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What is the Pediatric Intensive Care Unit? An introduction

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My name is Dr. Janine Zee-Cheng and I am a Pediatric Critical Care physician (also called a pediatric intensivist). If you’re reading this, I assume you’re curious about the Pediatric Intensive Care Unit, or PICU.

The PICU is a specialized unit of the hospital where the very sickest pediatric patients are admitted. Most PICUs are in tertiary care children’s hospitals, although smaller PICUs in community hospitals also exist. The PICU at Riley Hospital for Children has 36 beds.

Who gets admitted to the PICU? We admit any critically ill patient from newborn (if they’ve been home from the hospital–the patients admitted just after birth are sent to the Neonatal Intensive Care Unit, or NICU) to young adult. Although most of our patients are under the age of eighteen, some with rare diseases can be slightly older.

Unlike, say, cardiologists, who primarily care for heart diseases, or pulmonologists, who primary care for lung diseases, pediatric intensivists care for a wide range of conditions that affect the entire body. Patients have diagnoses ranging from breathing difficulties, infections, genetic conditions, metabolic conditions, traumas and accidents, surgeries, and many others.

Pediatric intensivists have specialized training. After completing medical school, one must complete a three year pediatric residency, and then a three year fellowship in pediatric critical care. Board certification examinations in pediatric critical care are offered every other year, and one has to also maintain board certification in general pediatrics as well.

During a fellowship in Pediatric Critical Care, fellows learn to care for the very sickest children. They learn procedures such as placement of breathing tubes, management of ventilators and sedation medications, central venous catheter placement, and appropriate management of rare and serious diseases. Even more importantly, fellows learn how to work with many different disciplines: nurses, respiratory therapists, pharmacists, dietitians, and many others. The participation of each of these disciplines is crucial to maintain the very best care for these children.

The most rewarding part of my job, though, isn’t the diagnosis of unusual diseases or the successful management of a severe conditions. It is helping these critically ill children and their families navigate a scary and distressing time in their lives, sitting with them, and helping them to understand the many unfamiliar circumstances they suddenly face. This, for me, is the essence of Pediatric Critical Care medicine, and a large part of why it is such an important field of medicine.