Pediatric intensive care unit

A pediatric 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 pediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in pediatric 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. A pediatric 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 pediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in pediatric 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. Goran Haglund is credited with establishing the very first pediatric ICU in 1955; this PICU was located at Children’s Hospital of Goteburg in Sweden. The first PICU in the United States was created at the Children’s Hospital of Philadelphia in 1967 by John Downes.The PICU at Lurie Children's Hospital was also established in 1967, the same year as the unit at the Children's Hospital of Philadelphia. The establishment of these early units eventually led to hundreds of PICUs being developed across North America and Europe. This number is still increasing today. There were a variety of factors that led to the development of PICUs. John Downes identified five specialties of medicine that aided in the development. These specialties included adult respiratory ICUs, neonatal intensive care, pediatric general surgery, pediatric cardiac surgery, and pediatric anesthesiology. 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 pediatric general surgery, cardiac surgery, and anesthesiology 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 pediatric unit, which led to Children’s Hospital of Philadelphia’s development of the first American PICU. Advancements in pediatric anesthesiology resulted in anesthesiologist treating pediatric patients outside of the operating room. This caused pediatricians to obtain skills in anesthesiology in order to make them more capable of treating critically ill pediatric patients. These pediatric anesthesiologists 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 staff is 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 pediatrics 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.