A History of Pediatric Critical Care Medicine

Abstract

Critical care medicine developed out of other subspecialties' need to provide care for their most critically ill patients. Advanced technologies, the understanding of the pathophysiology of critical illness, and the development of the multidisciplinary team have made this care possible. Pediatric critical care medicine emerged in the 1960s and has expanded dramatically since then. The field has made major advances in the areas of lung injury, sepsis, traumatic brain injury, and postoperative care. We review here the evolution of modern pediatric critical care medicine from its roots in general pediatric and cardiac surgery, adult respiratory care medicine, neonatology, and pediatric anesthesiology to its current state as a unique discipline. Pediatric intensive care has only been recognized as a distinct subspecialty for 20 y. The specialty grew out of a need for increasingly complex postoperative management, in the face of advances in surgical and medical subspecialties, and the development of sophisticated life-support technology. The intensivist now directs a multidisciplinary team that includes other subspecialists, nurse specialists, respiratory therapists, nutritionists, pharmacists, social workers, clergy, physical therapists, occupational therapists, and others. The pediatric intensivist's role is to provide supportive care during cardiorespiratory and/or multi-organ failure or recovery from surgical interventions or trauma. Intensivists coordinate complex treatment plans with multiple participants to further the care of critically ill children. DEVELOPMENT OF THE PEDIATRIC INTENSIVE CARE UNITA number of factors led to the development of the subspecialty of pediatric critical care medicine. In 1992, John Downes identified five crucial fields of medicine in the 1950s that led to the emergence of pediatric critical care: adult respiratory intensive care, neonatology and neonatal intensive care, pediatric general surgery, pediatric cardiac surgery, and pediatric anesthesiology (1).From the 1930s to 1950s, adult respiratory intensive care units were created to battle the scourge of the polio epidemic with "iron lung" ventilators. Out of necessity, these units also cared for children with polio (1). The neonatologists, in their newly created neonatal intensive care units, developed procedures for nutritional and environmental support of sick newborns and premature infants along with ventilation techniques and monitoring for treating hyaline membrane disease (also known as respiratory distress syndrome). The understanding and use of surfactant and continuous positive airway pressure mechanical ventilation greatly improved survival of infants with respiratory distress syndrome. By the 1960s, many infants with respiratory distress syndrome, who received extended mechanical ventilation, developed persistent lung disease, termed bronchopulmonary dysplasia (2). This created a need for extended care of older infants and children with the ensuing chronic lung disease (1).During this period, advances in pediatric surg...

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