Pediatric intensive care unit

A pediatric intensive care unit (also paediatric), usually abbreviated to PICU (/ˈpɪkjuː/), is an area within a hospital specializing in the care of critically ill infants, children, teenagers, and young adults aged 0–21. A PICU is typically directed by one or more pediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in pediatric intensive care. The unit may also have nurse practitioners, physician assistants, physiotherapists, social workers, child life specialists, and clerks on staff, although this varies widely depending on geographic location. The ratio of professionals to patients is generally higher than in other areas of the hospital, reflecting the acuity of PICU patients and the risk of life-threatening complications. Complex technology and equipment is often in use, particularly mechanical ventilators and patient monitoring systems. Consequently, PICUs have a larger operating budget than many other departments within the hospital.

Goran Haglund is credited with establishing the very first pediatric ICU in 1955; this PICU was located at Children's Hospital of Goteburg in Sweden. The first PICU in the United States is a topic often debated. Currently, Fuhrman's Textbook in Pediatric Critical Care lists Pediatric Critical Care Unit at the Children's Hospital of District of Columbia in Washington, DC, dating back to 1965, as the first pediatric critical care unit in the U.S.A. Medical Director was Dr. Berlin. As soon as 1966, another well-documented early pediatric intensive care unit opened at Kings County Hospital in Brooklyn, NY. It was caring for patients with open heart surgery and peritoneal dialysis under the helm of Dr. Rodriguez-Torres. The PICU most commonly referred to as first is the Children's Hospital of Philadelphia in 1967 by John Downes. The PICU at Lurie Children's Hospital was also established in 1967, the same year as the unit at the Children's Hospital of Philadelphia. The establishment of these early units eventually led to hundreds of PICUs being developed across North America and Europe.

There were a variety of factors that led to the development of PICUs. John Downes identified five specialties of medicine that aided in the development. These specialties included adult respiratory ICUs, neonatal intensive care, pediatric general surgery, pediatric cardiac surgery, and pediatric anesthesiology.

Between 1930 and 1950 the poliomyelitis epidemic had created a greater need for adult respiratory intensive care, including the iron lung. There were times when children would contract polio and would have to be treated in these ICUs as well. This contributed to the need for a unit where critically ill children could be treated. Respiratory issues were also increasing in children because neonatal intensive care units were increasing the survival rates of infants. This was due to advances in mechanical ventilation. However, this resulted in children developing chronic lung diseases, but there was not a specific unit to treat these diseases.

Advancements in pediatric general surgery, cardiac surgery, and anesthesiology were also a driving factor in the development of the PICU. The surgeries that were being performed were becoming more complicated and required more extensive postoperative monitoring. This monitoring could not be performed on the regular pediatric unit, which led to Children's Hospital of Philadelphia's development of the first American PICU. Advancements in pediatric anesthesiology resulted in anesthesiologist treating pediatric patients outside of the operating room. This caused pediatricians to obtain skills in anesthesiology in order to make them more capable of treating critically ill pediatric patients. These pediatric anesthesiologists eventually went on to develop run PICUs.

In the 2000s, the live discharging rate of child and adolescent patients in the US and in the UK become higher than 96%. As of 2003, in the same countries more than 250.000 children were introduced to PICU (paediatric intensive care unit).

With the growth of hospitals with PICUs in the 1980s, the American Academy of Pediatrics (AAP) and the pediatric section of the Society of Critical Care Medicine (SCCM) set forth guidelines in 1993 for PICUs. Since the establishment of those guidelines, both the number of PICUs and number of PICU beds has been steadily increasing in the US. This growth could be attributed to the advancement of medical care and the increased survival of children with chronic illnesses with the need for higher level of support. With this increase, there has been variability in the distribution across the US, mainly in areas with larger, specialized centers. Additionally, there was an expansion of specialized PICUs, for example cardiac, trauma and neuroscience PICUs, seen in this time frame.

There was a significant shortage of pediatric ICUs in the United States during the 2022–2023 pediatric care crisis.