Introduction

This book is intended for an audience whose main preoccupation is the care of adults, but it seems very appropriate to include a chapter on children. Until the early 1990s, it was not unusual for children in the United Kingdom to be managed on intensive care units for adults. With the development of neonatal intensive care units (NICUs), and more recently paediatric intensive care units (PICUs), this situation is now extremely rare. However, neither NICUs nor PICUs are available in every hospital, and children will continue to become ill, occasionally critically so, wherever they happen to be. Staff may therefore be called upon to manage infants or children with respiratory failure, often unexpectedly, at almost any time. In this chapter we will attempt to outline the major differences that need to be considered when faced with neonates and children who require mechanical ventilation. It is not a comprehensive text but more of a taster, looking at the anatomy, physiology and some particular examples of paediatric care.

Anatomy

Lung development occurs early in gestation, but maturation of the alveoli and surfactant production only commence in the third trimester, and this generally limits respiratory viability to infants of 23 weeks gestation or more. At this stage, the lungs are in the canalicular stage (17 to 27 weeks gestation), and the acinar gas exchange units are just beginning to form at the end of each terminal bronchiole.