Longacre, Mckenna M. MD, MM; Cummings, Brian M. MD; Bader, Angela M. MD, MPH
Anesthesia & Analgesia: February 2019 – Volume 128 – Issue 2 – p 328-334
Urgent intubation of a child with refractory seizures and respiratory distress, analgesia for a neonate with necrotizing enterocolitis, sedation for a child undergoing incision and drainage of a complex abscess at the bedside, pain management in a teenager with refractory cancer pain, preoperative evaluation of a complex patient with cystic fibrosis following liver transplantation, scheduled for liver transplantation. How would our approach to these and other facets of pediatric critical care change if pediatric anesthesiologists formed a core part of the pediatric intensive care teams?
“The necessity to care for all aspects of a child’s critical illness and integrate the knowledge, wisdom, care, and focus of many providers is the key difference between critical care and other specialties.”1 Pediatric intensive care was born from the practice of pediatric anesthesia and rapidly grew to encompass several allied specialties, including adult respiratory care, neonatology, pediatric general surgery, and pediatric cardiac surgery.2 Yet today, pediatric anesthesiologists—and nonpediatricians in general—are largely absent from the pediatric and neonatal intensive care spaces (pediatric intensive care units [PICUs] and neonatal intensive care units). Contributing to this divide are a lack of exposure to pediatric intensive care training and significant credentialing barriers.1 These observations have led us to consider, does the current structure of training lead to the ability to optimally innovate and collaborate in the delivery of pediatric critical care? We suggest that redesigning the pediatric critical care training pathway for pediatric anesthesiologists may improve care of children both in and out of the operating room (OR) by facilitating further sharing of skills, research, and clinical experience. Read More
