Rogers Textbook of Pediatric Intensive Care
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Autor: Donald H. Shaffner MD, John J. McCloskey MD, Elizabeth Anne Hunt, Robert C. Tasker MBBS, MD, FRCP.
Editura: LWW
Limba: Engleza
Nr. pagini: 2288
Coperta: Hardcover
Dimensiuni: 213 x 276 mm
An aparitie: 6 oct 2023
Description:
Long recognized as the leading text in this dynamic field, Rogers’ Textbook of Pediatric Intensive Care provides comprehensive, clear explanations of both the principles underlying pediatric critical care disease and trauma as well as how these principles are applied. Led by Drs. Donald H. Shaffner, John J. McCloskey, Elizabeth A. Hunt, and Robert C. Tasker, along with a team of 27 section editors as well as more than 250 expert global contributors, the fully revised Sixth Edition brings you completely up to date on today’s understanding, treatments, technologies, and outcomes regarding critical illness in children.
Table of Contents:
PART ONE ■ CRITICAL CARE INTEGRATION
Section I ■ Introduction to the Practice of Pediatric Critical Care
Chapter 1 Pediatric Intensive Care: A Global Perspective
INTRODUCTION
IMPROVEMENT IN GLOBAL CHILD HEALTH OVER THE LAST FEW DECADES
CAUSES OF GLOBAL CHILD MORTALITY
THE WORLD HEALTH ORGANIZATION APPROACH TO IMPROVING THE QUALITY OF HOSPITAL CARE FOR CHILDREN
ETHICS OF PROVIDING PEDIATRIC INTENSIVE CARE IN LOW- AND MIDDLE-INCOME COUNTRIES
EXPERIENCES OF PEDIATRIC INTENSIVE CARE IN LOW- AND MIDDLE-INCOME COUNTRIES
Regionalization or Decentralization
THE ROLE OF PEDIATRIC INTENSIVE CARE IN COMPLEX EMERGENCIES AND THE LESSONS LEARNED FROM COVID-19
Lessons From COVID-19
Pediatric Intensive Care and Interconnectivity—Opportunities for Health Care and Education
THE STATE OF THE WORLD’S CHILDREN
CONCLUSION
Chapter 2 Impact of Pediatric Critical Care on the Family, Community, and Society
PATIENT-CENTERED AND FAMILY-PARTNERED CARE
Family Structure and Function
Dimensions of Patient-Centered and Family-Partnered Care
Communication Skills and the Therapeutic Alliance
Parental Satisfaction Surveys and Quality Improvement
RECOVERY AND REINTEGRATION AFTER CRITICAL ILLNESS
Discharge Planning
Post–Intensive Care Syndrome—Pediatrics
Physical Aspects of Recovery and Reintegration
Technologic Aspects of Recovery and Reintegration
Psychological Aspects of Recovery and Reintegration—The Child
Psychological Aspects of Recovery and Reintegration—The Family
Reintegration Into the Community
PREPARING FOR AND RESPONDING TO DEATH
Anticipating Loss
Trauma, Abuse, and Unexpected Deaths
Respecting Family Context: Cultural and Religious Considerations
Decision-making and End-of-life Care
RESILIENCE IN THE PEDIATRIC INTENSIVE CARE UNIT
Burnout and Self-Care in the Pediatric Intensive Care Unit
THE ROLE OF THE PEDIATRIC CRITICAL CARE PROFESSIONAL IN SOCIETY
Diversity and Ethnicity
Health Disparities
Social Determinants of Health and Health Care Inequity
Health Disparities in the Pediatric Intensive Care Unit
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENTS
Section II ■ Professionalism, Leadership, and Systems-Based Practice
Chapter 3 Diversity, Equity, and Inclusion
INTRODUCTION
COMPOSITIONAL DIVERSITY OF THE PEDIATRIC CRITICAL CARE MEDICINE WORKFORCE
PATIENT-LEVEL DIVERSITY, EQUITY, AND INCLUSION
THE FIERCE URGENCY OF NOW
CONCLUSION
Chapter 4 Professionalism and Leadership in Pediatric Critical Care
PROFESSIONALISM
Professionalism Standards
Personal Attributes of Medical and Other Health Care Professionals
Teaching Professionalism
LEADERSHIP
What Is a Leader?
Leadership Training
Leading Multidisciplinary Teams
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 5 Simulation Training and Team Dynamics
INTRODUCTION
SIMULATION TRAINING
Scenario Design and Delivery
Performance Analysis and Feedback
Application of Simulation Across Health Care Settings Globally
TEAMWORK DYNAMICS
Key Definitions
Teamwork Competencies in Critical Care
Improvement Strategies
SIMULATION-BASED TEAM TRAINING
Delivery Site for Simulation-Based Team Training
Simulator Fidelity
Simulation Scenarios
Providing Feedback
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 6 Pediatric Intensive Care Unit Organization and Physical Design
HISTORY OF PEDIATRIC INTENSIVE CARE UNIT
REGIONALIZATION OF PEDIATRIC CRITICAL CARE SERVICES
PEDIATRIC INTENSIVE CARE UNIT LEVELS OF CARE
PEDIATRIC INTENSIVE CARE UNIT POPULATION
Admission Criteria
Adults With Childhood-Onset Chronic Conditions
Pediatric Cardiac Intensive Care Units and Other Specialty Intensive Care Units
PEDIATRIC INTENSIVE CARE UNIT PERSONNEL AND STAFFING MODELS
Intensivist Credentialing and Certification
Physician Staffing Models
Advanced Practice Providers
Pediatric Intensive Care Unit Nurses
Respiratory Therapists
Pediatric Clinical Pharmacists
Other Ancillary Personnel
PHYSICAL DESIGN
Unit Architectural Design
Noise
Lighting
Electrical and Communication Requirements
Emergency Power and Water Sources
Central Areas
Storage
Family and Caregiver Areas
Additional Considerations
Green Environment
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 7 Practice Management: The Business of Pediatric Critical Care
INTRODUCTION
PERSONNEL MANAGEMENT (HUMAN RESOURCES)
Practice Membership
Communication and Cohesiveness
Development and Retention
Burnout and Wellness
FINANCE
Hospital Costs and Billing
The Framework for Professional Reimbursement in the United States
PRODUCTIVITY AND PERFORMANCE
Revenue-Based Productivity
Nonrevenue-Based Productivity
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 8 Research Design and Statistical Analysis
INTRODUCTION
STUDY DESIGN
The Research Team
Choosing a Study Design
Observational Versus Experimental Studies
Randomized Controlled Trial
Alternative Study Designs and Noncontrolled Randomized Controlled Trials
Observational Studies
Case Report
Case Series
Case-Control Study
Pre-Post Intervention Study
Cohort Studies, Registries, and Administrative Data
Systematic Reviews and Meta-Analysis
Qualitative Research
Comparative Effectiveness Research
STATISTICAL ANALYSIS
Sample Versus Population
Types of Data
Descriptive Statistics
Normal Distribution
Skewed Data and Transformation
Hypothesis Testing and Confidence Intervals
Confidence Intervals
Multiple Comparisons
Power Analysis and Sample Size Calculations
Sensitivity and Specificity
Receiver Operating Characteristic Curves
Specific Statistical Tests
Student’s t Test
Analysis of Variance
Nonparametric Tests
Chi-Squared and Fisher’s Exact Test
Correlation
Regression
Longitudinal Data
Survival Analysis
REPORTING RESULTS
COLLABORATIVE RESEARCH NETWORKS AND PLATFORMS
RESEARCH TRAINING
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENT
Chapter 9 Evidence-Based Medicine
CASE SCENARIOS
Case 2
Case 3
INTRODUCTION
GETTING STARTED: THE CLINICAL QUESTION
TYPES OF EVIDENCE 3
SEARCHING FOR THE EVIDENCE 4
APPRAISING AND APPLYING THE EVIDENCE
Therapy Article Appraisal
Prediction Article Appraisal
Cohort Article Appraisal
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 10 Quality Improvement, Patient Safety, and Medical Error
INTRODUCTION
DEFINITIONS
MEDICAL ERROR: HUMAN ERROR AND SYSTEMS
THE PEDIATRIC INTENSIVE CARE UNIT ENVIRONMENT
Impact of the Pediatric Intensive Care Unit Environment on Human Error
Workload and Fatigue
Communication
ERROR PREVENTION: SAFETY CULTURE, REPORTING, SYSTEMS ANALYSIS, CONTINUOUS QUALITY IMPROVEMENT, AND TECHNOLOGY
MEDICAL ERROR AND THE PEDIATRIC INTENSIVE CARE UNIT ENVIRONMENT
QUALITY MANAGEMENT AND RESOURCE ALLOCATION
LEGAL ISSUES AND QUALITY CONTROL IN THE PEDIATRIC INTENSIVE CARE UNIT
CONCLUSIONS AND FUTURE DIRECTIONS
Section III ■ Information Management
Chapter 11 Severity-of-Illness Measurement in Pediatric Critical Care Medicine: Foundations, Principles, Outcomes, and Applications
INTRODUCTION
HISTORICAL PERSPECTIVE
Intensive Care Unit Approaches to Severity Assessment
Pediatric Intensive Care Unit–Specific Approaches to Severity-of-Illness Measurement
Emerging Applications for Severity-of-Illness Measurement
FOUNDATIONS
DATA
EPIDEMIOLOGY
Standardized Ratios
STATISTICS
Statistics for Model Development
Model Development and Performance
Model Reliability
Model Validation
Score Performance: Discrimination and Calibration
Next-Generation Modeling: Machine Learning, Artificial Intelligence, and Neural Networks
PRINCIPLES FOR APPLYING SEVERITY-OF-ILLNESS MEASUREMENT
Outcomes
APPLICATIONS
Quality Assurance, Improvement, and Management
Clinical Research
SUMMARY
FUTURE DIRECTIONS
Resource Allocation
Future Models
Chapter 12 Clinical Informatics and Communication Technology in Pediatric Critical Care
INTRODUCTION
THE DATA ECOSYSTEM IN HEALTH CARE
Data Acquisition
Data Access
Data Storage
Data Quality
Data Standardization
CLINICAL DECISION SUPPORT SYSTEMS
Clinical Decision Support Overview and Classification
Best Practices for Clinical Decision Support Development
Clinical Decision Support Examples in the Pediatric Intensive Care Unit
TELEMEDICINE
THE ROLE OF INFORMATICS IN PATIENT SAFETY AND QUALITY OF CARE
Alarm Burden and Alert Fatigue
Technology-Driven Patient Safety Interventions
IMPLEMENTATION OF CLINICAL INFORMATICS TOOLS
Implementation
The Learning Health System
THE CLINICAL INFORMATICS PROFESSION
Clinical Informatics Education
Applications of Informatics
PROFESSIONAL SOCIAL MEDIA AND THE GLOBAL PEDIATRIC CRITICAL CARE COMMUNITY
