Teenagers in intensive care: adult or paediatric ICU?

Standards have been published for the provision of healthcare for teenagers and standards have been published for the management of children in intensive care. Unfortunately, there are no standards that delineate the model of care that should be provided specifically for teenagers in intensive care. Teenagers have specific healthcare needs that should be addressed whether they are in an adult or a paediatric environment. In either setting healthcare providers need to be familiar with issues such as confidentiality and consent. Most critically ill teenagers are cared for in paediatric rather than adult intensive care units (ICUs; 10% versus 3% of ICU admissions, respectively). At the upper age limit of the teenage spectrum, it would seem appropriate to manage patients in adult ICUs, especially in the context of trauma and other disease processes that adult intensivists will be familiar with. At 16 years or below, teenagers should be cared for in a paediatric ICU and only in an adult ICU within an agreed regional protocol. Critically ill teenagers with complex chronic conditions arising during childhood, which commonly require multidisciplinary input, are best managed in a children’s hospital with paediatric ICU back up.