Patient Care Vignette
Twelve-year-old Maya wasn’t quite herself at her Saturday soccer game, complaining of headache. The next morning she couldn’t walk to the bathroom. Her parents took her to the emergency department where her symptoms worsened. By early Monday, Maya had difficulty breathing. She was quickly transported to the nearest pediatric intensive care unit (PICU) across the state border. Upon arrival, she was intubated and found to be completely paralyzed with the exception of the ability to open her eyes. Initially, Maya’s differential diagnosis included a paralysis recently seen among children in the western United States who had been infected with Enterovirus d68 as well as Guillain-Barre syndrome (GBS). Even after confirmation of a diagnosis of atypical GBS, Maya’s family faced uncertainty about her long-term prognosis. The medical team told them that Maya might not regain function of her arms or legs. Maya’s family, school, and church communities were instrumental in supporting Maya and her family during their arduous journey, taking turns to stay with Maya’s siblings while her parents juggled being at the hospital, work, or home.
The medical team was also tireless; after several courses of plasmapheresis and intravenous immunoglobulin treatment in tandem with ongoing physical, occupational, and speech therapy, Maya slowly regained the ability to move. After a few weeks in the PICU, she underwent tracheostomy tube placement to facilitate chronic mechanical ventilation support, ongoing therapies, and discharge to a rehabilitation facility. After 1 month, she was discharged home, and within 6 months, Maya made a full physical and psychological recovery—walking without assistance, undergoing tracheostomy decannulation, playing soccer again, returning to school, and eventually graduating from high school on time with plans to attend college. Her parents and siblings were also able to resume work and return to leisure routines that had been interrupted and put on hold during Maya’s PICU admission and lengthy recovery.
Children admitted to the PICU have experienced life-threatening critical illness or injury. Stories like Maya’s illustrate the fundamental importance of the multiprofessional team in healthcare. Each team member has a pivotal role in supporting the child and family, contributing to their care, and facilitating recovery. With a shortage of intensivists and the increasing medical complexity of patients, the core PICU team is dependent not only on intensivists and nurses but advanced practice providers (e.g., physician assistants, nurse practitioners, hospitalists, etc.), pharmacists, therapists (respiratory, physical, occupational, and speech-language), dietitians, social workers, case managers, and a host of other hospital-based clinicians. Professionals trained in each of those different disciplines must work collaboratively, using their diverse training and experience to address patient needs and improve care. This collaboration results in improved outcomes related to all aspects of acute care.
Critically ill children are often evaluated by a wide range of specialists during their PICU stay, making it difficult for the child and the parents to keep track of who is involved in care. Importantly, the bedside nurse commonly serves ...