Applications of Social Media in Pediatric Critical Care Medicine
Medical Journals and Social Media
Real-time Sharing of Clinical Experiences: Lessons From the COVID-19 Pandemic
Professional Networking and Medical Education
Advocacy
Avoiding the Pitfalls of Professional Social Media
The Road Ahead
THE FUTURE OF CLINICAL INFORMATICS AND COMMUNICATION TECHNOLOGY IN CRITICAL CARE
ACKNOWLEDGMENT
Chapter 13 Learning From Patient Data: Data Science for Critically Ill Children
INTRODUCTION
THE PROCESS OF DATA SCIENCE
Get the Data to Answer the Question
Understand the Data: Visualize, Explore, and Think
Munge the Data
Features: Generation and Selection
Machine Learning Algorithms
SIMPLE MACHINE LEARNING MODELS
CLASSICAL MACHINE LEARNING MODELS
Gradient Boosting Machines
Clustering
DEEP LEARNING
PERFORMANCE ASSESSMENT
Holdout Test Versus Cross-Validation
Importance of Data Partitioning Methodology
Comparing Performance of Multiple Models
Receiver Operating Characteristic Versus Precision Recall Curve
Looking Beyond the Area Under the Receiver Operating Characteristic Curve
MODEL INTERPRETABILITY
CONCLUSION
Section IV ■ Ethical and Palliative Concerns in the Care of the Critically Ill
Chapter 14 Palliative and End-of-Life Care in the Pediatric Intensive Care Unit
INTRODUCTION
LOCATION OF DEATH
HOME AND HOSPICE SUPPORT
PALLIATIVE CARE TEAMS
PAIN AND SYMPTOM MANAGEMENT
Analgesics
Sedatives
Nonpharmacologic Adjuncts
LIMITATIONS ON ICU INTERVENTIONS
Do Not Attempt Resuscitation Orders
Discontinuing Mechanical Ventilation
SUPPORT OF THE FAMILY
MULTIDISCIPLINARY APPROACH AND SUPPORT OF THE STAFF
BROADER PERSPECTIVE AND THE FUTURE
Chapter 15 Pain and Sedation Management
INTRODUCTION
PAIN AND SEDATION ASSESSMENT
Sedation Assessment
Protocol-Directed Sedation and Daily Sedation Interruption
PAIN AND SEDATION MANAGEMENT—GENERAL PRINCIPLES
ANALGESICS IN THE PEDIATRIC INTENSIVE CARE UNIT
Analgesics With Antipyretic Activity or Nonopioid (“Weaker”) Analgesics
Opioid Analgesics
DRUG SELECTION
Morphine
Fentanyl(s)
Hydromorphone
Methadone
Patient- and Surrogate (Parent, Nurse)-Controlled Analgesia
Preventing Opioid-Induced Side Effects
LOCAL ANESTHETICS
Pharmacology and Pharmacokinetics of Local Anesthetics
EPIDURAL ANESTHESIA/ANALGESIA
Local Anesthetic Dosage for Epidural Analgesia
Adjuvants Used in Epidural Analgesia
SEDATIVES IN THE PEDIATRIC INTENSIVE CARE UNIT
α2-Adrenergic Agonists in Sedation and Pain Management
Clonidine
Dexmedetomidine
Benzodiazepines
Diazepam
Midazolam
Lorazepam
Ketamine
Barbiturates
Propofol
INHALATIONAL ANESTHETICS
Isoflurane
THE CHALLENGING PATIENT
Neuromuscular Blockade
Succinylcholine
Nondepolarizing Neuromuscular Blocking Drugs
Reversal of Paralysis
WEANING OF OPIOIDS/SEDATIVES
Withdrawal Scales and Weaning Strategies
SLEEP IN THE PEDIATRIC INTENSIVE CARE UNIT
DELIRIUM IN THE PEDIATRIC INTENSIVE CARE UNIT 17
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 16 Ethics in the Pediatric Intensive Care Unit
ETHICS FRAMEWORKS AND LENSES
Ethical Frameworks
Value Plurality and Culture
ETHICS AND LAW
Determining Capacity/Competence for Decision-Making in the Pediatric Intensive Care Unit
Decision-Making
Laws Relevant to End-of-Life Decision-Making
MEDICAL DECISION-MAKING
Consent to Treatment
Shared Decision-Making
Decisional Autonomy
Substituted Judgment and Best Interests Standards
Shared Decision-Making at the End of Life
WITHHOLDING AND WITHDRAWING LIFE-SUSTAINING MEDICAL THERAPIES IN PEDIATRIC CRITICAL CARE
Do Not Resuscitate Orders
Doctrine of Double Effect
The Use of Paralyzing Agents at the End of Life
ETHICAL CONSIDERATIONS IN EXTRACORPOREAL MEMBRANE OXYGENATION
SPECIAL TOPICS IN CARDIAC CRITICAL CARE
Trisomy 18 and 13
Mechanical Cardiac Support
Fetal Intervention
SPECIAL TOPICS IN NEUROETHICS
Brain Death/Death by Neurologic Criteria
JUSTICE CONSIDERATIONS IN THE INTENSIVE CARE UNIT
PUBLIC HEALTH AND ETHICS IN PANDEMICS
Duty to Care
Family Presence Restrictions During a Pandemic
Need for System-Wide Planning
ORGAN DONATION
SUMMARY AND FUTURE DIRECTIONS
Chapter 17 Organ Donation
INTRODUCTION
HISTORY OF ORGAN DONATION
ORGAN DONATION AFTER BRAIN DEATH (DONATION BY NEUROLOGIC DETERMINATION OF DEATH)
Process
ORGAN DONATION AFTER CIRCULATORY DETERMINATION OF DEATH
Candidates
Process
EVALUATION OF DONOR ELIGIBILITY
Contraindications to Organ Donation
PHYSIOLOGIC CONSIDERATIONS AND MEDICAL MANAGEMENT OF THE PEDIATRIC ORGAN DONOR
General
Cardiovascular Pathophysiology
Evaluation and Management of Cardiovascular Abnormalities
Respiratory Pathophysiology
Evaluation and Management of Respiratory Abnormalities
Immune System Pathophysiology
Evaluation and Management of Inflammation
Endocrine Pathophysiology
Temperature Instability
Renal, Electrolyte, and Acid-Base Disorders
Coagulopathy
ORGAN RECOVERY AND SURVIVAL RATES
IMPACT OF CORONAVIRUS PANDEMIC
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENT
Chapter 18 Early Mobilization and Acute Rehabilitation in Critically Ill Children
INTRODUCTION AND LANDSCAPE OF ACUTE REHABILITATION IN THE PEDIATRIC INTENSIVE CARE UNIT
BASIC CONCEPTS OF PEDIATRIC ACUTE REHABILITATION
WHY IS REHABILITATION IN THE PEDIATRIC INTENSIVE CARE UNIT IMPORTANT?
Negative Effects of Inactivity and Bed Rest
Neuromusculoskeletal Complications
Cardiovascular Complications
Pulmonary Complications
Integument
Vascular
GASTROINTESTINAL
POST–INTENSIVE CARE SYNDROME
OPTIMIZING REHABILITATION IN THE PEDIATRIC INTENSIVE CARE UNIT
INTERPROFESSIONAL COMPONENTS OF THE REHABILITATION TEAM
KEY FACTORS IN ESTABLISHING A CULTURE OF MOBILITY
REHABILITATION IN THE PEDIATRIC INTENSIVE CARE UNIT—GENERAL PRINCIPLES
REHABILITATION CONTINUUM OF CARE
SPECIAL CONSIDERATIONS/POPULATIONS FOR PEDIATRIC INTENSIVE CARE UNIT REHABILITATION
Prognostic Factors and Outcome After Acquired Brain Injury
Recovery and Rehabilitation After Acquired Brain Injury
Rehabilitation After the Pediatric Intensive Care Unit in Patients With Acquired Brain Injury
Acquired Spinal Cord Injuries
Prognostic Factors and Outcome After Spinal Cord Injury
Rehabilitation After Spinal Cord Injury
Amputations
Rehabilitation Care for Critically Ill Children With Burns
CHRONIC CRITICAL ILLNESS/BASELINE FUNCTIONAL IMPAIRMENT/COMPLEX CARE
Rehabilitation Care for Children With Heart Disease and After Cardiac Surgery
Palliative Care and Rehabilitation
CONCLUSIONS AND FUTURE DIRECTIONS
Section V ■ Basic Science Concepts of Pediatric Critical Care
Chapter 19 Omics and Critical Care
GENOMICS
EPIGENETICS
TRANSCRIPTOMICS
MICROBIOME
PROTEOMICS
METABOLOMICS AND LIPIDOMICS
Data Acquisition
Data Processing
Spatial Biology
Applications of Metabolomics and Lipidomics
CONCLUSIONS AND FUTURE DIRECTIONS
SUMMARY
Chapter 20 Innate Immunity and Inflammation
INTRODUCTION
Historical Perspective
DEFINITIONS
Adaptive Immune System
Inflammation
INNATE IMMUNE SENSING: RECOGNITION OF DANGER
PRRs, Including the NLRP3 Inflammasome, and Cell Death Pathways
PAMPS and DAMPS 2
Intracellular Signaling 4
MAPKs in Myeloid Cells 4
CELL-SPECIFIC INNATE 5 RESPONSES
Summary and Relevance to Disease
Mono-Macro-Phagocytic Pathways and Tissue Specificity
Relevance to Human Disease
NK Cells
Relevance to Human Disease
Summary of Cellular Responses
SOLUBLE COMPONENTS: COMPLEMENT
Relevance to Human Disease
DYSREGU LATION OF THE INNATE IMMUNE RESPONSE 6
Immunoparalysis
EMERGING CONCEPTS IN INNATE IMMUNITY AND FUTURE DIRECTIONS
COVID/MISC
SUMMARY
ACKNOWLEDGMENT
Chapter 21 Cellular Adaptations to Stress
INTRODUCTION
HYPOXIA
OXIDATIVE STRESS/ANTIOXIDANT SYSTEMS
Superoxide Dismutase
Catalase, Glutathione Peroxidase, and Peroxiredoxins
Nrf2-Keap1 Antioxidant System
PROTEIN-RELATED STRESS RESPONSES
Heat Shock Response
ER Stress and the Unfolded Protein Response
HEME OXYGENASE
THE DNA DAMAGE RESPONSE
FUNCTIONAL AND METABOLIC ALTERATION
PRECONDITIONING, TOLERANCE, AND MEMORY
CLINICAL CONSIDERATIONS
FUTURE DIRECTIONS AND CONCLUSION
Chapter 22 Shock, Ischemia, and Reperfusion Injury
INTRODUCTION
OXYGEN DELIVERY AND ACUTE CELLULAR OXYGEN DEFICIENCY
DEFINITION AND CLASSIFICATION OF SHOCK
CELLULAR AND MOLECULAR MECHANISMS OF INJURY
Reperfusion Injury
Oxidative and Nitrosative Stress
Sources of Reactive Oxygen and Nitrogen Species
Direct Cytotoxic Effects of Reactive Oxygen Species and Reactive Nitrogen Species
Molecular Signaling Pathways of the Pathophysiologic Events
Complement System Activation
Endothelial Dysfunction
Recruitment and Transmigration of Leukocytes
LABORATORY TESTS AND BIOMARKERS
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 23 Pharmacology
INTRODUCTION
SCIENTIFIC FOUNDATIONS
Physiologic Differences in Critical Illness That Affect Drug Disposition 4
Physiologic Differences in Children That Affect Drug Disposition 2
Pharmacodynamics
Pharmacogenomics
APPLICATION TO PEDIATRIC INTENSIVE CARE 3
Barbiturates
Opioids
Ketamine
Propofol
Etomidate
Dexmedetomidine
Neuromuscular Blockers
Sympathomimetics
Vasodilators
Steroids
Miscellaneous
CURRENT ISSUES SURROUNDING PHARMACOTHERAPY
SUMMARY
Chapter 24 Multiple Organ Dysfunction Syndrome
1 INTRODUCTION
DEFINING MULTIPLE ORGAN DYSFUNCTION SYNDROME
SCORING SYSTEMS 2
EPIDEMIOLOGY OF MULTIPLE ORGAN DYSFUNCTION SYNDROME
Risk Factors for Development of Multiple Organ Dysfunction Syndrome
Outcome
PATHOPHYSIOLOGY OF MULTIPLE ORGAN DYSFUNCTION SYNDROME
What Constitutes Normal Physiologic Homeostasis?
