PICU difference

manusko · Oct 30, 2013

Hi how much of a difference is it in managing pediatric ICU patients compared to adult ICU patients besides drug adjustment r/t weight? For instance, do certain parameters, such as hemodynamics, response to meds, etc, fluctuate drastically or are they more or less similar to adults'? Thanks[/quote']
Pediatrics are not small adults. They have very different needs and they also have family members that are going to be way more aggressive than adult PTs family members, which is totally understandable.

Esme12, ASN, BSN, RN · Oct 30, 2013

The difference is huge. Each child is unique. Critical children even more so. Their physiologic response to distress is completely different from adults. If you want for a child's vital signs to crump...you have waited too long. An adult airway with 1mm of swelling is no big deal....a child with 1mm of swelling has no airway at all. Their airway is different than adults...that is why they can breathe and drink...you and I will choke. With congenital anomalies they each have individual assessment and signs of trouble. The child's vitals vary according to age and they need to be treated accordingly.

Before you take employment as a NP in critical care...I suggest you look at some pedi courses like ENPC and other pediatric certification courses through the ANCC and ENA

Pediatric Critical Care Columnist · Oct 31, 2013

Children tolerate hypoxia much less well than adults do. When adults go into cardiopulmonary arrest, it's typically due to cardiac causes, but kids with normal hearts will stop breathing well before their hearts stop. They also compensate far longer than adults and continue to look almost well... until the second their defences are overwhelmed and then, as Esme says, it's WAY too late. Children maintain their cardiac output by increasing their heart rate and their BP will be within the expected range until BOOM! Infants have a much lower BP to start with and a narrower pulse pressure. It doesn't take much to tip them over. The blood vessels in their brains are very fragile and won't tolerate huge swings in BP - they bleed. Their kidneys don't function in the same way as adult kidneys do so any drug excreted renally has the potential to become toxic quickly. They also process sedation differently, often requiring much larger doses than would be expected given their size. They process heparin differently and the usual adult ranges for coag panels are usually inappropriate for kids. Areas at rick for pressure injury vary depending on age. The occiput on a baby is at far greater risk than the coccyx. Their ears, because of the relative paucity of cartilage, are also at high risk - I pay special attention to the ear closest to the mattress to ensure it's not folded over. Necrotic pinnae are no fun. And one other really important difference is that kids tend not to make the association between movement and pain as quickly as adults do. So a fresh post-op cardiac patient may try to get out of bed while still attached to a pacemaker, with chest tubes hanging out from everywhere and an intracardiac line just waiting to be ripped out. You can't reason with them or expect them to behave by telling them to. Doesn't happen. Meanwhile, the adult CABG patient will lie completely still in bed until you get out the cattle prod. Kids'll continue to play despite being in significant pain, so level of activity isn't a good indicator of pain. We've only scratched the surface here so I hope you'll continue to gather information so that you can make an informed decision.