• paediatric critical care
• organisation

The paediatric critical care landscape has changed since the 1997 report, Framework for the future,1 which called for a more rigorous organisation of paediatric critical care. We have got better at helping children survive their critical illness as well as preventing critical illness in the previously well child. Critical illness secondary to serious infections has reduced as a result of vaccinations and with public health interventions, we see less children with severe traumatic brain injury.

Large-scale changes were made in organisation and expectations of practitioners and, therefore, it is not unreasonable to take stock and reassess. The Review of Paediatric Critical Care and Specialist Surgery2 aims to develop a sustainable and high-quality model for provision of paediatric critical care and the interlinked paediatric specialised surgery and extracorporeal membrane oxygenation (ECMO).

One area of concern is that paediatric critical units in Wales, England, Scotland, Northern Ireland and the Ireland contribute to an emerging picture of increased activity with increased survival but also to a population with a prolonged length of stay ultimately ending in death.3 4

In 2016, the combined 32 paediatric critical care units admitted 20 320 children of which 13 060 received invasive ventilation, 3246 non-invasive ventilation (NIV), 255 ECMO, 6469 vasoactive medication, 32 left ventricular assist device (LVAD), 364 intracranial pressure (ICP) monitoring, 589 renal support, 321 tracheostomies and 3361 high flow nasal cannula (HFNC) oxygen with an overall mortality of 3.4%.3

This compares to 2006 when 14 328 admissions were described across 25 trusts in England, Wales and part of Scotland. Then 9857 children received invasive …