Goran Haglund is credited with establishing the very first pediatric ICU in 1955; this PICU was located at Children’s Hospital of Goteburg in Sweden. The first PICU in the United States was created at the Children’s Hospital of Philadelphia in 1967 by John Downes. The PICU at Lurie Children's Hospital was also established in 1967, the same year as the unit at the Children's Hospital of Philadelphia. The establishment of these early units eventually led to hundreds of PICUs being developed across North America and Europe. 

Advancements in pediatric general surgery, cardiac surgery, and anesthesiology were also a driving factor in the development of the PICU. The surgeries that were being performed were becoming more complicated and required more extensive postoperative monitoring. This monitoring could not be performed on the regular pediatric unit, which led to Children’s Hospital of Philadelphia’s development of the first American PICU. Advancements in pediatric anesthesiology resulted in anesthesiologist treating pediatric patients outside of the operating room. This caused pediatricians to obtain skills in anesthesiology in order to make them more capable of treating critically ill pediatric patients. These pediatric anesthesiologists eventually went on to develop run PICUs.

There are a variety of PICU characteristics that allow the healthcare providers to deliver the most optimal care possible. The first of these characteristics is the physical environment of the PICU. The layout of the unit should allow the staff to constantly observe the patients they are caring for. The staff should also be able to rapidly respond to the patients if there is any change in the patient’s clinical status. Correct staffing is the next vital component to a successful PICU. The nursing staff is highly experienced in providing care to the most critical patients. The nurse to patient ratio should remain low, meaning that the nurses should only be caring for 1-2 patients depending on the clinical status of the patients.

There are a variety of factors that have led to poor outcomes in PICU patients. The main factor that leads to inadequate care for PICU patients is improper health assessment by the healthcare providers. This may include not observing a change in the patient’s clinical status, delayed resuscitation efforts, delayed decision making, or a combination of any of these factors. If any of these factors do occur, it may result in permanent deficits in the most critical patients. This education is not only for the PICU staff, but also for emergency medical services, the emergency department staff, and staff of the pediatric unit.

They must collaborate with other members the healthcare team in order to develop the best plan of care. Once a plan of care is developed, then the staff must communicate the plan with the patient's family in order to see if it matches their beliefs. If the plan of care does not match the family's beliefs, then it must be modified the plan causing more stress on the staff. All of this causes the staff a great deal of stress and each member of the unit must develop their own coping mechanisms in order to prevent burnout.

Regards
Rutherford
Managing Editor
Journal of pharmacy Practice and Education