Learning About Breathing Support in the Pediatric Intensive Care Unit (PICU)

How does breathing support work in the PICU?

A PICU is a part of the hospital where children who are very sick get care. Sometimes this care may include helping your child breathe.

The PICU has special equipment to help your child breathe, such as:

• A ventilator. This is a machine that breathes for a child who has trouble breathing. It sends oxygen or air into the lungs through a thin tube and allows carbon dioxide to escape. The tube is placed in the windpipe through the nose or mouth. If a child needs the ventilator for a long period of time, the surgeon may place the tube in an opening made directly into the windpipe through the neck. This is called a tracheostomy, or "trach" (say "trayk") tube. The tube is placed in the opening.
• A continuous positive airway pressure (CPAP) machine. This gently pushes oxygen or air into the lungs through a mask over the nose or mouth. It may be used when a ventilator isn't needed.
• A nasal cannula. This has two prongs that are placed in the nostrils when a child just needs more oxygen. The oxygen goes through the tubes and into the nostrils.
• An oxygen mask. Oxygen flows through a tube and into a mask that is placed over the nose and mouth.
• An oxygen tent or hood. An oxygen tent helps small children get enough oxygen. An oxygen hood does the same for babies. They may help keep the air warm and moist.

The equipment that helps your child breathe may need to be adjusted a lot. If you have questions about breathing support, the PICU staff can help explain the different types of equipment and how they work.

The PICU staff can use other devices to check breathing, heart rate, and oxygen levels.

• A heart monitor has a sensor that attaches to the chest to track heart rate.
• A pulse oximeter is put on the earlobe or on the end of a toe or finger. For babies, it may be put on the palm or foot. It measures how much oxygen is in the blood.
• An arterial line is a thin, flexible tube that's placed into an artery. This line is usually placed in the wrist or groin. It can take blood samples to measure the oxygen and carbon dioxide in the blood. (It can also measure blood pressure.)

What can you expect?

Over time, a child in the PICU may not need as much breathing support. As a child gets stronger, the doctor may move (or wean) the child from a ventilator to a CPAP machine. A child may then be moved to a mask or nasal cannula with oxygen, and finally to breathing without the need for help.

You may see tubes and wires attached to your child. This can be upsetting to see. But these things help the doctor treat your child.

The tubes supply air, fluid, and medicines to your child. The wires are attached to machines that help the doctor keep track of vital signs. These include temperature, blood pressure, breathing rate, and pulse rate.

Ventilators and other equipment have alarms that alert the care team to any sudden changes. Usually an alarm just means that something needs to be adjusted. The care team may come in and check on it. If you have questions about any alarms, you can ask a PICU staff member.

The PICU staff is highly trained to care for children who are very sick. They will do everything they can to help. If you need it, ask for support from friends and family. You can also ask the hospital staff about counseling and support.