Issues in pediatric critical care medicine

'T IS AN OFTEN-HEARD ADAGE that chil.dren are a unique species and not just small adults. There are few areas of pediatrics where this is more true than in the care of the critically ill child. Even though it has taken many years to organize the specialized skills and care into dedicated units and develop the subspeciality of pediatric critical care medicine, few specialities have experienced the tremendous growth that pediatric critical care has seen. Critically ill children can now receive care that results from a marriage of the most powerful advances in technology with an in-depth understanding of the unique physiology of the developing child under the guidance of physicians schooled within a multidisciplinary framework incorporating anesthesia, pediatrics, and all of the pediatric medical and surgical subspecialties. It has been through this synthesis and the thoughtful application of technology that the role of the pediatric critical care physician has evolved from that of a postoperative adjunct to that of the true intensivist of today. Pediatric intensive care units are multidisciplinary ICUs that care for children with the whole spectrum of critical illness. Clearly, pediatric critical care medicine is a complex area that is constantly evolving. Thus, it would be impossible to discuss the entire spectrum of critical care for children in this article. The authors have selected a few areas of interest where significant developments in understanding or practice have changed in the last few years, and they present these as an update on the practice of pediatric critical care medicine. As the pediatric ICU continues to develop technologically, thus enabling increasingly sophisticated monitoring and intervention, new challenges