Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.

Acute respiratory distress syndrome (ARDS) is a significant cause of morbidity and mortality in critically ill patients. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) group published diagnostic criteria for pediatric ARDS (PARDS) and consensus-based treatment guidelines. In adults, provider recognition (PR) of ARDS has been associated with improved adherence to clinical guidelines. In pediatric populations, patterns of PARDS recognition since the publication of the PALICC guidelines are unknown. The purpose of this study is to determine the rate of PARDS recognition and examine clinical factors that may be associated with making the diagnosis.

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Learning critical care medicine in the pediatric intensive care unit (PICU) can be stressful. Through semistructured interviews (n = 16), this study explored the emotions, perceptions, and motivations of pediatric medicine (PM) and emergency medicine (EM) residents, as they prepared for their first PICU rotation. Qualitative data were collected and analyzed using the grounded theory method. Three resultant themes emerged: (1) residents entered the PICU with a range of intense emotions and heightened expectations; (2) they experienced prior history of psychologically traumatic learning events (adverse learning experiences or ALEs); and (3) informed by ALEs, residents prepared for their rotation by focusing heavily on their most basic level of physiological needs and adopting a survival mindset prior to the start of the rotation. These three themes led to a substantive, or working, theory that ALE-associated events may affect how residents approach upcoming learning opportunities. Consequently, adapting a trauma-informed approach as a component of medical education may improve resident learning experiences in the PICU and beyond.