Transport and Energy Metabolism
Communication/Regulation
Systemic Inflammatory Response and Immune Dysregulation 4a
Coagulation/Thrombosis and Microcirculatory Impairment 4b
Mitochondrial Dysfunction and Bioenergetic Failure4c
TREATMENT OF MULTIPLE ORGAN DYSFUNCTION SYSTEM
CONCLUSIONS AND FUTURE DIRECTIONS
PART TWO ■ EMERGENCY CARE AND ACUTE MANAGEMENT
Section I ■ Initial Stabilization
Chapter 25 Airway Management
ANATOMY AND AIRWAY DEVELOPMENT
1 Developmental Airway Considerations
INITIAL AIRWAY ASSESSMENT
The Oropharyngeal Examination
Evaluation of Atlantooccipital Joint Extension
Evaluation of Potential Mandibular Displacement Area
IDENTIFYING THE DIFFICULT AIRWAY
Clues to Identification
BASIC AIRWAY MANAGEMENT
Oral and Nasal Airways
Bag-Mask Ventilation
ADVANCED AIRWAY MANAGEMENT
General Indications for an Advanced Airway
Choice of Advanced Airway
Endotracheal Intubation
Nasotracheal Intubation
Rapid Sequence Intubation
Cricoid Pressure
Apneic Oxygenation
Advanced Airway Techniques
Transglottic Intubation Assist Devices
Techniques Used to Verify Placement of Advanced Airway
Support of a Patient With an Advanced Airway
Complications of Endotracheal Intubation
Planned Extubation and Post-extubation Care
MANAGEMENT OF THE DIFFICULT AIRWAY
Surgical Airways: Front of Neck Access (FONA)
MANAGEMENT OF SPECIFIC PROBLEMS
Awake Intubation
Cervical Spine Abnormalities and Injuries
Intracranial Hypertension
Shock
Facial or Laryngotracheal Injury
Mediastinal Mass
Craniofacial Abnormalities
Infiltration of Soft Tissues
Obesity
Acute Infectious Airway Obstruction
Foreign-Body Aspiration
Acute on Chronic Respiratory Failure
Airway Management in Children With Novel Airborne Pathogens
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENT
Chapter 26 Cardiopulmonary Resuscitation
INTRODUCTION
DEFINING CARDIAC ARREST: FOUR PHASES
EPIDEMIOLOGY OF PEDIATRIC CARDIAC ARREST
Pediatric In-Hospital Cardiac Arrest
Pediatric Out-of-Hospital Cardiac Arrest
Cardiac Arrest Rhythm
Children With Cardiac Disease
Differences Between Pediatric and Adult Cardiac Arrest
INTERVENTIONS DURING THE PREARREST PHASE: PROTECT
INTERVENTIONS DURING THE CARDIAC ARREST (“NO-FLOW”) PHASE AND CARDIOPULMONARY RESUSCITATION (“LOW-FLOW”) PHASE: PRESERVE AND RESUSCITATE
Recognizing Cardiac Arrest
Underlying Etiology
Overview of CPR and the Physiology of Chest Compressions
The Anatomy of a Chest Compression
Chest Compression Targets
Physiologic Targets During CPR
Ventilation Management During CPR
Defibrillation
Pediatric Automated External Defibrillators
Medication Use During Cardiac Arrest
Routes of Medication Administration During CPR
Point of Care Ultrasound During CPR
Extracorporeal Cardiopulmonary Resuscitation
Etiology-Specific Critical Care Considerations for Cardiac Arrest Management
Duration of CPR
THE POSTARREST PHASE: REGENERATE
Postarrest Interventions
SUCCESSFUL RESUSCITATION SYSTEMS OF CARE
HEALTH CARE DISPARITIES
CONCLUSIONS
Chapter 27 Stabilization and Transport
INTRODUCTION
HISTORICAL DEVELOPMENT OF PEDIATRIC TRANSPORT PROGRAMS
TRANSPORT IN DEVELOPING COUNTRIES
ORGANIZATION OF PEDIATRIC TRANSPORT SYSTEMS
Administrative Issues
Training, Certification, and Licensure
Finances and Reimbursement
Legal Considerations
Risk Management and Insurance
Transfer Agreements
Quality Improvement and Accreditation
THE TRANSPORT ENVIRONMENT
Mobile Intensive Care
Ground Transport Considerations
Aeromedical Transport
Intrahospital Transport
Safety Considerations
PATIENT CARE DURING TRANSPORT
Resuscitation and Stabilization
Preparation for Transport
Family Communication
Ethical Considerations
TRANSPORT CONSIDERATIONS FOR SPECIFIC POPULATIONS
Pediatric Emergency Department Considerations
Trauma Centers
PICU Considerations
Burn Centers
NICU Considerations
Extracorporeal Membrane Oxygenation and Inhaled Nitric Oxide
Postgraduate Education in Transport Medicine
OUTCOMES
Transport Scoring Systems
Team Composition
Specialty Pediatric Teams Versus General Teams
Air Versus Ground Transport
Transport of Patients With Suspected COVID-19
Telemedicine
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 28 Invasive Procedures
GENERAL APPROACH AND EVIDENCE FOR USING ULTRASOUND GUIDANCE
PERIPHERAL VASCULAR ACCESS
CENTRAL VENOUS CATHETERIZATION
Femoral Venous Catheterization
Subclavian Venous Catheterization
Internal Jugular Catheterization
Complications
ULTRASOUND ASSISTANCE IN CENTRAL VENOUS CATHETER PLACEMENT
INTRAOSSEOUS ACCESS
ARTERIAL CATHETERIZATION
Radial Artery
Femoral Artery
Dorsalis Pedis and Posterior Tibial Arteries
Axillary Artery
Brachial Artery
Complications
Emergency Pericardiocentesis
Thoracostomy
Thoracentesis
Tube Thoracostomy
TRANSPYLORIC FEEDING TUBE PLACEMENT
ABDOMINAL PARACENTESIS
TRANSURETHRAL BLADDER CATHETER PLACEMENT AND BLADDER PRESSURE MONITORING
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 29 Recognition and Initial Management of Shock
INTRODUCTION
CLASSIFICATION OF SHOCK
PATHOPHYSIOLOGY
Oxygen Delivery
Decreased Oxygen Delivery
Decreased Oxygen Extraction
ASSESSMENT
2 Physical Examination and Vital Signs Monitoring
Laboratory Markers of Shock 3
Assessment of Circulating Volume and Physiologic Rationale of Fluid Administration
Assessment of Global Blood Flow
Optical Monitoring
Monitoring Dilemmas and Pitfalls
MANAGEMENT 5
General Supportive Measures
Fluid Resuscitation
Blood Product Replacement
Vasoactive Agents
Antibiotic Therapy
Chapter 30 Rapid Response Systems
INTRODUCTION
ORIGINS AND PREVALENCE OF PEDIATRIC RAPID RESPONSE SYSTEMS
RAPID RESPONSE SYSTEM COMPONENTS
The Afferent Limb: Deterioration Detection and Triggering a Response
The Efferent Response
The Process Improvement Limb
The Administrative Support Limb
SUMMARY AND FUTURE DIRECTIONS
Section II ■ Environmental Crises
Chapter 31 Multiple Trauma
EPIDEMIOLOGY OF PEDIATRIC TRAUMA
PEDIATRIC INJURIES: MECHANISMS AND PATTERNS
PATHOPHYSIOLOGY
INITIAL ASSESSMENT AND STABILIZATION
Trauma Centers and Field Trauma Triage Recommendations
Trauma Scoring
First Impression
Primary Survey
SECONDARY SURVEY
Complete History and Physical Examination
Imaging Studies
Laboratory Examinations
CRITICAL CARE MANAGEMENT
Definitive Management of Nonneurologic Injuries
Abdominal Trauma
Skeletal Trauma
CHILD ABUSE
COMPLICATIONS
Acute Stress and Posttraumatic Stress Disorder
Infection
Thromboembolic Events
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 32 Drowning
DEFINITION
EPIDEMIOLOGY
PREVENTION
MECHANISM OF DROWNING AND PATHOPHYSIOLOGY
Pulmonary Manifestations
Cardiac Manifestations
Central Nervous System Manifestations
MANAGEMENT
Management in the Emergency Department
Management in the Pediatric Intensive Care Unit
OUTCOMES
FUTURE DIRECTIONS
SUMMARY
ACKNOWLEDGMENTS
Chapter 33 Burns and Smoke Inhalation
EVALUATION OF THE PATIENT
Extent of Burn Injury
Types of Injury
RESUSCITATION AND INITIAL MANAGEMENT
Fluid Resuscitation
Inhalation Injury
Timing of Tracheostomy in Pediatric Burn Survivors
Decision to Transfer to Specialized Care
Collaborative Practice
Neglect and Abuse
WOUND CARE
Pain Management
Prophylaxis Against Wound Infection
Surgical Care
Circumferential Burns
INFECTION
Burn-Wound Infection
Pneumonia
Suppurative Thrombophlebitis
Bacteremia Associated With Wound Manipulation
Other Infections
HYPERMETABOLISM AND NUTRITION
Hypoalbuminemia
Glycemic Control
OUTCOME
PSYCHOLOGICAL IMPACT
REHABILITATION
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 34 Injury From Chemical, Biologic, Radiologic, and Nuclear Agents
CHEMICAL AGENTS
Initial Approach to Chemical Attack
Nerve Agents
Asphyxiants
Choking/Pulmonary Agents
Blistering/Vesicant Agents
BIOTERRORISM/BIOLOGIC AGENTS
Terror-Related Bacterial Agents
Terror-Related Viral Agents
Terror-Related Toxin-Mediated Disease
RADIOLOGIC/NUCLEAR AGENTS
Decontamination
Pathophysiology
Clinical Signs and Symptoms
Treatment
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 35 Mass Casualty Events
BACKGROUND
THE STATE OF PEDIATRIC EMERGENCY PREPAREDNESS
PEDIATRIC DISASTER TRIAGE
HOSPITAL RESPONSE TO MASS CASUALTY EVENTS
Surge Response
