Update in Pediatric Critical Care

  • Lisa A. DelSignoreEmail author
  • Traci A. Wolbrink
  • Niranjan Kissoon


This chapter discusses recent updates that have occurred over the last several years within the field of pediatric critical care. Included in these recent updates are selected clinical conditions with updated guidelines related to diagnosis and/or patient management. These clinical updates are categorized according to organ-based systems throughout the chapter. This chapter also reviews recent updates in technology, quality improvement, and education as they pertain to pediatric critical care.


Pediatric critical care Education Technology Quality improvement Traumatic brain injury Resuscitation Sepsis Lung disease 



Declared none.

Conflict of Interest

The author(s) confirm that this chapter contents have no conflict of interest.


  1. Abend NS, Bearden D, Helbig I, et al. Status epilepticus and refractory status epilepticus management. Semin Pediatr Neurol. 2014;21:263–74.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Agulnik A, Forbes PN, Stenquist N, et al. Validation of a Pediatric Early Warning Score in hospitalized pediatric oncology and hematopoietic stem cell transplant patients. Pediatr Crit Care Med. 2016;17(4):e146–53.CrossRefPubMedGoogle Scholar
  3. Akre M, Finkelstein M, Erickson M, et al. Sensitivity of the Pediatric Early Warning Score to identify patient deterioration. Pediatrics. 2010;125:e763–9.CrossRefPubMedGoogle Scholar
  4. ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.Google Scholar
  5. Bell MJ, Kochanek PM. Pediatric traumatic brain injury in 2012: the year with new guidelines and common data elements. Crit Care Clin. 2013;29(2):223–38.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Blanch L, Romero PV, Lucangelo U. Volumetric capnography in the mechanically ventilated patient. Minerva Anestesiol. 2006;72:577–85.PubMedGoogle Scholar
  7. Breuer RK, Taicher B, Turner DA, et al. Standardizing postoperative PICU handovers improves handover metrics and patient outcomes. Pediatr Crit Care Med. 2015;16:256–63.CrossRefPubMedGoogle Scholar
  8. Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666–88.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Cheifetz IM. Advances in monitoring and management of pediatric acute lung injury. Pediatr Clin N Am. 2013;60:621–39.CrossRefGoogle Scholar
  10. Conlon TW, Himebauch AS, Fitzgerald JC, et al. Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU. Pediatr Crit Care Med. 2015;16(3):219–26.CrossRefPubMedGoogle Scholar
  11. de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt E, Schexnayder SM, Samson RA. Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(Suppl 2):S526–42.CrossRefPubMedGoogle Scholar
  12. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefPubMedGoogle Scholar
  13. Drayna PC, Abramo TJ, Estrada C. Near-infrared spectroscopy in the critical setting. Pediatr Emerg Care. 2011;27(5):432–9.CrossRefPubMedGoogle Scholar
  14. Dugan MC, McCracken CE, Hebbar KB. Does simulation improve recognition and management of pediatric septic shock, and if one simulation is good, is more simulation better? Pediatr Crit Care Med. 2016;17(7):605–14.CrossRefPubMedGoogle Scholar
  15. Faustino EVS, Hanson S, Spinella PC, et al. A multinational study of thromboprophylaxis practice in critically ill children. Crit Care Med. 2014;42(5):1232–40.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Figueroa MI, Sepanski R, Goldberg SP, Shah S. Improving teamwork, confidence, and collaboration among members of a pediatric cardiovascular intensive care unit multidisciplinary team using simulation-based team training. Pediatr Cardiol. 2013;34(3):612–9.CrossRefPubMedGoogle Scholar
  17. Fivez T, Kerklaan D, Mesotten D, et al. Early versus late parenteral nutrition in critically ill children. N Engl J Med. 2016;347(12):1111–22.CrossRefGoogle Scholar
  18. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58.CrossRefPubMedGoogle Scholar
  19. Ghanayem NS, Wernovsky G, Hoffman GM. Near-infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med. 2011;12(4 Suppl):S27–32.CrossRefPubMedGoogle Scholar
  20. Grinspan ZM, Pon S, Greenfield JP, et al. Multimodal monitoring in the pediatric intensive care unit: new modalities and informatics challenges. Semin Pediatr Neurol. 2014;21:291–8.CrossRefPubMedGoogle Scholar
  21. Jacobi J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012;40(12):3251–76.CrossRefPubMedGoogle Scholar
  22. Jeffers J, Eppich W, Trainor J, Mobley B, Adler M. Development and evaluation of a learning intervention targeting first-year resident defibrillation skills. Pediatr Emerg Care. 2016;32(4):210–6.CrossRefPubMedGoogle Scholar
  23. Kardong-Edgren SE, Oermann MH, Odom-Maryon T, Ha Y. Comparison of two instructional modalities for nursing student CPR skill acquisition. Resuscitation. 2010;81(8):1019–24.CrossRefPubMedGoogle Scholar
  24. Kleinpell R, Ely EW, Williams G, Liolios A, Ward N, Tisherman SA. Web-based resources for critical care education. Crit Care Med. 2011;39(3):541–53.CrossRefPubMedGoogle Scholar
  25. Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents—second edition. Pediatr Crit Care Med. 2012;13(Suppl 1):S1–82.PubMedGoogle Scholar
