What Is the PICU? A Guide to Pediatric Intensive Care

• The PICU is a specialized hospital unit that provides intensive care to children with life-threatening or highly unstable medical conditions.
• The PICU treats a wide range of conditions in children, including respiratory issues, cardiac problems, trauma, neurological disorders, infections, surgical recovery, and metabolic or genetic disorders.
• The PICU staff includes pediatric intensivists, pediatric consultants, nurses, respiratory therapists, and surgical teams, among others.

Children are some of the most vulnerable members of society. Their small, developing bodies are not just physically different from adults but require a level of care that accounts for their distinctive needs. 

For many pediatricians, the motivation lies in the opportunity to help children through the most challenging and sometimes life-threatening conditions. But, while all pediatricians can find immense fulfillment in their work, there’s a specific group that addresses the most critical and delicate cases working in the PICU. But what is the PICU, and why is it such an important part of pediatric care?

What Is the PICU?

The Pediatric Intensive Care Unit (PICU) is a specialized hospital unit designed to provide intensive treatment to children with life-threatening conditions or highly unstable medical conditions. It is equipped to offer advanced medical and surgical care that addresses severe or acute illnesses, accidents, or other critical health situations in children.

The American Academy of Pediatrics (AAP), in their guidelines from back in 1983, defined a PICU as  “a hospital unit which provides treatment to children with a wide variety of illnesses of life-threatening nature including children with highly unstable conditions and those requiring sophisticated medical and surgical treatment.”

PICUs cater to children across different age groups, from neonates to adolescents, and handle a wide range of conditions that demand constant, intensive monitoring and specialized care. They are necessary for treating children who require interventions beyond what is available in a general pediatric ward or other hospital areas.

What Conditions Are Treated in the PICU?

The PICU, much like the adult ICU, is used to treat a wide range of life-threatening conditions in children. Some of the most common conditions treated in this unit include:

Respiratory issues

Respiratory illnesses are the most common reason for PICU admissions, often involving severe breathing difficulties. Conditions such as pneumonia, asthma exacerbations, and respiratory failure due to diseases like croup or bronchiolitis are frequently treated. 

For instance, children with severe asthma might require mechanical ventilation or other life-support measures to help them breathe when conventional treatments no longer suffice.

Cardiac problems

Many children admitted to the PICU have heart-related issues. These issues can range from congenital heart defects to heart failure or arrhythmias. Although some larger pediatric hospitals have dedicated cardiac ICUs, many PICUs still treat cardiac conditions. 

A child recovering from heart surgery, like repair for a congenital heart defect, may need intensive monitoring and support for cardiac function, including the use of ventilators or medication to stabilize blood pressure.

Trauma and accidents

Trauma, including injuries from accidents, is another leading cause of PICU admissions. This may include head injuries, fractures, or damage to internal organs caused by car accidents or falls. 

A child with a traumatic brain injury would be admitted to the PICU for constant monitoring of brain function, possibly requiring surgery, mechanical ventilation, or medication to manage swelling and intracranial pressure.

Neurological disorders

Neurological disorders such as seizures, coma, or status epilepticus (prolonged seizures) are also treated in the PICU. For instance, a child experiencing continuous seizures may be placed on sedatives or anticonvulsants while their neurological status is monitored closely. 

Other conditions like meningitis, encephalitis, or brain injuries also require intensive care to manage swelling, infection, and other complications.

Infections

Severe infections, particularly those leading to sepsis (a systemic infection), can rapidly deteriorate a child’s condition, necessitating PICU care. Children with bacterial or viral infections that lead to respiratory failure or organ dysfunction may require intensive treatments to manage the infection and stabilize vital signs.

Surgical recovery

After surgeries like organ transplants, heart surgery, or neurosurgery, children must be closely monitored in the PICU. During the recovery period, children may require additional support for breathing, circulatory function, or pain management. 

Metabolic and genetic disorders

PICUs also manage children with metabolic or genetic disorders that can cause acute, life-threatening symptoms. Disorders like diabetic ketoacidosis (a complication of diabetes) or metabolic crises in children with inherited conditions can be life-threatening and require specialized care, including intravenous fluids, electrolyte management, and close monitoring of organ function.

Who Is Part of the Staff in the PICU?

The aforementioned conditions treated in the PICU require team effort as a range of professionals work together to deliver the necessary care to children. Most of them work within the unit, whereas some others may move between units but still contribute to the care. These medical professionals are:

Pediatric intensivists 

Pediatric intensivists are, arguably, the most important members of the PICU team, much like cardiologists in a cardiac unit or neurologists in a neurology unit. These specialists must have advanced training in pediatric critical care because they are responsible for diagnosing and managing all aspects of care for patients in the PICU. 