Alternate Levels of Care and Allocation of Scarce Resources
Children With Special Needs and the Technology-Dependent Child
BOMBINGS AND BLAST INJURIES
Mechanisms, Manifestations, and Management of Blast Injuries
Patient Risk Stratification
CIVILIAN PUBLIC MASS SHOOTINGS
CHEMICAL AND RADIOLOGIC MASS CASUALTY EVENTS
Chemical Mass Casualty Events
Radiologic/Nuclear Mass Casualty Events
PANDEMICS AS MASS CASUALTY INCIDENTS
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 36 Poisoning
EPIDEMIOLOGY
CLINICAL APPROACH TO THE POISONED CHILD
Patient History
Physical Examination
Laboratory Evaluation
Radiologic Imaging
MANAGEMENT
Toxicokinetics
Decontamination
Antidotes
Diuresis
TOXIDROMES
Sympathomimetic/Adrenergic Agents
Cholinergic Agents
Anticholinergic Agents
Opioid Agents
FOCUSED REVIEW OF COMMON TOXINS
Acetaminophen
Salicylates
Alcohols
Caustics
Iron
Asphyxiants
Cyanide
Calcium Channel Blockers
β-Blockers
Digoxin
Tricyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
HERBAL TOXICITY/NUTRITIONAL SUPPLEMENT TOXICITY
CLUB DRUGS
Ecstasy (X, E, XTC, Adam, Molly)
γ-Hydroxybutyrate (G, Liquid Ecstasy, Liquid E)
Methamphetamines (Tina, Ice, Crystal Meth, Tweak, Crank, Glass)
Cocaine
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 37 Thermoregulation
PHYSIOLOGY OF THERMOREGULATION
Heat Gain
Heat Loss
HYPERTHERMIA
Classification of Hyperthermia Syndromes
Heat Stroke (Environmental/Exertional Heat-Related Illness)
Prevention 2
Core Pathophysiology
CLINICAL FEATURES
Central Nervous System
Cardiovascular System
Respiratory System
Acid-Base, Electrolyte, and Renal Disorders
DIFFERENTIAL DIAGNOSIS
LABORATORY EVALUATION
Urine
Blood Testing
Imaging
Lumbar Puncture
COMPLICATIONS
TREATMENT
HYPERTHERMIA SYNDROMES
Malignant Hyperthermia-Like Syndrome
Neuroleptic Malignant Syndrome
Serotonin Syndrome
Sympathomimetic and Anticholinergic-Induced Hyperthermia Syndromes
HYPOTHERMIA
Definitions
Mechanisms of Disease
Etiology of Hypothermia
Clinical Presentation and Diagnosis
Clinical Management
Outcomes
Prevention 10
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 38 Envenomation Syndromes
SNAKEBITE
Venoms
Diagnosis of Envenomation
Laboratory Testing
Differential Diagnosis of Venomous Snakebite
Treatment of Venomous Snakebite
Antivenom
Dose of Antivenom
Surgical Intervention
SPIDERBITE
Comb-footed (Widow) Spiders
Recluse or Violin Spiders
Funnel-web Spiders
SCORPION STINGS
Venom
Envenomation
Treatment
BEE, WASP, AND ANT (HYMENOPTERA) STINGS
Bees
Wasps
Ants
Hymenoptera Venoms
Envenomation by Bee, Wasp, and Ant Stings
Treatment for Bee, Wasp, and Ant Stings
TICK BITE
Envenomation
Differential Diagnosis
Treatment
Laboratory Investigations
JELLYFISH STINGS
Chirodropids
Other Chirodropids
Carybdeids
Carybdeid Jellyfish Causing “Irukandji” Syndrome
VENOMOUS FISH STINGS
Stonefish
Other Stinging Fish
Stingrays
OCTOPUS BITE
Envenomation
Treatment
CONE SNAIL STING
Treatment
FISH AND SHELLFISH POISONOUS TO EAT
Tetrodotoxin Poisoning
Ciguatera Poisoning
Maitotoxin Poisoning
Paralytic Shellfish (Saxitoxin) Poisoning
Scombroid Poisoning
CONCLUSIONS AND FUTURE DIRECTIONS
Section III ■ Life-Support Technologies
Chapter 39 Mechanical Ventilation
INTRODUCTION
PHYSIOLOGY OF MECHANICAL VENTILATION
VENTILATOR CONTROLLERS
Control Variables
Volume Measurement
Phase Variables
Trigger Variables
Limit Variable
Cycle Variable
MODES OF VENTILATION
Modes With Continuous Mandatory Ventilation and Intermittent Mandatory Ventilation Breath Sequences
Assist Modes
Airway Pressure Release Ventilation
Closed-Loop Methods
Work of Breathing
PATIENT-VENTILATOR ASYNCHRONY
Trigger Asynchrony
Flow Asynchrony
Termination Asynchrony
Expiratory Asynchrony
Reverse Triggering
WHY ARE CHILDREN DIFFERENT?
INDICATIONS FOR MECHANICAL VENTILATION
APPROACH TO MECHANICAL VENTILATION BASED ON DISEASE STATE
LUNG RECRUITMENT AND POSITIVE END-EXPIRATORY PRESSURE TITRATION STRATEGIES
Gas Exchange
Positive End-Expiratory Pressure/Fraction of Inspired Oxygen Tables
Positive End-Expiratory Pressure Titration
Imaging
HIGH-FREQUENCY VENTILATION
Application of High-Frequency Ventilation Through Different Devices
Mechanisms of Gas Exchange
Technical Description of High-Frequency Ventilation
WEANING FROM MECHANICAL VENTILATORY SUPPORT
Predictive Indices for Weaning
Process of Weaning
Extubation Readiness
Advances in Weaning
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 40 Inhaled Gases and Noninvasive Ventilation
INTRODUCTION
HUMIDIFICATION
OXYGEN
Energy Metabolism
Physiologic Mechanisms
Oxygen Delivery Systems
Risks
INHALED NITRIC OXIDE
Pharmacology
Nitric Oxide Delivery Systems
Inhaled Nitric Oxide Metabolite Monitoring
Inhaled Nitric Oxide Dosing
Nitric Oxide Weaning
INHALED PROSTACYCLIN
HELIUM-OXYGEN MIXTURES (HELIOX)
Pharmacology
Heliox Delivery Systems
Safety Considerations
INHALED BRONCHODILATOR THERAPY
Pharmacology
Delivery Systems
INHALATIONAL ANESTHETICS
General Principles of Inhalation Anesthetics
Isoflurane
Delivery Systems
Safety Considerations
Nitrous Oxide
NONINVASIVE VENTILATION
Noninvasive Positive-Pressure Ventilation (Continuous Positive Airway Pressure and Bilevel Positive Airway Pressure)
High-Flow Nasal Cannula
Safety Considerations
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 41 Extracorporeal Life Support
INTRODUCTION
CIRCUIT COMPONENTS
Artificial Membrane Lung
Blood Pump
Vascular Cannulas
OTHER COMPONENTS
PATIENT SELECTION
Contraindications
SUPPORT MODES
Venovenous
Venoarterial
Other Modes
CANNULATION
Peripheral Surgical Cannulation
Central Cannulation
PHYSIOLOGY OF EXTRACORPORE7AL CIRCULATION
Venoarterial
Adverse Effects
CIRCUIT MANAGEMENT
Initiation of Support
Anticoagulation and Hematologic Management
Troubleshooting
Weaning
Decannulation
PATIENT MANAGEMENT
Hemodynamic Management
Sedation and Analgesia
Fluids and Renal Replacement Therapy
Nutritional Support
Withdrawal of Care
COMPLICATIONS
Neurologic Injury
Vascular Injury
Infection
OUTCOMES FROM EXTRACORPOREAL LIFE SUPPORT
Long-Term Outcomes
ORGANIZATION
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 42 Extracorporeal Organ Support Therapy
INTRODUCTION
GENERAL CONCEPTS
Circuit Components of Extracorporeal Organ Support Therapy
Complications of Extracorporeal Therapy
Anticoagulation Use
Anticoagulation Monitoring
RENAL REPLACEMENT THERAPIES
Indications
Contraindications
Solute and Water Removal Mechanisms
PERITONEAL DIALYSIS
Physiology of Peritoneal Dialysis
Indications for Peritoneal Dialysis
Catheters Used for Peritoneal Dialysis
Manual Versus Automated Peritoneal Dialysis
Continuous-Flow Peritoneal Dialysis
Complications of Peritoneal Dialysis
Peritoneal Dialysis Fluid Composition
Cardiopulmonary Interactions
HEMODIALYSIS
Physiology of Hemodialysis
CONTINUOUS RENAL REPLACEMENT THERAPY
Goals of Pediatric Continuous Renal Replacement Therapy
Physiology of Continuous Renal Replacement Therapy
Modes of Continuous Renal Replacement Therapy
Complications of Continuous Renal Replacement Therapy
How to Choose the Type of Renal Replacement Therapy
When to Discontinue Renal Replacement Therapy
Renal Replacement Therapy in the Newborn
Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy
Cardiopulmonary Bypass and Continuous Renal Replacement Therapy
THERAPEUTIC PLASMA EXCHANGE
Background
Adsorption Techniques
Indications for Therapeutic Plasma Exchange
Training of Health Care Providers in the Pediatric Intensive Care Unit
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 43 Blood Products and Transfusion Therapy
BRIEF HISTORY OF TRANSFUSIONS
RED BLOOD CELL TRANSFUSION
Scientific Foundation of Red Blood Cell Transfusion
Transfusion of Red Blood Cells: Application to the Pediatric Intensive Care Unit
Conclusions
PLASMA
Scientific Foundation of Transfusion of Plasma
Transfusion of Plasma: Application to Pediatric Intensive Care Unit
Conclusions
PLATELETS
Scientific Foundation of Transfusion of Platelets
Immunologic Effects of Platelet Transfusions
Transfusion of Platelets: Application to Pediatric Intensive Care Unit
Conclusion
GRANULOCYTES
Scientific Foundation of Granulocyte Transfusion
