Pediatric Critical Care: Frequently Asked Questions
Intensivist Linda Snelling, MD,
is Hasbro Children's Hospital's chief of pediatric critical care and
medical director of pediatric inpatient services, sedation services and
the 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
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
In an emergency such as trauma, near drowning,
sudden life-threatening illness or complications
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).