Pediatric consultants

Pediatric consultants are experts in specific areas of pediatrics, such as cardiology, neurology, or infectious diseases. When a child in the PICU has a condition that requires specialized knowledge, a pediatric consultant is brought in to provide additional insights and guidance on treatment.

Nurses

Registered nurses in the PICU are in charge of the day-to-day care of the patients. They monitor their vital signs and administer medications as needed. 

Licensed practical nurses assist them. However, they tend to take on more routine aspects of care, like monitoring basic health metrics and providing comfort care. 

Respiratory therapists​

Respiratory therapists in the PICU specialize in treating patients with respiratory problems. They work to assess the child’s breathing and then provide suitable therapies that help maintain proper oxygen levels.

Pharmacists​

Pharmacists in the PICU review prescriptions to make sure that the drug dosages administered are appropriate for the child’s age and weight. They also monitor for potential drug interactions.

Child life specialists 

Child life specialists are trained to help children cope with the stress and trauma of being in a hospital. They provide emotional and psychological support, using play and therapeutic activities to distract and comfort children, helping them understand their treatments.

Dietitians

For children who are critically ill, proper nutrition is crucial, whether it’s through specialized diets, tube feedings, or intravenous nutrition. Therefore, dietitians in the PICU work with the medical team to develop nutrition plans that support the child’s healing process.

Physical and occupational therapists

Physical and occupational therapists in the PICU assist with the rehabilitation of children who have experienced trauma or surgery. They help improve movement, coordination, and muscle strength, as well as support children in regaining independence in daily activities.

Surgical teams

Surgical teams are often involved in the care of children in the PICU, especially for those undergoing major surgeries or requiring emergency procedures. These teams may include pediatric surgeons, neurosurgeons, or cardiothoracic surgeons, who work to repair injuries, correct congenital abnormalities, or treat conditions that cannot be managed without surgery.

PICU Equipment

All PICUs should be equipped with advanced medical technology that enables the medical staff to accurately diagnose the patients as well as manage and treat them. Some essential equipment for this includes:

• Ventilators
• Monitors
• Infusion pumps
• Defibrillators
• ECG (Electrocardiogram) machines
• Oxygen therapy equipment (oxygen cylinders, nasal cannulas, and oxygen masks )
• IV and arterial lines
• Pulse oximeters
• Heating and cooling systems
• Suction devices

What Is It Like to Work in the PICU?

Working in the PICU is incredibly rewarding, but there can be days when it’s just as emotionally and physically demanding. A typical day begins early, and considering the nature of the unit, you always notice a sense of urgency in the air. As soon as you step into the unit, you’re greeted by the beeping monitors and the hum of ventilators, each sound marking the life of a child you’re responsible for. 

The patients are vulnerable, and many of them are fighting for their lives, which can weigh heavily on your heart. However, you don’t have to carry this responsibility on your own, as you’re part of a team, all working together to try and stabilize the patients.

The hours can be long, often spent in constant motion—adjusting the medications of one patient, monitoring the vital signs of the other, and communicating with both their parents, who are understandably anxious and scared. In the midst of it all, you might face moments of heartbreak as you watch a child struggle or a family grieve. However, there are also many moments of triumph when a treatment plan works as intended.

The work is intense, and it demands a level of focus and resilience that can be mentally taxing. But despite the challenges, there’s an undeniable satisfaction and a deep sense of purpose that comes from knowing you’re directly helping a child to grow old and experience life.

Conclusion

Children are meant to have their whole lives ahead of them, to grow, learn, and experience the world without the weight of illness hanging over them. Unfortunately, for many children, this isn’t the reality. They face life-threatening conditions that place them in the care of units like the PICU, where they fight to stay alive. 

So, becoming a pediatrician is incredible in itself, but choosing to specialize in pediatric critical care takes that commitment to an entirely new level. As a pediatric intensivist, you become part of their fight. You help them in their most vulnerable moments. You give them a chance to live out the future they deserve—a future full of childhood wonder, free from hospital beds. 

Children in the PICU deserve the same opportunities as any child, and through your care, you have the power to help them achieve that.

Frequently Asked Questions (FAQs):

What is the difference between the PICU and NICU?

The main difference between the two is that the PICU cares for critically ill children of all ages, while the NICU (Neonatal Intensive Care Unit) specifically focuses on premature or critically ill newborns. 

What is the average age of PICU patients?

The average age of PICU patients is around 16 years old.

What is the most common cause of PICU admission?

Respiratory illnesses are one of the most common causes of PICU admissions. This includes conditions like pneumonia, asthma, and respiratory failure.