Rogers Textbook of Pediatric Intensive Care

■ FOREWORD

Pediatric Intensive Care traces its origin to a time about half a century ago when the growth of sophisticated pediatric sur gery, particularly for pediatric cardiac surgery, required post operative care at a level of sophistication beyond that ever required before. Coming at a time when adult intensive care for coronary surgery and for myocardial infarction had be gun and developing when neonatal intensive care units were spreading throughout the world, it now seems that it was both logical and inevitable that Pediatric Intensive Care would be the next, easy step. That was not the case. In my own memory of having provided ventilator support for infants and small children with Harvard animal ventilators and being limited to getting arterial blood gases to twice a day, I have an equally strong memory of the resistance to creating a pediatric intensive care unit (PICU) as we know it today. There were intense battles over “whose patient, is it?” be tween pediatricians who cared for the children out of the hos pital and the new physicians who only saw them in intensive care. The same disputes occurred between pediatric surgeons who performed heroic surgery but then went back into the op erating room and were unavailable for hours. I can remember at a prestigious medical center which did pediatric open heart surgery that all members of the surgical team went back to the operating room and post-op care was supervised by senior medical students.

Nor were the battles merely about patients. Many were about money. Who would bill for the care in the PICU? The physician or surgeon with the primary relationship to the patient or the specialist who provided the care in the PICU? What training should those specialists have, pediatrics, anes thesiology, both, or other? Should there even be a specialty? There was intense opposition to the proliferation of “too many new specialties” and many senior medical leaders were opposed to any new specialties such as upstarts like Pediatric Intensive Care and Emergency Medicine. Of course, in the end, Pediatric Intensive Care survived and thrived, and this 6th edition of the Rogers’ Textbook of Pedi atric Intensive Care is testimony to it. Its use throughout the world is now done both by distribution of the physical book and by internet. We hope that, just as the specialty of Pediatric Intensive care has evolved, grown, and matured over the de cades, this new edition of the textbook has done the same and remains as useful to you as it was when it was first published. Mark C. Rogers, MD, MBA Professor Emeritus Former Chair Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore, Maryland

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