Anesthetists will find themselves treating critically ill children as part of their responsibilities. This requires fundamental skills such as recognizing the child who is seriously ill or deteriorating, and then quickly intensifying treatment. Critically ill children are tachypneic, tachycardic and have signs of respiratory and cardiac failure. The critically ill infant may have an undiagnosed congenital disorder. Advice from on-call pediatric intensivists in specialized centers will help with escalation of therapy. Common problems during transfer to intensive care are hypoventilation and hypoxemia, hypotension, hypoglycemia, hypothermia, unrecognized seizures, and inadequate cerebral perfusion pressure. The decision to intubate and ventilate before transfer can be difficult, and depends on the likelihood of deterioration in transit. Well secured intravenous access and tracheal tube are basic to safe transfer, and a nasotracheal tube usually allows better fixation than oral. A frequent reason for ICU admission of infants is croup or bronchiolitis, with epiglottitis being rare now. Children with fulminant sepsis caused by streptococcus or meningococcus are often among the most ill in the intensive care, and children with these conditions can benefit the most from early recognition and aggressive resuscitation.
Recognition of the seriously ill child Transfer to pediatric intensive care Acute severe asthma in children Meningococcemia, treatment Diabetic ketoacidosis children
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