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Chapter 41 - Principles of Paediatric Intensive Care

Published online by Cambridge University Press:  06 February 2025

By
Mae Johnson  and
James Diviney
Edited by
James Ip ,
Grant Stuart ,
Isabeau Walker  and
Ian James
James Ip
Affiliation:
Great Ormond Street Hospital for Children, London
Grant Stuart
Affiliation:
Great Ormond Street Hospital for Children, London
Isabeau Walker
Affiliation:
Great Ormond Street Hospital for Children, London
Ian James
Affiliation:
Great Ormond Street Hospital for Children, London
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Summary

This chapter provides an outline of the areas of paediatric intensive care relevant to an anaesthetist. The chapter examines current epidemiology in critical care and the characteristics of children requiring transfer from local hospitals to specialist centres. It reviews differences between adult and paediatric respiratory physiology, outlines an approach to medications used in intubation and discusses respiratory support for critically unwell children. The chapter provides key basic guidance on the use of high-frequency oscillatory ventilation (HFOV) in children. Maintenance fluid and inotrope selection are also reviewed. The chapter also reviews presentations commonly encountered on paediatric intensive care units (PICU) across respiratory, cardiovascular, gastrointestinal, renal, neurological, metabolic and infectious conditions. Neuroprotection criteria are provided, with key relevance to anaesthetists who may need to undertake time-critical transfers from their usual place of work to neurosurgical centres. Organ donation and non-accidental injury are also discussed.

Keywords

PICUpaediatricintensive careanaestheticscritical careintubationHFOVoscillatoryneuroprotectionrespiratory
Type
Chapter
Information
Core Topics in Paediatric Anaesthesia , pp. 467 - 479
Publisher: Cambridge University Press
Print publication year: 2025

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References

Further Reading

Academy of Medical Royal Colleges. A Code of Practice for the Diagnosis and Confirmation of Death. 2008. Available at: www.aomrc.org.uk/wp-content/uploads/2016/04/Code_Practice_Confirmation_Diagnosis_Death_1008.pdf. Accessed 25 April 2024.Google Scholar
Davis, AL, Carcillo, JA, Aneja, RK et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Critical Care Medicine 2017 June; 45(6):1061–93.CrossRefGoogle ScholarPubMed
Heddy, N, British Society for Paediatric Endocrinology and Diabetes. Guideline for the Management of Children and Young People under the Age of 18 Years with Diabetic Ketoacidosis. 2021. Archives of Disease in Childhood – Education and Practice.CrossRefGoogle Scholar
Healthcare Improvement Scotland. British Guideline on the Management of Asthma: A National Clinical Guideline. 2019.Google Scholar
Kotloff, RM, Blosser, S, Fulda, GJ et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations consensus statement. Critical Care Medicine 2015; 43(6):1291–325.CrossRefGoogle ScholarPubMed
Murphy, PJ, Marriage, SC, Davis, PJ. Case Studies in Pediatric Critical Care. Cambridge University Press. 2009.CrossRefGoogle Scholar
Nichol, DG, ed. Rogers’ Textbook of Pediatric Intensive Care, 5th ed. Lippincott, Williams & Wilkins. 2016.Google Scholar
Pearson, GA. Intensive care: because we can or because we should? Archives of Disease in Childhood 2018; 103(6):527–8.CrossRefGoogle ScholarPubMed
PICANet, Universities of Leeds and Leicester. Paediatric Intensive Care Audit Network Annual Report 2020. 2021.Google Scholar
Royal College of Paediatrics and Child Health. The Diagnosis of Death by Neurological Criteria in Infants Less than Two Months Old. 2015.Google Scholar

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