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Updated: Jun 16, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
[Paediatric intensive care]
1Klinikk for anestesi og akuttmedisin, St. Olavs hospital, 7006 Trondheim, Norway. ulf.mostad@stolav.no
Insights
Pediatric intensive care presents unique challenges compared to adults, with treatments often relying on experience due to limited evidence. Key issues include managing head injuries, septic shock, and respiratory failure in children.
Area of Science:
- Pediatric intensive care medicine
- Critical care for children
- Neonatal and pediatric critical care
Context:
- Child physiology and disease pathophysiology differ significantly from adults.
- Intensive care for children presents distinct diagnostic and therapeutic challenges.
- Paediatric intensive care units (PICUs) manage diverse critical conditions in young patients.
Purpose:
- To review the specific diagnostic and therapeutic challenges in pediatric intensive care.
- To highlight differences in critical care management between children and adults.
- To provide insights into optimizing care for critically ill children.
Summary:
- Common PICU admissions include head injuries, septic shock, and respiratory failure.
- Management strategies for pediatric septic shock differ from adults, with dopamine or adrenaline preferred for circulation support.
- Non-invasive ventilation is increasingly used for pediatric respiratory failure, potentially reducing intubation needs; long-term sedation poses risks of tolerance and dependency.
Impact:
- Emphasizes the need for age-appropriate critical care guidelines and evidence-based practices in pediatrics.
- Highlights the gap between clinical experience and robust clinical study data in pediatric intensive care.
- Informs clinicians about current therapeutic options and challenges in managing critically ill children.
Background:
Child physiology and disease is not the same as in adults, which implies different challenges within intensive care. The aim of this review article is to shed light on special diagnostic and therapeutic problems in paediatric intensive care.
Material And Methods:
The review is based on literature identified through a non-systematic search in PubMed, and on the authors' own clinical experience.
Results:
Common causes for admitting children to intensive care units are head injuries; septic shock and respiratory failure. Perfusion-directed therapy of severe traumatic head injuries is well recognized, but optimal age-appropriate cut-off values have yet to be defined for cerebral perfusion pressure and intracranial pressure. Therapeutic hypothermia is still controversial and the latest study concludes against this option. Paediatric septic shock is usually caused by low cardiac output, and dopamine or adrenaline are the most suitable agents for pharmacological circulation support, in contradiction to treatment in adults for whom noradrenaline is the preferred vasopressor because of dominating vasoplegia. Activated protein C is not recommended in children. Non-invasive pressure ventilation is used increasingly in children with respiratory failure. The authors have experienced that this reduces the need for intubation, but it has not been documented in studies. Development of tolerance, withdrawal symptoms and physical dependency are substantial clinical problems in long-term sedation and analgesic treatment of children, and are associated with high doses and long duration of infusions.
Interpretation:
Paediatric intensive care is different from that in adults. Therapy is more based on experience than evidence from well-designed clinical studies.
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