Associate Editors Note

Associate Editor's Note:

Feature Articles: Pediatric Critical Care

Pediatric Critical Care has evolved and matured from management of respiratory failure during the Polio epidemic of 1952 to a multi-disciplinary specialty which encompasses physiology, pharmacology, cardiology, and pulmonary medicine. As a specialty, it transverses all uni-organ disciplines and involves many other specialties including anesthesiology, neonatology, and traumatology. As such, the critical care physician is expected to be the "Jack of All Trades."

The field has emerged from the practical aspects of organ support to other issues such as ethical and cost considerations, as well as management of systemic conditions including multi-system failure and death. While many of you may not be involved in hands-on care in the pediatric critical care unit, many physicians in the community interact with the critical care team when their pediatric patients are critically ill. In the critical care setting, the referring physician should be an integral part of the team. The team is multi-disciplinary and consists of physician, nurses, paramedics, physician-assistants, respiratory therapists, laboratory personnel, pastoral care, social workers, etc. working in a coordinated fashion to bring their expertise to the child.

This issue of Jacksonville Medicine is devoted to some selected aspects of pediatric critical care medicine. The preview on Acute Respiratory Failure provides an up-to-date review of techniques that are in use in pediatric critical care as well as emerging techniques. These new therapies signal a new dawn and optimism for many children with acute lung injury and respiratory failure. The manuscript by DeNicola and Gayle is an informative review on Bronchiolitis, one of the commonest problems in pediatric critical care during the winter months. Doctors D'Agostino and Ceithaml provide an overview of Cyanotic Heart Disease which may be seen initially by the primary care physician. Neurological Emergencies, a cause of high morbidity and mortality, are discussed by the Division of Neurology of the Nemours Children's Clinic. Progress in organ transplantation in children is exciting but is limited by lack of pediatric organ donors. Ms. D'Agostino provides us with an insightful review of the major issues in Pediatric Organ Donation.

It has been a pleasure to work with my colleagues to bring this issue to fruition. The most difficult task was deciding which of the many issues in pediatric critical care are worthy of inclusion. Ultimately, all diseases that may lead to morbidity and mortality are worthy of discussion. It is my hope however that the topics chosen here will provide an overview of the wide and complex derangements seen in the pediatric critical care unit.

Niranjan Kissoon, M.D.
Professor and Chief, Critical Care Medicine
University of Florida & Nemours Children's Clinic

Jacksonville Medicine / September, 1998