It can be frightening whenever kids are in the hospital - maybe
even more so when they're admitted to the pediatric intensive
care unit (PICU). But a basic understanding of the people and
equipment in the PICU can help you feel less scared and better
prepared to help your child recover.
What's the PICU?
The PICU is the section of the hospital that provides sick
children with the highest level of medical care. It differs from
other parts of the hospital, like the general medical floors, in
that the PICU allows intensive nursing care and monitoring of
bodily functions and conditions (heart rate, breathing, and blood
pressure, for example). The PICU also allows medical staff to
provide therapies that might not be available in other parts of the
hospital. Some of these more intensive therapies include
ventilators, or breathing machines, and certain medications that
can be given only under close medical supervision.
Who's Sent to the PICU?
Any child who's seriously ill and needs intensive care and
whose medical needs can't be met on the hospital's main
medical floors goes to the PICU.
Kids in the PICU might include those with severe breathing
problems from asthma, serious infections, certain heart defects,
some complications of diabetes, or those involved in a serious
automobile accident or near-drowning. Some kids may have been
stable enough to initially be cared for on the hospital's main
medical floor, but may be transferred to the PICU if they become
more acutely ill. Following major surgery, many children are cared
for in the PICU for several days.
Kids are admitted to the PICU when they're at their sickest.
How long they'll be in the PICU depends on their condition -
some kids might stay a single day; others might need to stay for
weeks or even months. As always, ask the doctor or nurse caring for
your child if you have any questions.
Who Takes Care of Kids in the PICU?
One of the biggest advantages of the PICU is that it has many
highly skilled people to closely care for your child. But not
knowing who everyone is and what they do can be confusing and a
little overwhelming at first. Most people will introduce themselves
and indicate how they're involved in your child's care, but
if they don't, feel free to ask. At all times, you should feel
comfortable asking the doctors and nurses questions about your
child and the care being given.
The nurses who work in the PICU are experienced in caring for
the sickest children in the hospital. They're the people most
intimately involved with the minute-to-minute care of the kids. The
PICU also tends to have a higher nurse-to-patient ratio than other
parts of the hospital (in other words, each nurse cares for fewer
patients, which gives them more time with your child).
Numerous physicians may care for your child, but the attending
intensivist is the leader in the PICU. A pediatric intensivist is a
doctor who did a 3-year residency in pediatrics after medical
school, followed by additional years of subspecialty fellowship
training in intensive care. Also on the PICU team are residents
(doctors who've completed medical school and are training to be
pediatricians) and PICU fellows (pediatricians training to be
attending intensivists).
Many other subspecialists, such as cardiologists (heart doctors)
or neurosurgeons (brain surgeons), may be involved, depending on
your child's needs. Respiratory therapists are experienced with
ventilators and other breathing equipment, and are often involved
in the care of PICU patients. In addition, physical therapists,
occupational therapists, nutritionists, and pharmacists may play a
role in your child's care.
You may also meet social workers who help families cope with the
emotional burdens of having a critically ill child. They can help
to arrange housing for families (through organizations like Ronald
McDonald House), assist with insurance issues, or coordinate
discharge planning when your child is ready to go home.
You may also want to ask whether the hospital has child life
specialists. Trained in fields like development, education,
psychology, and counseling, they can help your child understand and
manage being in the hospital by, for example, listening if your
child needs to talk, calming fears about what's happening, or
providing distractions like books and games.
The medical team meets every day, usually in the morning, to
discuss each patient's case in detail; these discussions are
known as rounds. You may see a group of doctors, nurses, and others
walking from patient to patient, planning the medical care for each
child. By understanding everyone's role and how each
contributes, you may find the group of people caring for your child
less intimidating.
What Should Kids Expect While in the PICU?
Possibly the most alarming aspect of the intensive care
environment is the medical equipment that may be attached to your
child. The machines have alarms and display panels, and the noise
and lights can be overwhelming. Your child's stay in the PICU
might include:
-
IVs.
Almost all kids in the PICU have an intravenous catheter (or IV
for short) for fluids and medications - usually in the hands or
arms, but sometimes in the feet, legs, or even scalp. An IV is a
thin, flexible tube inserted into the vein with a small needle.
