No one willingly wants to be admitted to the hospital -- and certainly not in an emergency. Unfortunately, sometimes some of my young patients do need to be admitted, and it is comforting for both the children and parents to know what to will happen once they are there.

Kyle Rehder, MD, a pediatric intensivist, explains what you can expect if your child is admitted to the hospital with a critical illness.

-- Dennis Clements MD, PhD, MPH

Kyle Rehder, MDIt is usually clear what a pediatric subspecialist does: a cardiologist takes care of children’s hearts; a neurologist takes care of the brain.

But what about a pediatric intensivist? In short, a pediatric intensivist, or critical care physician, specializes in the stabilization and care of extremely ill children. 

Early Interventions

When a critically ill child presents for medical attention, time is truly of the essence.

Whether the child is sick from injury, infection, cancer, heart disease, surgery, or some other crisis, lost minutes can mean the difference between life and death.  

Rapid interventions are often required to ensure the child gets blood flow and oxygen to vital organs and injured tissues. Attention must then be paid to reversing the underlying disease process that led to critical illness.  

Rigorous care and monitoring continues after the initial stabilization, until the child is stable enough to be moved out of the intensive care unit (ICU).

Advanced Technologies

Children with critical illness often require various types of support for their failing organs. Fortunately, pediatric intensivists also have sophisticated tools at their disposal, including different types of mechanical ventilators, medicines to keep the heart pumping and maintain blood pressure, and in extreme cases, heart-lung bypass machines.

When one system fails, state-of-the-art technology may often be used to support the patient during their recovery.   

Coordination of Care

Teamwork is essential for the critically ill child. The combined efforts of physicians, nurses, respiratory therapists, and pharmacists are required to act quickly to stabilize children during this precarious time.

Each team member has a specific role to fill, and all ICU providers receive training in structured communication and teamwork to ensure seamless cooperation, particularly in emergencies.

Thoughtful coordination of care with other specialists is also often necessary for treatment of children in the pediatric intensive care units.

Patient safety is a constant concern and priority in the intensive care unit. Not only are critically ill children more susceptible to injury and infection due to their fragile state, but the number and complexity of medical interventions required for children in the intensive care unit also places them at increased risk.

Multidisciplinary teams within the ICUs tirelessly work to minimize these risks whenever possible.

Family-Centered Approach to Care

Despite the need for immediate interventions and the sometimes hectic nature of the ICU, family-centered care is an important priority. There will rarely be a more stressful time in a parent’s life than during the critical illness of one of their children.

It is important for the medical team to partner with families in determining care plans.  Families are included in daily rounds and encouraged to be present at the bedside. A Family Advisory Committee, containing parents of former ICU parents, also helps guide unit policies to foster family-centered care.  

ICU care extends beyond the walls of the unit, as the critical care team responds to pediatric medical emergencies throughout the inpatient hospital and outpatient clinics, through the Code Blue and Rapid Response Teams.

Children are also commonly admitted directly from other hospitals and emergency rooms, providing support by phone to help stabilize children and transport them safely to the ICU. When you need help, the ICU team is always just a call away.

It is always rewarding to see children recover from life-threatening illness. Children tend to get critically ill much faster than adults, but have amazing resilience and ability to mend. With early intervention and the proper support, even the sickest of children can make it home to lead full lives.

-- Kyle Rehder, MD, is a pediatric intensivist with Duke Department of Pediatric's Division of Critical Care Medicine.

-- Dennis Clements, MD, PhD, is the chief of primary care pediatrics at Duke Children's Hospital.