Pediatric
Intensive Care Unit :
Frequently Asked Questions
Intensivist Linda
Snelling, MD, is Hasbro Children's Hospital's
chief of pediatric critical care and medical director of its pediatric intensive care unit.
Below, Snelling answers commonly asked questions about
pediatric intensive care at Hasbro Children's Hospital and her
work as an intensivist.
- How do children get to the
intensive care unit?
If the child is in our hospital or comes to the Hasbro
Children's Hospital emergency room and needs intensive
care, we bring the child to our intensive care unit as soon
as possible (often within minutes). If a child is first
taken to another hospital and is critically ill, we will
take a team from our intensive care unit (a transport team),
go to the referring hospital, help stabilize the child and
bring the child back to our intensive care unit in an
ambulance. Referring doctors at other hospitals can contact
our transport team by calling 401-444-6600.
- What is unique about the
pediatric intensive care unit at Hasbro Children's
Hospital?
I see parents as crucial to their child's well-being while
in hospital. We do not have visiting hours for parents;
parents stay 24 hours a day if they wish. Parents remain
with their child for "rounds," during which our
multidisciplinary team of doctors, nurses, respiratory
therapists, nutritionists, pharmacists and child life
workers discuss the child's problems and our data. We
share all the information we have about the child and we
include the parents in all decisions and plans. Parents are
rarely (if ever) asked to leave their child's bedside, and
procedures are performed with the parents present if they
wish to be.
- What is an intensivist?
A pediatric intensivist is a physician who has completed at
least three years of subspecialty training in pediatric
critical care medicine. The training focuses heavily on
normal and abnormal human developmental physiology,
resuscitation from acute life-threatening illness or trauma,
regaining and maintaining a stable physiologic state, and
technology as a means of sustaining life. It has been
recognized by board certification for approximately 10
years.
- Why is it an advantage to have
intensivists on staff in addition to general pediatricians?
In pediatric intensive care we see hundreds of children who
have almost as many different diagnoses. Many of these
illnesses are relatively uncommon and may be seen
infrequently by a general pediatrician. Rapid action and
appropriate treatment is absolutely essential, and there is
no room for a "learning curve" during
resuscitation. A critically ill child does best when cared
for by someone who spends all their time caring for very ill
children.
As an example, several years ago, we had approximately 60
patients with meningococcal infection (many with meningitis
and most with devastating total body infection). This
infection causes profound shock, bleeding, and shutdown of
many organs in the body. It can kill a child within hours.
Immediate and expert resuscitation is crucial to save a
child's life.
Although we saw 60 children over the course of about 18
months, most pediatricians in the state saw none, or one
patient each. Because we have four intensivists, all the
children were cared for by the same four doctors, using
aggressive techniques extremely familiar to us in our
everyday practice. We all reviewed each patient and were all
aware of the treatments that had been most crucial and
successful. We were able to lead a team of doctors, nurses,
respiratory therapists, laboratory personnel and others that
could spring into action at the first sign that a child had
meningococcemia. A physician and staff who sees only an
occasional critical case cannot possibly gain or maintain
the experience necessary to give a child the best chance of
survival. We also are fortunate that in our area
pediatricians and family doctors act rapidly and refer ill
children immediately to Hasbro Children's Hospital for
emergent treatment. We are ready to treat a critically ill
child at any time.
- Would my pediatrician refer me to
you, or would a child see an intensivist only in an
emergency?
There are three major ways a child comes under the care of
an intensivist:
- In an emergency such as trauma, near drowning, sudden
life-threatening illness or complications of
cancer;
- After a scheduled major surgery such as a brain
operation or open heart surgery; and
- If a child has a short-term (months to years) or
life-long condition that interferes with breathing or
that needs the support of a respirator (these children
usually live at home and we see them at regular
intervals).
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