Redefining Success in the PICU: New Patient Populations Shift Targets of Care

Over the last 3 decades, mortality rates of children admitted to PICUs in North America have declined significantly.¹  By this measure alone, PICUs have been extremely successful, offering children the best possibility for survival and recovery after life-threatening trauma and illness. Yet as mortality rates have declined, the PICU patient population has become steadily more complex. A recent analysis of admissions across 54 PICUs in the United States (n = 52 791) revealed that 53% of critically ill children had underlying chronic, complex illnesses.²  This finding is supported by a secondary analysis of a national administrative database in the United States that revealed comorbid illness among critically ill children increased from 35% in 1997 to 41% in 2006.³  The emergence of this new population of critically ill children reflects the medical and technological advances of recent decades.¹ 

What do we mean by children with chronic,...