Once in the vein, the needle is removed, leaving just the soft
plastic tubing. Some situations require larger IVs that can be
used to deliver greater volumes of fluids and medications. These
special IVs are known as central lines because they're
inserted into the larger, more central veins of the chest, neck,
or groin, as opposed to the hands and feet. Arterial lines are
very similar to IVs, but they're placed in arteries, not
veins, and are not generally used to administer medication but to
monitor blood pressure and oxygen levels in the blood.
-
Medications.
Most medicines can be administered anywhere in the hospital, but
certain ones that can have dangerous side effects are only
administered to children who are closely monitored in the PICU.
Instead of being given every few hours, some are given
continuously, several IV drops at a time, and are known as drips.
Doctors may use these medications - like epinephrine, dopamine,
and morphine, for example - to help with heart function, blood
pressure, or pain relief.
-
Monitors.
Children are always attached to monitors while in the PICU. The
monitors are secured to the body with chest leads, which are
small painless stickers connected to wires. The chest leads can
count the child's heart rate and breathing rate. Many kids
are also connected to a pulse oximetry machine (or pulse ox) to
check blood oxygen levels. Also painless, the pulse ox machine is
attached to the fingers or toes like a small bandage and emits a
soft red light. Unless blood pressure is being directly monitored
through an arterial catheter, the child will usually have a blood
pressure cuff in place as well.
-
Tests.
Doctors may order a variety of tests to obtain more information,
including tests on the child's blood and urine, and sometimes
on the cerebrospinal fluid, which surrounds the brain and spinal
cord. Additionally, images or pictures of different parts of the
body may be taken through X-rays, ultrasound, computed tomography
(also called a CT or CAT scan), and magnetic resonance imaging
(MRI).
-
Ventilators.
Kids in the PICU sometimes need extra help to breathe. This may
mean getting some extra oxygen from a mask on the face or tubing
in the nose. But sometimes, a child needs to be connected to the
ventilator (or breathing machine). This is done via an
endotracheal tube (a plastic tube placed into the windpipe
through the mouth or nose) or a tracheostomy (a plastic tube
inserted directly through the skin into the windpipe) connected
to the ventilator on the other end. There are many different
kinds of ventilators - different situations call for different
machines - but they all serve the same basic purpose: to help
your child breathe.
What Should Parents of Kids in the PICU Do?
In the PICU, all of your child's physical needs will be met
by the staff. You, as a parent, are there to provide emotional
support, love, and a familiar voice or touch. However, you
shouldn't feel as if you have to stay at your child's
bedside every minute of the day. Getting away from the commotion of
the PICU briefly or even leaving the hospital grounds can help you
gather your thoughts.
Staying around the clock with a child who's in the PICU for
more than a few days can be both physically and emotionally
draining. Although some hospitals allow parents to spend the night
with their child, many do not. Often, hospitals encourage parents
to go home, get a good night's rest in their own bed, and
return to the PICU refreshed in the morning, which can help them be
even more of a comfort to their child.
If the hospital does allow you to spend the night, the decision
whether to stay in your child's room is a personal one. Either
way, the PICU staff will support you and reassure you that your
child will be well cared for. Whatever you do, make sure you get
enough rest to be able to support your child throughout the PICU
stay.
What Happens When Kids Leave the PICU?
While some patients are sent home directly from the PICU, most
are transferred to the regular floor of the hospital for further,
less intense monitoring and follow-up care. Still, discharge from
the PICU is a significant milestone on the road to recovery. It
means that a child no longer needs such an intensive level of
monitoring, therapy, and nursing care.
But leaving the PICU might also cause some anxiety. It's not
unusual for parents of children who were in the PICU to think,
"He was so sick, and now he's better. But shouldn't he
stay here until he's completely back to normal?" Although
certainly understandable, this shouldn't be a concern. The
doctors and nurses in the PICU won't transfer kids before
they're ready and stable, and the team on the hospital's
regular floor will have the resources necessary to continue guiding
your child's recovery.
Caring for a critically ill child is always stressful and
difficult. But with a basic understanding of the people and things
in the PICU, the stress on the family can be minimized - leaving
you better able to support your child and plan for when the entire
family is home together again.
Reviewed by:
Larissa Hirsch, MD
Date reviewed: January 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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