Critical care clinics
-
The first ICU in Toronto was opened at the Toronto General Hospital as a "Respiratory Unit" in 1958. The early days of this unit have been described in various articles published at the time, such as a description in the Canadian Medical Assn. Journal of the establishment of the Unit itself, including the 4 sine qua nons for intensive care. This article will focus particularly on some of the significant issues that arose in the initial years between the opening of the unit in 1958 and the arrival of clinically available blood gas measurement in the early 1960s.
-
Critical care clinics · Apr 2023
ReviewExtracorporeal Membrane Oxygenation Then and Now; Broadening Indications and Availability.
Extracorporeal membrane oxygenation (ECMO) is a life support technology provided to children to support respiratory failure, cardiac failure, or cardiopulmonary resuscitation after failure of conventional management. Over the decades, ECMO has expanded in use, advanced in technology, shifted from experimental to a standard of care, and evidence supporting its use has increased. The expanded ECMO indications and medical complexity of children have also necessitated focused studies in the ethical domain such as decisional authority, resource allocation, and equitable access.
-
Children who survive the pediatric intensive care unit (PICU) are at risk of developing post-intensive care syndrome in pediatrics (PICS-p). PICS-p, defined as new physical, cognitive, emotional, and/or social health dysfunction following critical illness, can affect the child and family. Historically, synthesizing PICU outcomes research has been challenging due to inconsistency in study design and in outcomes measurement. PICS-p risk may be mitigated by implementing intensive care unit best practices that limit iatrogenic injury and by supporting the resiliency of critically ill children and their families.