Granulocyte Transfusion: Application to Pediatric Intensive Care Unit
Conclusions
WHOLE BLOOD
Scientific Foundation and Current Evidence for Whole Blood Transfusion
Transfusion of Whole Blood: Application to Pediatric Intensive Care Unit
Conclusions
MASSIVE TRANSFUSIONS
COMMON COMPLICATIONS OF BLOOD PRODUCT TRANSFUSIONS
Late Reactions
BLOOD BANKS AND ADMINISTRATION OF BLOOD PRODUCTS
Administration of Blood and Blood Products
LIMITING BLOOD PRODUCT UTILIZATION
NARRATIVE SUMMARY
NARRATIVE FUTURE DIRECTIONS
ACKNOWLEDGMENTS
PART THREE ■ CRITICAL CARE ORGAN SYSTEMS
Section I ■ Respiratory Disease
Chapter 44 Respiratory Physiology
PULMONARY GAS EXCHANGE
1 The Blood-Oxygen Equilibrium Curve
Hemoglobin
Blood-Oxygen Equilibrium Curves
Modulation of Blood-Oxygen Equilibrium Curves
Oxygen Transport in Fetal Blood
Carbon Dioxide in Blood
Forms of Carbon Dioxide in Blood
Modulation of Blood-Carbon Dioxide Equilibrium Curves
Alveolar Ventilation and Alveolar Po2
Alveolar Ventilation Equation Predicts Alveolar Pco2 2
Alveolar Gas Equation Predicts Alveolar Po2
3 Diffusion
Pathway for Oxygen
Po2 Changes Along the Pulmonary Capillary
Diffusion-Limited and Perfusion-Limited Gases
Measuring Diffusing Capacity
Limitations of Pulmonary Gas Exchange
The A/Q· Ratio
a/ Mismatching Between Different Alveoli
Carbon Dioxide Exchange
Cardiovascular and Tissue Oxygen Transport
Tissue Gas Exchange
GAS CHANNELS AND CO2 GAS EXCHANGE
MECHANICS OF THE LUNG AND RESPIRATORY SYSTEM
Pressure-Flow Relationships in the Respiratory System
5 Developmental Aspects of the Lung as They Affect Elastic Recoil
Surface Tension and Elastic Recoil
6 Flow Limitation
Muscles of Respiration
Respiratory Muscle Fatigue: Does It Happen?
Cough Mechanics
7 A Consolidated Model of the Dynamics of Breathing
Clinical Implications
8 The Forced Oscillation Technique
Clinical Relevance of Forced Oscillation Technique
PULMONARY CIRCULATION
Anatomic Considerations
9 Pulmonary Vascular Pressures
Pulmonary Vascular Resistance
Fetal and Perinatal Pulmonary Circulation
Regulation of Pulmonary Vascular Tone
Hypoxic Pulmonary Vasoconstriction
Distribution of Pulmonary Blood Flow
Bronchial Circulation
Lung Fluid Balance
RESPIRATORY CONTROL
12 Developmental Aspects of Respiratory Control
Central Aspects of Respiratory Control
Peripheral Sensory Aspects
Oxygen Deprivation, Oxygen Sensing, and Cell Injury
SUMMARY AND FUTURE DIRECTIONS
Chapter 45 The Molecular Biology of Acute Lung Injury
INTRODUCTION
INJURY, INFLAMMATION, AND EDEMA FORMATION
Inflammasomes and Neutrophil Extracellular Trap
INFLAMMATORY MEDIATORS IN LUNG INJURY
Inflammation and Dysregulated Redox Signaling
Signaling and Transcriptional Mediators
Cytokine Mediators
Inflammatory Cells and Chemokines
Angiogenic Mediators
Barrier-Protective Mediators
Immunometabolism
MicroRNAs and Extracellular Vesicles
REGULATION OF THE ALVEOLAR-CAPILLARY BARRIER
Epithelial Barrier Integrity and Function in the Injured Lung
Control of Pulmonary Vascular Tone
SURFACTANT BIOCHEMISTRY IN THE INJURED LUNG
FIBROPROLIFERATION AND REPAIR IN THE INJURED LUNG
Alveolar Epithelial Repair
Mechanisms of Fibroproliferation
Stem Cells in the Injured Lung
THE MOLECULAR BIOLOGY OF COVID-19 LUNG DISEASE
Summary and Future Directions
ACKNOWLEDGMENTS
Chapter 46 Respiratory Monitoring
1 WHY MONITOR?
PHYSICAL ASSESSMENT
Respiratory Rate and Pattern
GUIDELINES AND PRINCIPLES
2 Assessment of Gas Exchange
PULSE OXIMETRY 3
Oxygen-Dissociation Curve
Beer–Lambert Law
Factors That Affect the Performance of Pulse Oximeters
4 Clinical Applications
TRANSCUTANEOUS MEASUREMENT OF GAS TENSION
Physiologic Basis for Transcutaneous Monitoring
Principle of Operation
Clinical Applications
5 CAPNOGRAPHY
Sampling Techniques
Evaluation of Respiratory Pattern
Clinical Applications
MONITORING RESPIRATORY MECHANICS 6
Respiratory Inductive Plethysmography
Monitoring of Respiratory Muscle Function
Monitoring Respiratory Mechanics in Ventilated Patients
Mechanical Ventilators and Airway Graphics Monitoring
Esophageal and Gastric Manometry
Measurements of Diaphragmatic Function
POINT-OF-CARE ULTRASOUND (POCUS) IN RESPIRATORY MONITORING 7
Position of Endotracheal Tube Placement
Diaphragmatic Atrophy and Paresis
Weaning From Mechanical Ventilation
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 47 Acute Severe Asthma
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
MECHANISM OF DISEASE: CORE PATHOPHYSIOLOGY
Inflammation and Immunobiology
Pulmonary Mechanics and Gas-Exchange Abnormalities
Cardiopulmonary Interactions in Asthma
CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS
History
Physical Exam
Laboratory Evaluation
Radiographic Evaluation
CLINICAL MANAGEMENT
Clinical Pathways
Pediatric Intensive Care Unit Management
Fluids
Intravenous and Subcutaneous β-Agonists
Methylxanthines
Anticholinergics
Magnesium Sulfate
Helium-Oxygen
Noninvasive Respiratory Support
Mechanical Ventilation
Bronchoscopy
Chest Physiotherapy
Infectious Concerns
Sedation and Neuromuscular Blockade
Inhaled Anesthetics
Extracorporeal Membrane Oxygenation
OUTCOMES
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 48 Neonatal Respiratory Failure
INTRODUCTION
DEVELOPMENTALLY REGULATED DISORDERS: RESPIRATORY CONDITIONS ASSOCIATED WITH PREMATURE LUNG
Bronchopulmonary Dysplasia
DISORDERS OF TRANSITION
Persistent Pulmonary Hypertension of the Newborn
Meconium Aspiration Syndrome
CONGENITAL LUNG ANOMALIES
Congenital Cystic Adenomatoid Malformation and Bronchopulmonary Sequestration
Pulmonary Hypoplasia
ACQUIRED DISEASE
Pulmonary Hemorrhage
Pulmonary Edema
Airway Injury
Infection
CONCLUSION AND FUTURE DIRECTIONS
Chapter 49 Pneumonia and Bronchiolitis
PNEUMONIA
Introduction and Definitions
Pathogenesis
Etiology
Differential Diagnosis
Management
Prevention
Complications
Prognosis
COVID-19 Pneumonia in Children
ACUTE BRONCHIOLITIS
Epidemiology
Microbiology
Pathogenesis
Diagnosis
Risk Factors for Severe Disease
Diagnostic Investigations
Criteria for Hospitalization
Genetic Predisposition
Management
Pediatric Intensive Care Unit Admission Criteria
Discharge Criteria
Prevention
Outcome
Chapter 50 Acute Lung Injury and the Acute Respiratory Distress Syndrome
INTRODUCTION AND DEFINITION
Epidemiology
MECHANISM OF DISEASE: CORE PATHOPHYSIOLOGY
Initiating Factors
Phases of Disease
Alveolar-Capillary Barrier Dysfunction and Edema Formation
Surfactant Dysfunction and Alteration of Pulmonary Mechanics
Mechanisms of Alveolar Fluid Clearance
Alteration of Gas Exchange
Host Immune Response: Role of Cytokines and Alteration of Hemostasis
Alteration of Cardiovascular Function: Effects on Pulmonary Hemodynamics
CLINICAL PRESENTATION
Imaging Studies
PRINCIPLES OF CLINICAL MANAGEMENT
Positive Pressure Ventilation
Biomechanical Stress and the Mechanically Ventilated Injured Lung
High-Frequency Oscillatory Ventilation
Fluid Management
Adjuvant Therapies in Acute Lung Injury/Acute Respiratory Distress Syndrome
Neuromuscular Blockade
Corticosteroids
Modifying Alveolar Fluid Clearance
Surfactant
Inhaled Nitric Oxide
Nutritional Support in Acute Lung Injury/Acute Respiratory Distress Syndrome
Role of Extracorporeal Membrane Oxygenation in Refractory Pediatric Respiratory Failure
OUTCOMES
CONCLUSION AND FUTURE DIRECTIONS
SUMMARY
Chapter 51 Chronic Respiratory Failure
INTRODUCTION
RESPIRATORY SYSTEM IN CHILDREN
ACUTE RESPIRATORY FAILURE
CHRONIC RESPIRATORY FAILURE
Addressing the Respiratory Load
Increasing Ventilatory Muscle Power
Improving Central Respiratory Drive
DECISION TO INITIATE CHRONIC VENTILATORY SUPPORT
CANDIDATES FOR HOME MECHANICAL VENTILATION
Ventilatory Muscle Weakness and Neuromuscular Diseases
Central Hypoventilation Syndromes
Chronic Pulmonary Disease
PHILOSOPHY OF CHRONIC VENTILATORY SUPPORT
MODALITIES OF HOME MECHANICAL VENTILATION
Portable Positive-Pressure Ventilator via Tracheostomy
Noninvasive Positive-Pressure Ventilation by Mask or Nasal Prongs
Negative-Pressure Ventilation
Diaphragm Pacing
HOSPITAL MANAGEMENT BEFORE DISCHARGE
HOME MANAGEMENT OF THE VENTILATOR-ASSISTED CHILD
OUTCOME
