PICU Basics

By PICUlearn · Published 21 Sept 2026

A beginner course for anyone starting in paediatric intensive care, in any country: doctors, nurses, physiotherapists and advanced practitioners. It covers the principles every PICU shares: how the team works, monitoring, airway and ventilation, common conditions, recognising deterioration, and looking after families and yourself, with guidance from the UK and internationally side by side.

1. 1Welcome and how to use this coursePICU Basics is a fifteen-module introduction for anyone beginning work in paediatric intensive care, in any profession and any health system. This first module explains who the course is for, what it covers, how it sits alongside your local induction and supervision, and how the modules, quizzes, final assessment and certificate work.
2. 2How a PICU works: people, roles, rhythms of the dayThis module introduces the people who make up a paediatric intensive care team and how they work together through the rhythms of a PICU day: handovers, ward rounds, huddles and shared goals. It explains how job titles differ between countries, how tasks are shared when staffing is limited, and how to ask for help and speak up safely. Knowing who does what, and how to reach them, is one of the fastest ways to become useful in your first weeks.
3. 3Monitoring: what the numbers meanThis module introduces the everyday monitoring used in paediatric intensive care: ECG, pulse oximetry, blood pressure, arterial and central venous lines, end-tidal CO2, temperature, urine output and fluid balance. It explains what each number does and does not tell you, how normal values change with age, and how to read trends alongside the child in front of you. It also covers alarms, common artefacts and how to monitor well when invasive devices are not available.
4. 4Airway basics and the intubated childThis module explains how the infant and young child's airway differs from an adult's, why cuffed endotracheal tubes are now widely used, and how tubes are secured, checked and cared for. It covers the DOPE approach to sudden deterioration in a ventilated child, safe suctioning and humidification, and recognising accidental extubation, including how these principles apply where monitoring and equipment are limited.
5. 5Ventilation basicsThis module explains why children need mechanical ventilation, how pressure and volume targeted breaths differ, and what each of the main settings actually does. It also covers reading the ventilator screen, linking a blood gas to the settings in front of you, recognising readiness to wean and extubate, and the range of non-invasive support including bubble CPAP where resources are limited.
6. 6PARDS and respiratory failureThis module explains how respiratory failure presents in children, what paediatric acute respiratory distress syndrome (PARDS) is and how it is defined in principle by the PALICC-2 consensus, and why the lungs are vulnerable to further injury from ventilation itself. It covers lung-protective ventilation, the oxygenation and saturation indices, adjuncts such as prone positioning, and the role of fluid balance. These are among the commonest reasons children are admitted to PICU anywhere in the world.
7. 7BronchiolitisBronchiolitis is one of the commonest reasons small infants are admitted to paediatric intensive care anywhere in the world, and most of the work is supportive: oxygen, careful respiratory support, and attention to feeding and fluids. This module explains the pathophysiology, who is at higher risk, how to assess severity and trends, and the ladder of respiratory support from nasal oxygen to invasive ventilation. It also covers what good bronchiolitis care looks like when oxygen and ventilators are scarce.
8. 8Sedation and analgesiaSedation and analgesia keep critically ill children comfortable, safe and able to tolerate intensive care, but too much or too little carries real harm. This module covers how comfort and pain are assessed, the main drug classes used, iatrogenic withdrawal and delirium screening, and the non-drug measures and family presence that underpin all of it.
9. 9Fluids, lines and accessThis module covers the principles of fluid therapy in critically ill children, including why isotonic maintenance fluids are now recommended internationally, how to think about fluid balance and fluid overload, and the main routes of vascular access used in PICU. It also covers the daily work of caring for lines and preventing line infections, and what the FEAST trial taught us about fluid boluses in resource-limited settings.
10. 10Procedures you will see: airway and breathingThis module walks through the airway and breathing procedures you are most likely to see in your first weeks in PICU: tracheal intubation, planned extubation, chest drain insertion and care, flexible bronchoscopy and tracheostomy care including tube changes. For each one it explains the purpose, how the child and family are prepared, who does what in the team, the safety steps and what to watch for afterwards. It is orientation reading only: it explains what happens and does not replace supervised, hands-on training with your unit's own checklists and competencies.
11. 11Procedures you will see: lines, access and other proceduresThis module walks through the procedures you will see most often in PICU: peripheral and ultrasound-guided cannulation, intraosseous access, central venous and arterial lines, lumbar puncture, nasogastric tubes and urinary catheterisation. For each it covers the purpose, preparation and consent, positioning and comfort, team roles, safety steps, and what to watch for afterwards. It explains what happens so you can contribute safely as part of the team; it does not replace supervised, hands-on training and local competency sign-off.
12. 12Shock and sepsisThis module explains the main types of shock in children and how they present, how to recognise sepsis early using the Phoenix sepsis criteria (2024) and national tools such as NICE NG51, and the principles behind the Surviving Sepsis Campaign paediatric guidelines (2020), including their different advice for settings with and without intensive care. It focuses on early antibiotics, cautious fluid resuscitation with reassessment, vasoactive support and monitoring the response. Recognising shock before blood pressure falls is one of the most useful skills you will learn in PICU.
13. 13Status epilepticus and the neurological patientThis module covers how to recognise status epilepticus in a child and the shared logic behind stepwise seizure algorithms such as APLS and PALS, without any doses. It also covers neurological assessment using GCS and AVPU, the signs of raised intracranial pressure, the principles of neuroprotective care, and how common causes differ by region.
14. 14DKA and metabolic emergenciesThis module explains how diabetic ketoacidosis develops, how it is recognised and how it is managed in principle, following national guidance such as the BSPED DKA guideline alongside international ISPAD guidance. It also covers the warning signs of cerebral injury, the approach to hypoglycaemia, and the electrolyte problems that arise in DKA and other metabolic emergencies. Because DKA management is highly protocol driven and thresholds differ between units, the focus here is on the reasoning behind each step rather than on any set of numbers.
15. 15Recognising deterioration and escalatingThis module covers how deterioration is recognised early in children, using paediatric early warning scores as a safety net alongside clinical judgement and family concern. It explains structured handover with SBAR or ISBAR, escalation pathways, speaking up, human factors, and triage approaches such as WHO ETAT where resources are limited. Recognising and communicating deterioration clearly is one of the highest value skills a new PICU team member can learn.
16. 16Communicating with familiesThis module covers how to talk with families in PICU: building partnership, giving regular clear updates, sharing uncertainty honestly and preparing for difficult conversations. It also covers working with professional interpreters, the principles of consent and shared decision-making across different legal systems, supporting siblings, and respecting cultural and spiritual needs.
17. 17Looking after yourself in PICUPICU is emotionally and physically demanding, and strong reactions to difficult work are normal rather than a sign of weakness. This module covers moral distress, debriefs, sleep and shift work, peer support and how to recognise when you or a colleague needs more help. It closes the course by pointing you towards continued learning.