Introduction

In the pediatric intensive care unit (PICU), you will care for the sickest children in the hospital. Many PICUs provide care for both medical and postsurgical patients with a multidisciplinary team of intensivists, surgeons, subspecialists, specially trained nurses, and technical personnel. The goal of this rotation guide is to introduce important concepts and literature that will help you understand, make, and support decisions regarding care for critically ill children.

The following topics are addressed in this rotation guide:

Other relevant topics in Pediatric Critical Care are covered in the following rotation guides:

Neonatal Sepsis (Neonatal Care)
Trauma, Resuscitation, Respiratory Distress and Chronic Asthma (Pediatric Emergency Medicine)
Procedural Sedation and Rapid-Sequence Induction for Intubation (Pediatric Emergency Medicine)
Arrhythmia (Pediatric Cardiology)
Seizures and Status Epilepticus (Pediatric Neurology)
Acute Kidney Injury (Pediatric Nephrology)
Seizures and Status Epilepticus (Pediatric Neurology)

A brief history of pediatric critical care medicine can be found here.

Michael R. Flaherty, DO, is an attending intensivist in the pediatric intensive care unit at MassGeneral Hospital for Children. He is also Associate Program Director for the Pediatric Critical Care Medicine Fellowship at Massachusetts General Hospital, and Instructor in Pediatrics at Harvard Medical School.

This rotation guide was developed by a collaborative team of contributors including:

Writers: Megan L. McBurnie, MD; Nathaniel Mosley, MD
Peer Reviewers: Zelda Ghersin, MD; Arianne Baker, MD; Youyang Yang, MD; and
Elizabeth Perzanowski, MD
Section Expert: Michael R. Flaherty, DO
Senior Editor: Shannon Scott-Vernaglia, MD
Last updated: June 2023 by Lisa Bartucca, MD

Brief Case Presentations with Videos

Critical Care Videos

Suprapubic Bladder Aspiration

Catheterization of the Urethra in Girls

Monitoring Neuromuscular Function

Laryngeal Mask Airway in Medical Emergencies

Orotracheal Intubation

Use of Pressure Transducers

Chest-Tube Insertion

Procedural Sedation and Analgesia in Children

Central Venous Catheterization

Noninvasive Positive-Pressure Ventilation

Placement of a Femoral Venous Catheter

Ultrasound-Guided Insertion of a Radial Arterial Catheter

Managing Procedural Anxiety in Children

When children need medical care, the situation can be stressful for both the parents and the child. This video describes the signs of acute anxiety in children and demonstrates approaches to interacting with children that minimize anxiety and maximize cooperation.