Page 702 - ACCCN's Critical Care Nursing

Paediatric Considerations

in Critical Care 25

Tina Kendrick
Anne-Sylvie Ramelet

although paediatrics is a specialty defined by age rather
Learning objectives than body systems.

Not only will children experience different patterns of
After reading this chapter, you should be able to: illness and injury compared to adults, their behavioural
l consider and anticipate the specific needs of critically ill and physiological responses to illness differ. It is impor-
infants and children tant that the child’s primary caregiver, who will usually
l describe common conditions that lead to critical illness in be a parent (the term used throughout this chapter), be
infants and children included in planning many aspects of care. While the
l discuss and apply the age-appropriate assessment, critical care team are expert in management of critical
monitoring and management of critically ill infants and illness, parents are generally the experts on their child,
children can provide the child’s health history and know how best
l identify age-appropriate parameters and care required by to settle the child in addition to knowing what their
critically ill infants and children who require ventilation ‘normal’ behaviours are. This child-centred knowledge
l discuss psychological and emotional care required by makes them valuable members of the team.
critically ill infants and children, and their family In mid 2007 the Australian paediatric population was
l consider the child’s family in all interactions estimated to be 4.1 million children aged 0–14 years,
1
with the New Zealand paediatric population 0–15 years
reported at 894,400. Approximately 559,000 children
2
were admitted to Australian public hospitals in 2007–
3
Key words 2008 with over 8300 children in Australia and New
Zealand requiring admission to intensive care units
(ICUs) in 2008. During the same period, there were over
4
paediatrics 145,000 total admissions to Australian and New Zealand
developmental considerations ICUs. Children represent 5.7% of all ICU admissions in
5
upper airway obstruction Australia and New Zealand. Over half of these children
lower airway obstruction required mechanical ventilation, compared with around
4
paediatric ventilation 41% of adults in intensive care. While just over half
5
shock (52.5%) of critically ill children were admitted to special-
neurological dysfunction ist paediatric ICUs, a significant number were managed
4
gastrointestinal tract dysfunction in or retrieved from adult ICUs. Geographical distances
paediatric trauma and the centralised nature of paediatric services can influ-
ence whether a child is nursed in a general or paediatric
ICU. In many circumstances, children will respond effec-
tively to initial resuscitation, particularly support of
INTRODUCTION breathing and fluid resuscitation, and may not require
transfer to a specialist paediatric unit. Paediatric clinical
This chapter focuses on specific considerations for the advice, support and information are available from chil-
care of critically ill infants and children experiencing, or dren’s hospitals and specialist paediatric retrieval services
at risk of experiencing, common life-threatening condi- and should be sought as early as possible in the absence
tions. These include respiratory diseases common in the of paediatric trained staff, or when the need for transfer
paediatric population, major trauma, shock and sepsis. It to a higher level of care becomes apparent.
is aimed at the critical care nurse who encounters paedi-
atric patients occasionally and, while not designed to The age distribution of children in ICUs has remained
meet all the needs of specialist paediatric critical care the same for a number of years, with the figures from
nurses, it provides a summary of the assessment, moni- 2008 showing that children under the age of five years
toring and care required by critically ill children. A systems represent just over 66% of admissions, with almost 59%
approach has been used in this chapter for convenience, of this age group under 12 months of age and 26% under 679