Pediatric Critical Care Pioneer to be Honored for Lifetime Achievement

John J. Downes, MD, will be honored for his pioneering contributions to the development of pediatric critical care when he receives the Society of Critical Care Medicine’s (SCCM) Lifetime Achievement Award during the 39th Critical Care Congress in Miami Beach, Florida, USA.

While training as an anesthesiologist, Downes followed a clinical and research interest in respiratory distress syndrome in infants and children. He went on to co-found what is believed to be the nation’s first pediatric intensive care unit (PICU) at Children’s Hospital of Philadelphia (CHOP) in 1967. He directed the unit until 1972, when he became head of the hospital’s Department of Anesthesiology and Critical Care Medicine.

Typical of his modesty and team focus, Downes was quick to acknowledge the colleagues who shared his passions. “My contributions were not individual but made with other people,” he noted. “I just happened to be in the right place at the right time for my particular area of interest.” Among those Downes noted were his supervisor, Leonard Bachman, MD, and colleague Russell Raphaely, MD, FCCM, now at the Nemours Foundation in Wilmington, Delaware, USA.

Downes had the vision to recognize an unmet need and the benefits of concentrating pediatric patients in a single unit where a specialization could be developed. He also possessed the persistence to make it happen, Bachman said. “Jack was the primary mover. He saw these newborns who needed ventilator support, and that was the beginning of how to care for them on a specialized unit.”

The personal and professional qualities for which Downes is extolled by his peers and colleagues are captured in qualities such as meticulousness, integrity, diligence, ingenuity, pragmatism, vision and natural leadership. “Jack found a way to work within an entrenched system and pull together disparate parts into a well-oiled machine,” observed George Lister, MD, chair of pediatrics at Southwestern Medical School in Dallas, Texas, USA. “He had the skill to work with multiple individuals and the passion not to let go of what he wanted for his patients – qualities that engendered trust and respect. He deserves a lot of credit for the development of pediatric critical care. I would see him as someone who stood a little taller.”

Mark Helfaer, MD, FCCM, professor of critical care medicine at CHOP, recalled that one of Downes’ key insights was that translating adult critical care concepts to children involved more than just downsizing the technology. It also meant creatively adapting adult approaches to children’s unique physiology, recognizing that children are not simply miniature adults.

After Loyola University School of Medicine in Chicago, Illinois, and an internship at the University of Indiana, Downes spent two years in the Division of Indian Health in the U.S. Public Health Service, practicing in a reservation hospital in Washington state. There, he met John Bonica, MD, a renowned anesthesiologist who encouraged him to complete his residency at the University of Pennsylvania.

During a residency rotation at CHOP, Downes began to see the need and the opportunity for extending the technical skills of the anesthesiologist to the care of children. He joined the staff of CHOP in 1963. A 1964 research grant from the National Institutes of Health to study respiratory failure in premature infants allowed him to travel to Europe to visit their emerging intensive respiratory units. All of these experiences culminated in CHOP’s pioneering PICU.

The unit filled quickly and “as we reduced the mortality for these infants, a troubling new problem emerged,” Downes recalled. Babies who formerly would not have survived could be kept alive with ventilator support, but some would need that support long term, perhaps for years. Downes obtained funding to establish the Pennsylvania Ventilator-Assisted Children’s Home Care Program in 1979. He continues to serve as its medical director, training other professionals and making home visits to patients.

Downes stepped down from administrative responsibilities at CHOP in 1996 but still teaches and mentors medical students. He has authored more than 100 research papers and book chapters on pediatrics and critical care and has trained more than 250 subspecialists in the field. He was a founding board member of SCCM and was involved in the 1981 creation of the Society’s Pediatrics Section. The American Association of Pediatrics honored him with its 2nd Distinguished Career Award in Pediatric Critical Care in 1996.

Downes and his wife, JoAnn Splon Downes, MSW, have four adult children and six grandchildren. Downes continues to enjoy outdoor activities such as running, snowshoeing and fishing. He is active in Physicians for Social Responsibility and in writing papers on medical history.