Intensive care units

The goals of intensive care and palliative care teams may at first seem to be polar opposites. The one focuses on advanced technologies directed towards saving or prolonging life, while the other focuses on providing comfort and support, accepting death as a likely outcome. In caring for patients in the paediatric intensive care unit (PICU), however, those two teams are brought into a close working relationship. PCIU provides a natural interface for these teams with different goals. Here children and families face potential or inevitable death, and alongside attempts to save or prolong life, they need access to the kind of care that is at the heart of palliation. Where PICU and palliative care meet, children can receive the most advanced technology alongside skilled, holistic, supportive care, and both teams can work together with families to facilitate appropriate support as goals change. Palliative care is not a separate or different approach, but a continuation of the philosophy that medicine must only intervene in ways that will do more good than harm. Palliative care continues to be integrated into the care of patients and families in both the neonatal and PICU settings. With focused research aimed at healthcare service delivery, effective symptom management, and the role of palliative care consultants in the PICU, the potential to broaden and improve palliative care in the PICU will be further advanced for all children and their families. The surprise is not that these two services should be integrated, but rather that it has taken us so long to realize the importance of such integration.