The Society of Critical Care Medicine (SCCM) and the American Academy of Pediatrics (AAP) have jointly released a set of updated recommendations that define new categories for ascending levels of pediatric intensive care unit (PICU) care for infants and children, including team structure, technology, education and training, academic pursuits, and indications for transferring patients to a higher level of care. Building on previous classifications, the statement proposes three levels of units providing care for critically ill infants and children:
- Community-based PICUs (previously categorized as level II), mainly located in general hospitals. Community PICUs are further classified as rural, suburban, or urban and academic versus nonacademic.
- Tertiary PICUs (previously categorized as level I), capable of providing advanced care for critically ill children with a wide range of medical and surgical conditions.
- Quaternary PICUs, a new category of PICUs providing comprehensive care to all children with complex conditions. These units may be found in children's hospitals, but also in specialized general hospitals. Some quaternary PICUs provide specialized care for conditions such as cardiovascular disease, transplantation, trauma, and cancer.
The full evidence-based statement – which updates the 2004 American Academy of Pediatrics/Society for Critical Care Medicine PICU guidelines –is published in the September issue of Pediatric Critical Care Medicine
. An executive summary is also published in the journal Pediatrics