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 52 Sleep and Breathing
INTRODUCTION
RESPIRATORY CONTROL AND SLEEP
OBSTRUCTIVE SLEEP APNEA SYNDROME
SUDDEN INFANT DEATH SYNDROME
BRIEF RESOLVED UNEXPLAINED EVENTS
SLEEP IN THE INTENSIVE CARE UNIT
FUTURE DIRECTIONS
Section II ■ Neuromuscular Disease
Chapter 53 Electrodiagnostic Techniques in Neuromuscular Disease
INTRODUCTION
SIGNAL RECORDING
Electrodes
Definitions and Diagnostic Findings
Performing Electromyography and Nerve Conduction Studies in the Pediatric Intensive Care Unit
2 Peripheral Nervous System Disorders in the Pediatric Intensive Care Unit
3 Conditions Acquired in the Pediatric Intensive Care Unit Affecting the Peripheral Nervous System
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENT
Chapter 54 Acute Neuromuscular Disease
INTRODUCTION
REGULATION OF RESPIRATION
RESPIRATORY MECHANICS
EVALUATION OF RESPIRATORY DYSFUNCTION IN A PATIENT WITH A NEUROMUSCULAR DISORDER
History
Examination
Blood Gases
Spirometry
Radiologic Studies
MANAGEMENT
Respiratory Monitoring and Care
Endotracheal Intubation
Mechanical Ventilation
Weaning
Complications of Mechanical Ventilation
Tracheostomy
General Supportive Care
Physiotherapy
Frequent Changes in Position
Bowel Care
Bladder Care
Nutrition
Pain Relief
Psychological and Emotional Support
DIAGNOSTIC ENTITIES
Acute Flaccid Paralysis
Acute Flaccid Myelitis
GUILLAIN-BARRÉ SYNDROME
Epidemiology
Etiology and Pathogenesis
Pathology
Clinical Features
Diagnosis and Differential Diagnosis
Lumbar Puncture
Electrodiagnostic Studies
Imaging
Management
Respiratory Monitoring and Care
Endotracheal Intubation
Mechanical Ventilation
Tracheostomy
Autonomic Dysfunction
General Supportive Care
Specific Therapy—Immunomodulation
Outcome
MYASTHENIA GRAVIS
Epidemiology
Pathogenesis
Clinical Features
Emergencies in Myasthenia Gravis
Diagnosis
Serologic (Immunologic) Tests
Management
Endotracheal Intubation
Mechanical Ventilation
General Pediatric Intensive Care Unit
Specific Therapies 15
Immunosuppressive Therapy
Plasmapheresis
Intravenous Immunoglobulin
Thymectomy
Natural Course and Outcome of Myasthenia Gravis
ACUTE INTERMITTENT PORPHYRIA
Pathophysiology
Clinical Features
Precipitating Factors
Diagnosis
Treatment of Acute Attack
Outcome
INTENSIVE CARE UNIT–ACQUIRED WEAKNESS
Incidence and Prevalence
Risk Factors
Pathogenesis
Clinical Features
Diagnosis
Tissue Biopsy
Treatment and Prevention
Outcome 24
DIAPHRAGMATIC PALSY
Incidence and Causes
Pathophysiology
Clinical Features
26 Diagnosis
Management
Outcome
CONCLUSIONS AND FUTURE DIRECTION
ACKNOWLEDGMENTS
Chapter 55 Chronic Neuromuscular Disease
INTRODUCTION
RECOGNIZING A CHRONIC NEUROMUSCULAR DISORDER
Chronic Disorder Presenting in the Neonatal Period With Respiratory Distress 2
3 Chronic Disorder Presenting With Later Onset of Diaphragmatic Respiratory Insufficiency
4 Chronic Disorder Presenting With Bulbar Motor Dysfunction
OVERVIEW OF CHRONIC NEUROMUSCULAR DISEASES
Nerve Disorders
Neuromuscular Junction Disorders
Muscle Disorders
CLINICAL MANAGEMENT IN INTENSIVE CARE
Disease-Specific Aspects of Respiratory Care
7 Practical Issues During Pediatric Intensive Care Unit Admission
ONGOING VENTILATORY SUPPORT
Long-Term, Noninvasive Ventilation for Chronic Neuromuscular Disease
Delivery of Respiratory Support
Bulbar Dysfunction
Orthopedic Complications
Cardiac Function
Anesthesia
QUALITY OF LIFE IN CHILDREN VENTILATED FOR CHRONIC NEUROMUSCULAR DISEASE
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENTS
Section III ■ Neurologic Disease
Chapter 56 Developmental Neurobiology, Neurophysiology, and the Pediatric Intensive Care Unit
INTRODUCTION
CENTRAL NERVOUS SYSTEM DEVELOPMENT
Development of Specific Brain Regions
Neurogenesis and Proliferation
Programmed Cell Death
Migration, Differentiation, and Axonal Guidance
Synaptogenesis, Gliogenesis, and Myelination
NEUROTRANSMITTER AND NEUROTROPHIN DEVELOPMENT
Glutamate and γ-Aminobutyric Acid
Glutamate Receptor Development
γ-Aminobutyric Acid and the γ-Aminobutyric Acid Switch
Adenosine
Acetylcholine
Norepinephrine and Dopamine
Serotonin
Neurotrophins
SYNAPTIC AND BEHAVIORAL DEVELOPMENT
NEUROIMMUNE INTERACTIONS IN BRAIN DEVELOPMENT
CEREBROVASCULAR AND METABOLISM DEVELOPMENT AND FUNCTION
Cerebral Blood Flow and Vascular Reactivity
Cerebral Blood Flow-Metabolism Coupling
Cerebral Metabolism
BLOOD-BRAIN BARRIER AND CHOROID PLEXUS DEVELOPMENT
CEREBROSPINAL FLUID DYNAMICS
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 57 Molecular Biology of Brain Injury
INJURY RESPONSE IN THE IMMATURE BRAIN
PATHWAYS AND APPLICATIONS TO PEDIATRIC INTENSIVE CARE
Evolution of Secondary Injury
Ischemia
Cell Death Pathways
Brain Injury Without Neuronal Death
Brain Swelling
Inflammation and Regeneration
Axonal Injury
MECHANISMS OF ENHANCED VULNERABILITY OF INJURED BRAIN
Hyperthermia
Hypoglycemia and Hyperglycemia
DEVELOPMENT AND TRANSLATION OF NEW MOLECULAR MECHANISM-BASED THERAPIES
Drug Discovery
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENTS
Chapter 58 Evaluation of the Comatose Child
INTRODUCTION
DEFINITIONS
ANATOMY
ETIOLOGIES OF COMA
EVALUATION OF THE COMATOSE CHILD
Patient History
Physical Examination
Diagnostic Testing and Early Management
CONCLUSIONS
Chapter 59 Neurologic Monitoring
INTRODUCTION
SCIENTIFIC FOUNDATIONS
Clinically Important Physiologic Systems and Signals
Continuous Electroencephalogram Monitoring
Clinical Reports of Continuous Electroencephalogram Monitoring in the Pediatric Intensive Care Unit
Intracranial Pressure Monitoring Devices
Intracranial Pressure Trend and Waveform Data
ADVANCED ASSESSMENT OF INTRACRANIAL COMPLIANCE USING INTRACRANIAL PRESSURE MONITORING
TRANSCRANIAL DOPPLER ULTRASONOGRAPHY
CLINICAL CONTEXT OF TRANSCRANIAL DOPPLER IN PEDIATRIC CRITICAL CARE
NONINVASIVE INTRACRANIAL PRESSURE MONITORING USING TRANSCRANIAL DOPPLER MONITORING
ASSESSMENT OF AUTOREGULATION
MONITORING BY NEAR-INFRARED SPECTROSCOPY
CLINICAL CONTEXT OF NEAR-INFRARED SPECTROSCOPY IN THE PEDIATRIC INTENSIVE CARE UNIT
ASSESSMENT OF AUTOREGULATION USING NEAR-INFRARED SPECTROSCOPY MONITORING
REGIONAL BRAIN TISSUE OXYGEN (PbtO2) MONITORING
MULTIMODALITY NEUROMONITORING
CLINICAL CONTEXT OF MULTIMODAL MONITORING IN THE PEDIATRIC INTENSIVE CARE UNIT
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 60 Neurologic Imaging
TECHNIQUES
Conventional Anatomic Imaging
Computed Tomography Angiography
Magnetic Resonance Imaging
Conventional Anatomic Imaging
Diffusion-Weighted Imaging
Susceptibility-Weighted Imaging
Diffusion Tensor Imaging (DTI)
Magnetic Resonance Angiography/Venography
Magnetic Resonance Spectroscopy
Magnetic Resonance Perfusion
SELECTED CLINICAL APPLICATIONS
Hypoxic-Ischemic Injury
Infection and Inflammation
Meningitis
Meningoencephalitis
Spinal Infections
Postinfectious Encephalomyelitis
Toxic and Metabolic Injury
Posterior Reversible Encephalopathy Syndrome (PRES, RPLS)
FUTURE DIRECTIONS
Chapter 61 Neurosurgical and Neuroradiologic Critical Care
PROCEDURAL AND OPERATING ROOM CONSIDERATIONS
Anesthetic Considerations and Neurodevelopmental Effects
Intraoperative Hemodynamic and Fluid Management
Surgical Considerations
Intraoperative and Postoperative Imaging
Emergence
POSTOPERATIVE NEUROSURGICAL CARE
Patient Handoff
Physiologic Targets
Analgesia, Sedation, and Delirium
Dysnatremias 2
Multimodal Neuromonitoring
Near-Infrared spectroscopy
4 SURGERY-SPECIFIC CONSIDERATIONS
Hydrocephalus
Hydrocephalus: Implantable Shunts
Hydrocephalus: Endoscopic Third Ventriculostomy
Hydrocephalus: Perioperative Plan
Epilepsy
Cerebrovascular Surgery
Arteriovenous Malformations
Aneurysms
Moyamoya Disease
Craniosynostosis and Craniofacial Surgery
Neuro-oncology
Chapter 62 Head and Spinal Cord Trauma
INTRODUCTION
EPIDEMIOLOGY
Traumatic Spinal Cord Injury
HEAD INJURY PATTERNS
Blunt Head Injury
Penetrating/Blast Injuries
Development and Head Injury Patterns
TYPES OF INTRACRANIAL INJURY
Hemorrhage and Other Focal Brain Tissue Effects
Diffuse Traumatic Axonal Injury
Diffuse Swelling of the Cerebrum at Presentation
Posttraumatic Ischemia, Tissue Oxygenation, and Metabolism
