For outside providers
Admission & Transfer Center
319-384-5000 or 1-866-890-5969
PICU staff offices
*** Please contact if interested in outreach education
*** Please contact for information regarding admitted patients
For internal providers
3433 = PICU fellow
3924 = PICU resident on call
3210 = Transport team
3920 = In-house floor senior
5678 = Peds Chief resident
3205 = Radiology resident (nights)
3911 = Urgent airway/Anesthesia
3268 = Neurosurgery resident on call
3792 = Neonatology Fellow
64300 – PICU Pharmacy
63527 – Core Lab
62591 – Microbiology Lab
NOTE: The pediatric critical care reference guide has been formatted for brevity. For more information, please review the PICU Charts.
|Toddler||10||1-2 or 1.5 Wis-Hipple||4.5|
Depth of ETT
- Newborn: 6 + weight (kg)
- Others: 3 X size of ETT
Size of ET tube
- Uncuffed tube: (Age/4) + 4
- Cuffed tube: (Age/4) + 3
Microcuff pediatric ETT (Green adapter) recommend size selection
|Tube Size ID||Age (Yrs)|
|3.5||8 mo to < 2yrs|
|4||2 to < 4 yrs|
|4.5||4 to < 6yrs|
|5||6 to < 8yrs|
|5.5||8 to <10 yrs|
|6||10 to < 12 yrs|
|6.5||12 to < 14 yrs|
|7||14 to < 16 yrs|
Please see PICU Common Medications page for general guidelines for drug choices for rapid sequence intubation.
PT with spontaneous respirations
- Monitor clinical status closely (WOB, anxiety, single breath count, airflow, mental status, pulse pressure, pulsus paradoxus)
- Do NOT intubate based on blood gas
- Silent chest - no air flow or pneumothorax
- Poor air movement - may be sign of impending respiratory failure
- Normal or high pCO2 in a tachypneic pt - may be sign of early muscle fatigue and impending respiratory failure
- Allow permissive hypercarbia (pH > 7.25)
- Use low respiratory rates and short inspiratory times to minimize hyperinflation and air trapping
- Ensure each breath returns to baseline
- Maintain adequate oxygenation
- PEEP settings controversial - consider low PEEP (0-5) because pt is already hyper expanded versus matching pt's auto PEEP on the ventilator
General management principles
- Hydration - pt will need fluid resuscitation because has been hyperventilating and has increased insensibles
- Continuous albuterol - use 0.25-0.5 mg/kg/hr (usually 10-20 mg/hr). May need to do back-to-back nebs while waiting for pharmacy and RT to set up
- Oxygen - use as carrier for nebulizer, will not suppress respiratory drive
- Steroids - give 2 mg/kg methylprednisolone as a bolus, then start 0.5 mg/kg Q 6 hrs
- My bolus - give 25-40 mg/kg bolus (over 30 minutes), may repeat if needed. Thought to help relax smooth muscle
- Sub-Q Epinephrine - Beta-agonist, often used if no IV access. Dose is 0.01 mg/kg of the 1:1000 soultion
- Terbutaline (Beta-agonist) - continuous infusion, typical dosing range 0.5-2 mcg/kg/min
- Ipratropium bromide (anti-cholinergic) - usually Atrovent 2 puffs Q 4-6 hrs
- Theophylline (methylxanthine) - give loading dose, followed by continuous infusion. Monitor levels (goal 10-20)
- Heliox - used to reduce air flow resistance in small airways, limited by degree of hypoxemia in pt. 70/30 or 80/20
- Ketamine - if sedation is needed, preferred drug due to bronchodilating properties, typical dosing range 0.1-2 mg/kg/hr
- Zithromax - most common infectious trigger for asthma is Mycoplasma or Chlamydia pneumoniae
- Anesthesia (inhaled anesthetics) and ECMO (VV) (for refractory cases)
Critical care primary authors
Sarah Haskell, DO
Sameer Kamath, MD
Clinical Assistant Professor, Medical Director of PICU
Keala (Dewey) Clark, MD
Clinical Assistant Professor
- Randall Grout
- Rose Lee
- Steven McGaughey
- Elizabeth Pitts
- Josie D’Agostino
- Gregory Johnson
- Nola Riley
- Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney International (2007) 71, 1028-1035.
- Annich, Lunch, MacLaren, Wilson, and Bartlett. ECMO Extracorporeal Cardiopulmonary Support in Critical Care. USA: Extracorporeal Life Support Organization, 2012.
- Chang, Hanley, Wernovsky, and Wessel. Pediatric Cardiac Intensive Care. Baltimore: Lippincott Williams & Wilkins, 1998.
- Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Critical Care Medicine (2008) 36(4): 1394-6.
- Helfaer, Nichols. Rogers' Handbook of Pediatric Intensive Care. Philadelphia: Lippincott Williams & Wilkins, 2009.
- Gunn, Nechyba. The Harriet Lane Handbook. Philadelphia: Mosby, 2002.
- Rollings, Robert. Facts & Formulas. USA: Rollings, 1984.
PICU Handbook disclaimer
All information contained on the uichildens.org PICU Handbook is intended for informational and educational purposes only. These guidelines are not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific pediatric medical question or condition.
This information should not be considered complete, nor should it be relied on in diagnosing or treating a medical condition. Content on this website does not contain information on all diseases, ailments, physical conditions or their treatment.