized, the child was frequently not brought to a specialized setting as generally there were no settings devoted to critically ill children. Rather, beds or rooms within general wards may have been outfitted in some fashion to better address the needs of these children than in other rooms, but certainly not at the level we have come to associate with modern children’s hospitals. While general hospitals with pediatric wards may not have pediatric critical care units, there is nonetheless great emphasis on immediate recognition, stabilization, and transfer of the child to a critical care setting.

Much of this highly precise and sophisticated script both leading up to and continuing with admission into the critical care unit has evolved over the last two decades, and so, many pediatricians practicing in the community have but limited notion as to what is occurring in modern critical care. In this issue of Pediatric Clinics of North America , we learn about the recent research pushing the frontiers of care for critically ill children and their families and their general pediatric care providers. Often families wish to better understand what is occurring in the critical care unit and turn to their pediatrician for explanation. Pediatricians practicing in the community for two or three decades may no longer be knowledgeable about critical care unit interventions. In this issue, we explain many of the new approaches to saving children with acute life-threatening conditions. Likewise, we talk about the innovations made in critical care settings that aid families in coping with the magnitude of the child’s illness, thereby helping the families to be of greater comfort to their sick children. It is our expectation that general pediatricians who read this issue will be well prepared to address most of the questions of families of children in contemporary critical care units.

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