Hypothalamic-Pituitary Injury
TRAUMATIC SPINAL CORD INJURY
Spinal Cord Injury Without Radiographic Abnormality
Traumatic Atlanto-occipital Dislocation
Odontoid Epiphysiolysis
INITIAL CLINICAL MANAGEMENT
History, Diagnosis, and Classification of Traumatic Brain Injury
Phase 1: Prehospital Care
Phase 2: Emergency Department and Hospital Management
Survey of Other Injuries
Head
Detailed Neurologic Examination
Functional Integrity of the Spine and Spinal Cord
INITIAL INVESTIGATIONS
Phase 3: Laboratory and Imaging Studies
NEUROCRITICAL CARE MONITORING OF INTRACRANIAL PRESSURE
Cerebrospinal Fluid and Intracranial Pressure
Invasive Intracranial Pressure Monitoring
Intracranial Pressure and Cerebral Perfusion Pressure Target Levels
NEUROCRITICAL CARE TREATMENTS 4
Initial Intracranial Pressure–Directed Therapies
Therapies for Refractory Intracranial Hypertension
SEIZURES AND ANTICONVULSANTS
POST-TRAUMATIC MENINGITIS AND FEVER
FLUIDS AND NUTRITION
HYPOTHALAMIC-PITUITARY DYSFUNCTION
OTHER ASPECTS OF TRAUMATIC BRAIN INJURY CARE
SPINAL CORD INJURY–DIRECTED THERAPIES
OUTCOMES AND PROGNOSIS OF BRAIN INJURY
Lethal and Fatal Injuries
Long-Term Outcome
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGEMENTS
Chapter 63 Abusive Head Trauma
BASICS OF AHT RESUSCITATION AND CARE
INTRODUCTION
EPIDEMIOLOGY
Risk Factors
Mechanisms of Injury
DIAGNOSIS
Differential Diagnosis
MANAGEMENT/TREATMENT
OUTCOMES
REPORTING AND LEGAL ISSUES
PREVENTION
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 64 Status Epilepticus
INTRODUCTION
DEFINITION
CLASSIFICATION
Prominent Motor Types of Status Epilepticus
Nonconvulsive Status Epilepticus
Refractory Status Epilepticus
Neonatal Status Epilepticus
EPIDEMIOLOGY
ETIOLOGIES
MECHANISM OF DISEASE
Laboratory Models and Experimental Data
Cerebral Injury Induced by Status Epilepticus
CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS
Motor Prominent Status Epilepticus
Nonconvulsive Status Epilepticus
Refractory Status Epilepticus
Systemic Manifestations
Differential Diagnosis
Initial Stabilization
Supportive Care for Associated Derangements
Diagnostic Tests
Medications for Seizure Termination
Quality Control and Monitoring of Care Delivery
OUTCOMES
Risk of Developing Epilepsy
Functional Disabilities
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 65 Cerebrovascular Disease and Stroke
INTRODUCTION
PRESENTATION, EPIDEMIOLOGY, OUTCOME, AND COSTS
Epidemiology
Definitions, Costs, and Outcomes
MECHANISM OF DISEASE
Stroke in Children With Recognized Diagnoses
CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS
General Management
DISEASE-SPECIFIC THERAPIES
FUTURE DIRECTIONS
ACKNOWLEDGMENTS
Chapter 66 Hypoxic-Ischemic Encephalopathy
INTRODUCTION
CORE PATHOPHYSIOLOGY AND PATHOBIOLOGY
Cardiac Arrest
Outcome
CLINICAL ASPECTS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY
Post-Return of Spontaneous Circulation Patient Management
Contemporary Neurointensive Care Monitoring
Therapies Targeting the Prevention and Treatment of Hypoxic-Ischemic Encephalopathy: Current and Future Directions
Extracorporeal Cardiopulmonary Resuscitation
Targeted Temperature Management
Reestablishment and Maintenance of Cerebral Blood Flow
Optimization of Bioenergetics and Preventing Energy Failure
Regeneration and Repair
Cerebral Edema Therapy
Neurocognitive Rehabilitation
CONCLUSIONS
ACKNOWLEDGMENTS
Chapter 67 Metabolic Encephalopathies in Children
EPIDEMIOLOGY AND MECHANISM OF DISEASES
Encephalopathies With Endogenous Intoxication
Encephalopathies Associated With Energy Failure
Encephalopathies With Acute Water, Electrolyte, and/or Endocrine Disturbances
DIAGNOSIS
General Clinical Presentation
Laboratory Investigations
Neurophysiology and Neuroimaging
MANAGEMENT
Management of Intracranial Hypertension
Seizure Monitoring and Control
Temperature Control
Specific Treatment
OUTCOMES
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 68 The Determination of Brain Death
INTRODUCTION
PREREQUISITE CONDITIONS THAT MUST BE SATISFIED PRIOR TO BRAIN DEATH TESTING
CLINICAL EXAMINATION CRITERIA TO DETERMINE BRAIN DEATH
APNEA TESTING
ANCILLARY STUDIES USED TO ASSIST WITH THE DETERMINATION OF BRAIN DEATH
DETERMINATION OF BRAIN DEATH FOR TERM NEWBORNS (37 WEEKS’ GESTATION) TO 30 DAYS OF AGE
DIAGNOSTIC ERRORS AND DETERMINATION OF BRAIN DEATH
DETERMINATION OF BRAIN DEATH IN SPECIAL CIRCUMSTANCES
DOCUMENTATION AND DETERMINATION OF DEATH
SPECIAL CONSIDERATIONS
COMMUNICATION WITH FAMILIES
CONCLUSIONS AND FUTURE DIRECTIONS
Section IV ■ Cardiovascular Disease
Chapter 69 Cardiac Anatomy
INTRODUCTION
SEGMENTAL APPROACH TO CONGENITAL HEART DISEASE
Atrial Situs
Atrial Septum
Ventricular Morphology and Topology
Atrioventricular Connections, Junctions, and Alignments
Ventricular Arrangements
Ventricular Septum
Great Arteries
SYSTEMIC AND PULMONARY VENOUS CONNECTIONS
CARDIAC POSITION
CLINICAL EXAMPLES
CONGENITAL CARDIAC DEFECTS
Congenital Heart Defects With Left-to-Right Shunts 4
Cyanotic Congenital Heart Defects
Obstructive Congenital Heart Defects
Complex Congenital Heart Defects
FUTURE DIRECTIONS
Chapter 70 Cardiovascular Physiology
INTRODUCTION
CARDIOVASCULAR CIRCUIT AND VASCULAR ANATOMY
HEMODYNAMIC PRINCIPLES
Pressure, Flow, and Resistance
Compliance
Imprecision of Mathematical Models
INTERACTION OF THE CARDIAC PUMP AND THE VASCULATURE
Vascular Function Curve
Cardiac Function Curve
Interaction of Vascular and Cardiac Function Curves
Pressure-Volume Loops
Ventricular-Ventricular Interactions
Ventricular-Arterial Coupling
REGULATION OF VASCULAR RESISTANCE
Autoregulation
Neural Control
Hormonal Control
Endothelial-Derived Factors
Myogenic Processes
Local Metabolic Products
REGULATION OF REGIONAL CIRCULATIONS
Fetal Circulation
Transition From the Fetal to Postnatal Circulation
Interaction of the Systemic and Pulmonary Circulations
Pulmonary Circulation
Coronary Circulation
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 71 Cardiorespiratory Interactions in Children With Heart Disease
INTRODUCTION AND HISTORICAL PERSPECTIVE
The Foundation of Our Current Knowledge
The Invasive Study of Cardiorespiratory Interactions: The Work of Cournand
INTRATHORACIC PRESSURE AND RIGHT VENTRICULAR PRELOAD
Spontaneous Inspiration and Right Ventricular Preload
Positive Pressure Ventilation and Right Ventricular Preload
INTRATHORACIC PRESSURE AND RIGHT VENTRICULAR AFTERLOAD
INTRATHORACIC PRESSURE AND LEFT VENTRICULAR PRELOAD
INTRATHORACIC PRESSURE AND THE LEFT VENTRICULAR AFTERLOAD
Spontaneous Ventilation and Left Ventricular Afterload
Positive Pressure Ventilation and Left Ventricular Afterload
Variation in Systolic Pressure and Pulse Pressure During the Respiratory Cycle
CARDIORESPIRATORY INTERACTIONS IN CHILDREN WITH HEART DISEASE
CARDIORESPIRATORY INTERACTIONS IN CHILDREN WITH SYSTOLIC HEART FAILURE
Cardiorespiratory Interactions During Spontaneous Respiration
Positive Pressure Ventilation in Systolic Heart Failure
Positive Pressure Ventilation in Children With Postcardiotomy Systolic Ventricular Dysfunction
Positive Pressure Ventilation in the Nonsurgical Patient With Systolic Ventricular Dysfunction
CARDIORESPIRATORY INTERACTIONS IN CHILDREN WITH DIASTOLIC VENTRICULAR DYSFUNCTION
Diastolic Dysfunction in Children With Cardiomyopathy
CARDIORESPIRATORY INTERACTIONS IN CHILDREN WITH CONGENITAL HEART DISEASE
Cardiorespiratory Interactions in a Functionally Univentricular Circulation
Cardiorespiratory Interactions After the Fontan Operation
Cardiorespiratory Interactions After the Bidirectional Cavopulmonary Shunt
Cardiorespiratory Interactions Following the Repair of Tetralogy of Fallot
Cardiopulmonary Interactions During Cardiopulmonary Resuscitation
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 72 Hemodynamic Monitoring
INTRODUCTION
PHYSICAL EXAMINATION
ELECTROCARDIOGRAM
TECHNIQUE
INTERPRETATION
TECHNICAL FACTORS
CAPNOGRAPHY
PHYSIOLOGIC CONSIDERATIONS
ARTERIAL PRESSURE
NONINVASIVE OSCILLOMETRIC ARTERIAL PRESSURE MEASUREMENT
INVASIVE ARTERIAL PRESSURE MONITORING
PLACEMENT AND COMPLICATIONS
INTERPRETATION
