Guidelines and levels of care for pediatric intensive care units

Objective: To provide recommendations that are current and attainable for the organization, personnel, equipment, facilities, and services necessary for pediatric intensive care units (ICUs). Data Sources: Review of the medical literature and concensus of practitioners in the field, including physicians from multiple specialties, critical care nurses, and respiratory therapists. Setting: Annual meetings of the Society of Critical Care Medicine and American Academy of Pediatrics. Participants: Leadership members of the Society of Critical Care Medicine and the American Academy of Pediatrics. Results: Members of the Society of Critical Care Medicine and the American Academy of Pediatrics met at annual meetings of the two organizations with the goal of updating guidelines for pediatric ICUs. It was agreed that pediatric intensive care is provided primarily at one level, although there exists a need for an additional level of care in geographically isolated areas to allow stabilization of children before transport and to avoid long- distance transfer for disorders of less complexity or low acuity. Guidelines were developed for a) levels I and II pediatric intensive care facilities and services; b) hospital facilities and services; c) personnel; d) prehospital care and interhospital transport; e) quality assurance; and f) research and training. Conclusions: Use of these guidelines should assist: a) hospitals, in staffing and equipping these units; b) physicians, as a reference in the referral and care of critically ill infants and children; c) emergency medical services personnel, for proper prehospital triage; and d) levels I and II pediatric ICUs as a means of ensuring proper patient care and professional credibility.