  26. Lacroix J, Hebert PC, Hutchison JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356(16):1609–18.CrossRefPubMedGoogle Scholar
  27. Lau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016;80(2):178–84.CrossRefPubMedGoogle Scholar
  28. Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364(26):2483–95.CrossRefPubMedGoogle Scholar
  29. McLellan MC, Gauvreau K, Connor JA. Validation of the Cardiac Children’s Hospital Early Warning Score: an early warning score tool to prevent cardiopulmonary arrests in children with heart disease. Congenit Heart Dis. 2014;9(3):194–202.CrossRefPubMedGoogle Scholar
  30. Mehta NM. Feeding the gut during critical illness—it is about time. J Parenter Enteral Nutr. 2014;38(4):410–4.CrossRefGoogle Scholar
  31. Mehta NM, Compher C, A.S.P.E.N. Board of Directors. A.S.P.E.N. Clinical guidelines: nutrition support of the critically ill child. J Parenter Enteral Nutr. 2009;33(3):260–76.CrossRefGoogle Scholar
  32. Mikhaliov TA, Kuhn EM, Manzi J, et al. Early enteral nutrition is associated with lower mortality in children. J Parenter Enteral Nutr. 2014;38(4):459–66.CrossRefGoogle Scholar
  33. Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015;372(29):1898–908.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Nishisaki A, Hales R, Biagas K, et al. A multi-institutional high-fidelity simulation “boot camp” orientation and training program for first year pediatric critical care fellows. Pediatr Crit Care Med. 2009;10(2):157–62.CrossRefPubMedGoogle Scholar
  35. O’Leary JA, Nash R, Lewis PA. High fidelity patient simulation as an educational tool in paediatric intensive care: a systematic review. Nurse Educ Today. 2015;35(10):e8–12.CrossRefPubMedGoogle Scholar
  36. Pageler NM, Longhurst CA, Wood M, et al. Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLASBIs. Pediatrics. 2014;133:e738–46.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.CrossRefPubMedGoogle Scholar
  38. Sanchez SM, Carpenter J, Chapman KE, et al. Pediatric ICU EEG monitoring: current resources and practice in the United States and Canada. J Clin Neurophysiol. 2013;30:156–60.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Scholtz AK, Monachino AM, Nishisaki A, Nadkarni VM, Lengetti E. Central venous catheter dress rehearsals: translating simulation training to patient care and outcomes. Simul Healthc. 2013;8(5):341–9.CrossRefPubMedGoogle Scholar
  40. Sion-Sarid R, Cohen J, Houri Z, Singer P. Indirect calorimetry: a guide for optimizing nutritional support in the critically ill child. Nutrition. 2013;29:1094–9.CrossRefPubMedGoogle Scholar
  41. Smith HAB, Boyd J, Fuchs C, et al. Diagnosing delirium in critically ill children: validity and reliability of the Pediatric Confusion Assessment Method for the intensive care unit*. Crit Care Med. 2011;39(1):150–7.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Smith HAB, Gangopadhyay M, Goben CM, et al. The preschool confusion assessment method for the ICU: valid and reliable delirium monitoring for critically ill infants and children*. Crit Care Med. 2016a;44:592–600.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Smith DM, McGinnis EL, Walleigh DJ, Abend NS. Management of status epilepticus in children. J Clin Med. 2016b;5(47):1–19.Google Scholar
  44. Srinivasan S, Cornell T. Bedside ultrasound in pediatric critical care: a review. Pediatr Crit Care Med. 2011;12(6):667–74.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Su E, Pustavoitau A, Hirshberg EL, et al. Establishing intensivist-driven ultrasound at the PICU bedside—it’s about time. Pediatr Crit Care Med. 2014;15:649–52.CrossRefPubMedGoogle Scholar
  46. Suarez-Sipmann F, Bohm SH, Tusman G. Volumetric capnography: the time has come. Curr Opin Crit Care. 2014;20:333–9.CrossRefPubMedGoogle Scholar
  47. The Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference*. Pediatr Crit Care Med. 2015;16:428–39.CrossRefPubMedCentralGoogle Scholar
  48. Traube C, Silver G, Kearney J, et al. Cornell assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med. 2014;42:656–63.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Van Tuijl SGL, Van Cauteren YJM, Pikhard T, et al. Management of pediatric delirium in critical illness: a practical update. Minerva Anestesiol. 2015;81:333–41.PubMedGoogle Scholar
  50. Wolbrink TA, Kissoon N, Burns JP. The development of an internet-based knowledge exchange platform for pediatric critical care clinicians worldwide*. Pediatr Crit Care Med. 2014;15(3):197–205.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lisa A. DelSignore
    • 1
    Email author
  • Traci A. Wolbrink
    • 2
  • Niranjan Kissoon
    • 3
  1. 1.Division of Pediatric Critical Care, Department of PediatricsFloating Hospital for Children at Tufts Medical Center, Tufts Medical SchoolBostonUSA
  2. 2.Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain ManagementBoston Children’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Division of Critical Care and the Child and Family Research Institute, Department of PediatricsBritish Columbia’s Children’s Hospital, University of British ColumbiaVancouverCanada

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