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 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).