What is intensive care following surgery?

Children who need close or specialized monitoring will spend time in the pediatric intensive care unit (PICU) or neonatal intensive care unit (NICU), depending on their age. Intensive care is needed for children who have had certain types of major surgery. These include heart operations, organ transplants, or neurosurgery. After some surgeries, your child may remain on a breathing machine and have special monitoring lines that measure pressures in major veins or arteries. In the ICU, your child will be closely watched 24 hours a day and cared for by specialized healthcare providers.

Learning about the ICU's equipment

ICUs are equipped with complex machines and monitoring devices designed for the unique needs of children who have had surgery and those who are critically ill. Equipment may include the following:

• Cardiorespiratory or heart monitor. This monitor continuously displays your child's heart and breathing rate. Wires from the monitor are attached to sticky patches on the skin of your child's chest and belly.

• Blood pressure monitor. Blood pressure is measured using a cuff placed on your child's arm or leg. Periodically, a blood pressure monitor pumps up the cuff and measures the blood pressure. Some children need continuous blood pressure monitoring. This can be done using a small catheter (small tube) placed in one of your child's arteries.

• Pulse oximeter. This machine measures the amount of oxygen in the child's blood through the skin. A tiny light is taped or connected to the child's finger, ear, or toe. A wire connects the light to the monitor which displays the percentage of oxygen in your child's red blood cells.

• Transcutaneous oxygen or carbon dioxide monitor. This machine measures the amount of oxygen and carbon dioxide in your child's skin. A small, circular pad is attached to the child's skin, most often on the chest or belly. The pad warms a small area of skin underneath and measures oxygen, carbon dioxide, or both. A wire connects the pad to the monitor and displays the levels. Because the transcutaneous monitor heats the skin, it may leave a temporary reddened spot on the skin. The pad must be moved to different places on the skin every few hours.

• X-ray. Portable X-ray machines are brought to the child's bedside in the ICU as needed. X-rays are taken for many reasons. These include checking placement of catheters and tubes, looking for signs of lung problems or bowel problems.

• Endotracheal tube (ET tube). This tube is placed through the child's mouth or nose and into the windpipe (trachea). The ET tube is held in place with tape or a tube holder, and is connected with flexible tubing to a breathing machine (mechanical ventilator). Because the ET tube is uncomfortable, your child will be sedated. Their wrists also might be restrained to prevent them from pulling the ET tube out. Your child will be unable to speak while the ET tube is in place. This is because the vocal cords are unable to vibrate and make sounds with the tube in place. This is temporary and your child will regain their voice after the ET tube is removed. Your child may be temporarily hoarse, or have a sore throat.

• Chest tube. This is a plastic hollow tube placed between the ribs into the chest cavity to drain blood, fluid, and air from the space around the lungs.

• Breathing machine (respirator or mechanical ventilator). This machine helps children who are unable to breathe on their own. This problem may be due to medicine that causes your child to be sedated. The machine may also be used for a child who needs help taking bigger or more effective breaths due to illness. Ventilators can also deliver extra oxygen, if needed.

• IV (intravenous) pumps. IV pumps deliver fluids, feedings, and medicines in very accurate amounts, through catheters into the veins.

• Foley catheter. This is a thin hollow tube placed in the bladder to drain urine. This tells the nurse how well your child's kidneys are functioning. The nurse will measure the amount of urine the child is making. .

How often will I be able to visit in the ICU?

Ask someone on your child's healthcare team when you first arrive about visiting hours. If needed, ask about services provided to families (such as social workers or chaplains, child life specialist, and phone numbers to call from home) when you can't be there with your child. Many pediatric ICU's encourage a parent to be at the bedside as much as possible. Check with the staff about visiting your child.

Will other healthcare providers be seeing my child in the ICU?

Your surgeon may ask other specialized healthcare providers to help manage your child's care while in the ICU. These specialists may include:

• Pulmonologists (who manage breathing or lung problems)

• Anesthesiologists (who help manage pain)

• Critical care medicine healthcare providers (who help coordinate your child's care when many healthcare providers are involved, and watch for complications that might arise after surgery)

What can I do for my child while they're in the ICU?

Even if your child is receiving medicine to control pain or help them sleep, your child needs to know you're there. The healthcare team that is caring for your child will be happy to suggest ways that you can comfort your child at every stage of recovery. They'll also welcome suggestions from you about how to make your child feel more comfortable and secure. A child life specialist can be a great resource for showing you and your child relaxation and pain management skills. Ask the ICU staff if you can do any of the following for your child while they're in the ICU:

• Touch your child and talk to them in soft, soothing, reassuring tones.

• Bring your child's favorite music from home.

• Record your family reading your child's favorite story.

• Place pictures of your family, child's friends, or family pets where your child can see them.

• Bring 1 or 2 items from home that help your child feel secure. These could include a favorite stuffed animal, a soft blanket, a special cup to drink out of, or a pacifier.