PEDIATRIC INTENSIVE CARE UNIT

A paediatric intensive care unit (also paediatric):

usually abbreviated to PICU (/ˈpɪkjuː/), is an area within a hospital specializing in the care of critically ill infants, children, and teenagers. A PICU is typically directed by one or more paediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in paediatric intensive care. The unit may also have nurse practitioners, physician assistants, physiotherapists, social workers, child life specialists, and clerks on staff, although this varies widely depending on geographic location. The ratio of professionals to patients is generally higher than in other areas of
The hospital, reflecting the acuity of PICU patients and the risk of life-threatening complications. Complex technology and equipment is often in use, particularly mechanical ventilators and patient monitoring systems. Consequently, PICUs have a larger operating budget than many other departments within the hospital.

Go ran Hoagland is credited with establishing the first paediatric ICU in 1955. The PICU was located at Children’s Hospital of Goteborg in Sweden. The first PICU in the United States, although commonly thought to be the unit at the Children’s Hospital of Philadelphia in 1967 by John Downers was established at Kings County Hospital, East Flatbush, Brooklyn, NY by Dr. Ramon Rodriguez-Torres in 1966.The establishment of these units would eventually lead to hundreds of PICUs being developed across North American and Europe. This number is still increasing in present day.

There were a variety of factors that lead to the development of PICUs. John Downers identified five specialties of medicine that aided in the development. These specialties included adult respiratory ICUs, neonatal intensive care, paediatric general surgery, paediatric cardiac surgery, and paediatric anaesthesiology.
Between 1930 and 1950 the poliomyelitis epidemic had created a greater need for adult respiratory intensive care, including the iron lung. There were times when children would contract polio and would have to be treated in these ICUs as well. This contributed to the need for a unit where critically ill children could be treated. Respiratory issues were also increasing in children because neonatal intensive care units were increasing the survival rates of infants. This was due to advances in mechanical ventilation. However, this resulted in children developing chronic lung diseases, but there was not a specific unit to treat these diseases.
Advancements in paediatric general surgery, cardiac surgery, and anaesthesiology were also a driving factor in the development of the PICU. The surgeries that were being performed were becoming more complicated and required more extensive postoperative monitoring. This monitoring could not be performed on the regular paediatric unit, which led to Children’s Hospital of Philadelphia’s development of the first PICU. Advancements in pediatric anaesthesiology resulted in anaesthesiologist treating pediatric patients outside of the operating room. This caused paediatricians to obtain skills in anaesthesiology in order to make them more capable of treating critically ill pediatric patients. These pediatric anaesthesiologists eventually went on to develop run PICUs.

There are a variety of PICU characteristics that allow the healthcare providers to deliver the most optimal care possible. The first of these characteristics is the physical environment of the PICU. The layout of the unit should allow the staff to constantly observe the patients they are caring for. The staff should also be able to rapidly respond to the patients if there is any change in the patient’s clinical status.
Correct staffing is the next vital component to a successful PICU. The nursing staffs are highly experienced in providing care to the most critical patients. The nurse to patient ratio should remain low, meaning that the nurses should only be caring for 1-2 patients depending on the clinical status of the patients. If the patient's clinical status is critical, then they will require more monitoring and interventions than a patient that is stable.
In most cases, the nurses and physicians are caring for the same patients for a long period of time. This allows the providers to build rapport with the patients, so that all of the patient’s needs are fulfilled. The nurses and physicians must work together as a collaborative team to provide optimal care. The successful collaboration between nurses and physician has resulted in lower mortality rates not just in PICUs, but all intensive care units.
As medicine has matured over time, the development of the paediatric intensive care unit has expanded to maintain a level one and a level two PICU. Among these two different levels, they are able to provide critical care and stabilization for each child before transferring to a different acuity.

In the level one PICU, health care team members must be capable of providing a wide variety of care that typically involves intensive, rapidly changing, and progressive approach. In the level two PICU, patients will present with less complex acuity and will be more stable.
As a PICU nurse, extended knowledge and certifications may be required. Recognition and interpretation are two of the many required skills for a PICU nurse. This allows nurses to be able to detect any changes in the patient's condition and to respond accordingly. Other skills may include route of administration, resuscitation, respiratory and cardiac interventions, preparation and maintenance of patient monitors, and psycho-social skills to ensure comfort of patient and family.

There are a variety of certificates that are required for registered nurses to acquire in order to work in the PICU. One of these certifications is the Critical Care Registered Nurse (pediatric) certificate. This certificate allows nurses to care for critically ill pediatric patients in any setting, not just the PICU. Other certificates include cardiopulmonary resuscitation, pediatric basic life support, and pediatric advance life support.
In the PICU, it is important that all team members hold a wide variability of training and experience in order to provide high quality care. Due to different priorities among inter-professionals, the PICU care team includes many different roles. (Physicians, nurses, pharmacists, respiratory therapists, child life, intensivists, cardiologists, physical / occupational therapists, social workers) Each member of the inter-professional team is highly skilled and trained to deliver the best care for each and every child. It is important for each one to introduce themselves to the family and to explain their role to hopefully expand understanding to family members.