Background: Child physiology and disease is not the same as in adults, which implies different challenges within intensive care. The aim of this review article is to shed light on special diagnostic and therapeutic problems in paediatric intensive care.
Material and methods: The review is based on literature identified through a non-systematic search in PubMed, and on the authors' own clinical experience.
Results: Common causes for admitting children to intensive care units are head injuries; septic shock and respiratory failure. Perfusion-directed therapy of severe traumatic head injuries is well recognized, but optimal age-appropriate cut-off values have yet to be defined for cerebral perfusion pressure and intracranial pressure. Therapeutic hypothermia is still controversial and the latest study concludes against this option. Paediatric septic shock is usually caused by low cardiac output, and dopamine or adrenaline are the most suitable agents for pharmacological circulation support, in contradiction to treatment in adults for whom noradrenaline is the preferred vasopressor because of dominating vasoplegia. Activated protein C is not recommended in children. Non-invasive pressure ventilation is used increasingly in children with respiratory failure. The authors have experienced that this reduces the need for intubation, but it has not been documented in studies. Development of tolerance, withdrawal symptoms and physical dependency are substantial clinical problems in long-term sedation and analgesic treatment of children, and are associated with high doses and long duration of infusions.
Interpretation: Paediatric intensive care is different from that in adults. Therapy is more based on experience than evidence from well-designed clinical studies.