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Published on: August 30, 2018
[Development of intensive care for pediatric infectious diseases over the last 20 years]
1Service de réanimation pédiatrique, Hôpital du Kremlin-Bicêtre, 78, rue du Général Leclerc, Le Kremlin-Bicêtre 94275, France. gilbert.huault@free.fr
Insights
Pediatric intensive care has evolved significantly, overcoming many infectious diseases. However, challenges like severe infections and superinfections in vulnerable patients persist, requiring optimized care and vaccination strategies.
Area of Science:
- Pediatric Intensive Care Medicine
- Infectious Diseases
- Critical Care
Context:
- Intensive care units (ICUs) have evolved over 40 years, initially addressing fatal infectious diseases.
- Significant progress has led to the decline of diseases like polio, diphtheria, and tetanus in France.
- Despite advances, serious infections (pneumococcus, staphylococcus), maternofoetal infections, and pertussis in infants remain critical concerns.
Purpose:
- To review the evolution of pediatric intensive care in the context of infectious diseases.
- To highlight persistent and emerging challenges in managing severe infections and vulnerable populations within ICUs.
- To discuss the impact of new medical interventions and the changing landscape of critical care.
Summary:
- Fatal infectious hepatitis is now manageable in over 50% of cases with liver transplants and ICU support.
- Human Immunodeficiency Virus (HIV) has emerged as a significant concern requiring intensivist involvement.
- Toxic shock syndrome, particularly purpura fulminans, presents a major challenge, understood as an overactive immune response.
Impact:
- ICUs increasingly manage highly vulnerable patients, including the immunosuppressed and extremely premature infants, leading to challenges like superinfections and multidrug-resistant organisms.
- Optimizing technical and working conditions, adhering to hygiene protocols, and promoting vaccination are crucial for improving outcomes.
- Advances in understanding disease mechanisms and supportive care continue to improve survival rates for complex pediatric critical conditions.
Abstract:
Intensive care and especially pediatric intensive care originated in connection with fatal forms of infectious diseases, some forty years ago. It has come a long way during the last quarter of the past century. Several infectious diseases have disappeared in France during this period such as poliomyelitis, dipteria and tetanus. Many other are receding. Nevertheless problems remain: serious infections by pneumococcus or staphylococcus, maternofoetal infections, whooping cough in very young infant. Now, thanks to liver transplantations and intensive care, the fatal forms of infectious hepatitis can be overcome in more than 50% of the cases. Meanwhile HIV appeared involving intensivists participation. Toxic shock, and especially the purpura fulminans, remains a major difficulty. Great advances in understanding its mechanisms have been made and it seems today like the result of excessive and unsuitable defence reactions. In addition, intensive care takes charge of more and more vulnerable ill persons: immunosuppressed, extreme premature babies, children who had to undergo heavy operations. In those cases, intensive care faces superinfections, nosocomial infections, multi-resistant germs, related in part to the particular working and environmental conditions and an unsuitable use of antibiotics. To conclude, it is necessary to optimize the technical and working conditions in intensive care units, to strictly observe the well established regulations of hygienics and to develop vaccinations.
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