Special considerations in paediatric intensive care

The modern-day paediatric intensive care unit (PICU) is staffed and equipped to provide care to the most critically ill children. It is by definition a low-volume, high-cost service. High staff-to-patient ratios are required both because of the potentially rapid evolution of critical illness in children and because of the complexity of the supportive therapy offered. Children are admitted to the PICU with a wide variety of medical illnesses and following diverse surgical procedures. Treatment strategies are complex. Although definitive evidence for specific paediatric therapies is often limited, international collaborative efforts have produced consensus treatment guidelines that serve to promote the use of best practice therapies. This article reviews critical therapies and techniques that define care in the PICU, and outlines the management of acute lung injury, traumatic brain injury and septic shock. Neonatal and cardiac intensive care medicine topics are outside the scope of this article.