Why I Fear High-Risk Procedures and Technologies in the Pediatric ICU

Tools of the Trade

Pediatric intensivists have been trained to perform life-saving procedures and provide children with the utmost life support technologies when they suffer from critical illness. If an infant, child, or adolescent suffers from respiratory failure, a breathing tube is placed in their windpipe (trachea) and attached to a mechanical ventilator to assist with breathing. There are machines to replace the kidneys if they should fail. There is even a machine, called ECMO (extracorporeal membrane oxygenation), to support the heart and lungs if they should be severely injured. The ECMO machine takes blood out of the body and puts it back into the body via a circuit of tubes to generate life-sustaining blood pressure after oxygen has been added and carbon dioxide has been removed. There is a litany of tubes, catheters, and other equipment that is used to sustain life in the pediatric intensive care unit. While I am comfortable with all these technologies and devices due to my training and experience, they also scare me.

Facing Fear

The fear of performing procedures or using technologies and devices does not lie in the act of performing the procedures or the actual use of the technologies, but in why we perform them or use them. The fact that an infant, child, or adolescent has gotten to the stage where they need intensive care procedures or technologies means that their body is compromised to the point where they can’t survive without the interventions. At that point, the stakes are raised, and the risk of death or disability is significantly elevated. My fear lies in the severity of the disease at hand.

The Balancing Act

Also, the greater the severity of the disease, the riskier it is to perform the procedure or use the technology as well. So, the procedure or technology is needed to improve survival, but there is also a risk of making things worse. However, there isn’t much of a choice at the time. It is the double-edged sword of medicine. It is where risks and benefits are weighed. Doing these procedures or using these technologies in healthy individuals doesn’t have the same risk. But, nobody is performing these procedures or using these technologies when someone is well.

The Sobering Reality

The illness is what scares me. The opportunity to navigate one’s health through the rocky waters of critical illness is an awesome responsibility. Procedures and technologies are but a small part of the journey. The bigger part is the coordination of complex care and managing the unpredictability of critical illness. Textbooks and articles are written, and the information is used to chart the proper course of action. But, ultimately, all we can do is support the body as it heals. The fear is not paralyzing, but it causes one to be extra vigilant and have a healthy respect for the disease process. The last thing that we want to do is underestimate the disease. Ultimately, as pediatric intensivists, our greatest fear lies not in the procedures or technologies, but in the sobering realization that despite our expertise, the outcome of critical illness remains beyond our complete control.

Have you encountered similar feelings of fear in your own professional life? If so, how has it affected your perspective?