CENTRAL VENOUS AND ATRIAL PRESSURES
PLACEMENT AND COMPLICATIONS
INTERPRETATION
LEFT ATRIAL PRESSURE MONITORING
PULMONARY ARTERIAL CATHETER
PLACEMENT AND COMPLICATIONS
INTERPRETATION OF THERMODILUTION-DERIVED CARDIAC OUTPUT
INTERPRETATION OF OTHER HEMODYNAMIC MEASUREMENTS FROM THE PULMONARY ARTERIAL CATHETER
FICK EQUATION AND INDIRECT CARDIAC OUTPUT MEASUREMENT
CALCULATION OF THE QP/QS RATIO
TECHNICAL FACTORS
PULSE CONTOUR ANALYSIS
TECHNICAL FACTORS
ECHOCARDIOGRAPHY
VENTRICULAR SHORTENING FRACTION AND EJECTION FRACTION
VENOUS OXIMETRY
BASIC PRINCIPLES
PHYSIOLOGY AND PATHOPHYSIOLOGY
COMPENSATORY CIRCULATORY RESPONSES TO MAINTAIN TISSUE OXYGENATION
CENTRAL VENOUS OXIMETRY
ADVANTAGES AND LIMITATIONS OF VENOUS OXIMETRY
CLINICAL APPLICATION AND CLINICAL STUDIES
CEREBRAL NEAR-INFRARED SPECTROSCOPY OXIMETRY
RENAL AND MESENTERIC NEAR-INFRARED SPECTROSCOPY OXIMETRY
LACTATE
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 73 Heart Failure: Etiology, Pathophysiology, and Diagnosis
INTRODUCTION
ETIOLOGY
Structural Heart Disease
Myocardial Heart Disease
PATHOPHYSIOLOGY
Neurohormonal Response
Cellular Adaptation and Energetics
Ventricular Remodeling
CLASSIFICATION AND EVALUATION
Physical Examination
Diagnostic Evaluation
SUMMARY AND FUTURE DIRECTIONS
Chapter 74 Cardiomyopathy, Myocarditis, and Mechanical Circulatory Support
INTRODUCTION
CARDIOMYOPATHIES
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
Arrhythmogenic Cardiomyopathy
Left-Ventricular Noncompaction
Acquired Cardiomyopathies
Outcomes From Cardiomyopathy
MYOCARDITIS
Etiology
Epidemiology
Pathogenesis and Histology
Clinical Manifestations
Age-Specific Differences in Presentation
Diagnostic Tests
THERAPEUTIC STRATEGIES IN CHILDREN WITH CARDIOMYOPATHY OR MYOCARDITIS
Specific Treatment for Myocarditis—Intravenous Immunoglobulin, Steroids, and Antiviral Agents
Management of Arrhythmias
Anticoagulation
COVID-19–Related Cardiac Involvement
Outcomes
Treatment of Chronic Heart Failure
Progressive Heart Failure Unresponsive to Conventional Management
MECHANICAL CIRCULATORY SUPPORT
Devices
Principles of Management
Weaning
Complications
Outcome Following Mechanical Circulatory Support
SUMMARY
FUTURE DIRECTIONS
Chapter 75 Treatment of Heart Failure: Medical Management
INTRODUCTION
MANAGEMENT OF ACUTE DECOMPENSATED HEART FAILURE
DIAGNOSIS AND ASSESSMENT OF ACUTE DECOMPENSATED HEART FAILURE
Algorithm for Rapid Assessment and Management of Heart Failure
Adequate Perfusion With Elevated Filling Pressures: “Warm and Wet”
Poor Perfusion With Normal Filling Pressures: “Cold and Dry”
Poor Perfusion With Elevated Filling Pressures: “Cold and Wet”
HEART FAILURE IN CONGENITAL HEART DISEASE
Single Ventricle Heart Disease
HEART FAILURE WITH PRESERVED EJECTION FRACTION
MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ASSOCIATED WITH COVID-19
Future Directions
NEW MEDIA
Chapter 76 Treatment of Heart Failure: Mechanical Support
INTRODUCTION
HEART FAILURE IN CHILDREN
PATIENT SELECTION
DEVICE SELECTION
EXTRACORPOREAL MEMBRANE OXYGENATION
Management
SHORT-TERM TEMPORARY VENTRICULAR ASSIST DEVICE IN PATIENTS WITH HEART FAILURE
VAD Cannulation and Management
LONG-TERM DURABLE VENTRICULAR ASSIST DEVICE
Management of LVAD
SPECIAL CONSIDERATIONS
VAD as Destination Therapy
VAD Support for Single Ventricle Congenital Heart Disease
Total Artificial Heart
CONCLUSION
Chapter 77 Thoracic Transplantation
CARDIAC TRANSPLANTATION
Indications for Cardiac Transplantation
Evaluation of the Cardiac Transplant Candidate
Evaluation of the Cardiac Donor
Postoperative Management and Early Complications
Medium-Term and Late Complications
Survival
Conclusions and Future Directions
LUNG TRANSPLANTATION
Indications for Transplantation
Evaluation of the Transplant Candidate
Care of the Preoperative Lung Transplant Candidate
Lung Allocation Score
Evaluation of the Lung Donor
Surgical Techniques of Graft Implantation
Extracorporeal Support as Bridge to Lung Transplantation
Postoperative Management and Early Complications
Acute Complications
Cardiovascular Considerations
Respiratory Support
Gastrointestinal Complications
Endocrine Considerations
Renal Function
Infectious Precautions
Immunosuppression, Rejection, and Posttransplant Lymphoproliferative Disorder
Immunoprophylaxis
Outcomes
Pediatric Heart-Lung Transplantation
Conclusions and Future Directions
Chapter 78 Cardiac Conduction, Dysrhythmias, and Pacing
INTRODUCTION
GUIDE TO INTERPRETATION OF ELECTROCARDIOGRAPHIC RECORDINGS
THE CARDIAC CONDUCTION SYSTEM
TACHYDYSRHYTHMIAS
Diagnostic Approach to Tachydysrhythmias
SPECIFIC DIAGNOSIS
Treatment for Atrioventricular Reciprocating Tachycardia
Atrial Flutter/Intra-atrial Reentrant Tachycardia
Intra-atrial Reentrant Tachycardia
Automatic Supraventricular Tachycardia
Ectopic Atrial Tachycardia
Multifocal Atrial Tachycardia
Treatment of Ectopic Atrial Tachycardia/Multifocal Atrial Tachycardia
Atrial Fibrillation
Junctional Ectopic Tachycardia
Treatment of Junctional Ectopic Tachycardia
Ventricular Tachycardia
BRADYDYSRHYTHMIAS
Diagnostic Approach to Bradydysrhythmias
Bradydysrhythmia Etiologies
Abnormalities of Atrioventricular Conduction
Treatment of Abnormalities of Atrioventricular Conduction
PRINCIPLES OF TEMPORARY PACING
ANTIDYSRHYTHMIC DRUGS
Class I
Class II
Class III
Class IV
Non–Vaughan-Williams Classified Medications
CONCLUSION
Chapter 79 Preoperative Care of the Pediatric Cardiac Surgical Patient
INTRODUCTION
PATIENT DEMOGRAPHICS
NEWBORN CONSIDERATIONS
PREOPERATIVE MANAGEMENT AND CARE
Echocardiographic and Doppler Assessment
Cardiac Catheterization
Computed Tomography and Magnetic Resonance Imaging
Assessment of Patient Status and Predominant Pathophysiology
PREOPERATIVE MANAGEMENT OF PATIENTS WITH A SINGLE VENTRICLE
Preoperative Management
PREOPERATIVE ENTERAL NUTRITION IN NEONATAL PATIENTS
RISK STRATIFICATION IN PEDIATRIC CARDIAC SURGERY
SUMMARY AND FUTURE DIRECTIONS
Chapter 80 Postoperative Care of the Pediatric Cardiac Surgical Patient
INTRODUCTION
CARDIOPULMONARY BYPASS
THE INFLAMMATORY RESPONSE TO CPB
End-Organ Injury
Treatment
GENERAL POSTOPERATIVE CONSIDERATIONS
Assessment of Hemodynamics and Oxygen Transport Balance
Maintenance of Tissue Oxygenation: Manipulation of O2 Demand and Delivery
Vasoactive Therapy
Catecholamines
Dopamine
Dobutamine
Epinephrine
Norepinephrine
Milrinone
Nitroprusside
Nitroglycerin
Calcium Channel Blocker
Vasopressin
RESPIRATORY FUNCTION, DYSFUNCTION, AND TREATMENT
Pump/Ventilatory Issues
Extubation Readiness
NEUROLOGIC ISSUES
Patient-related Factors
Perioperative Management
ENDOCRINE ISSUES
GASTROINTESTINAL ISSUES
HEMATOLOGIC ISSUES
INFECTIOUS ISSUES
RENAL ISSUES
LESION-SPECIFIC MANAGEMENT
Patent Ductus Arteriosus
Atrial and Ventricular Septal Defects
Atrioventricular Septal Defects
Mitral Valve Disease
Aortic Stenosis & LV Outflow Tract Obstruction
Coarctation of the Aorta
Interrupted Aortic Arch
Tricuspid Atresia
Ebstein Anomaly
Valvar Pulmonary Stenosis
Pulmonary Atresia With Intact Ventricular Septum
Tetralogy of Fallot
Tetralogy of Fallot With Pulmonary Atresia
Tetralogy of Fallot Absent Pulmonary Valve Syndrome
Double Outlet Right Ventricle
d-Transposition of the Great Arteries
Truncus Arteriosus
Total Anomalous Pulmonary Venous Return
Single Ventricle Physiology
Systemic-to-Pulmonary Artery Shunt
Pulmonary Artery Band
Damus-Kaye-Stansel Procedure
Norwood Procedure
Superior Cavopulmonary Anastomosis
Modified Fontan Procedure
Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 81 Pulmonary Hypertension
INTRODUCTION
CLASSIFICATION
EPIDEMIOLOGY
PATHOPHYSIOLOGY OF PULMONARY HYPERTENSION
Right Ventricle in Pulmonary Hypertension
Pulmonary Hypertension in Acute Lung Disease
Genetics
DIAGNOSIS
Pulmonary Hypertension Diagnostic Evaluation
Invasive Evaluation
TREATMENT
Oxygen and General Supportive Measures
Inhaled Nitric Oxide
Calcium Channel Blockers
Phosphodiesterase Type-5 Inhibitors
Prostacyclins
Endothelin Receptor Antagonists
INVASIVE OPTIONS FOR REFRACTORY PULMONARY HYPERTENSION
Potts Shunt
Transplantation
PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN
SUMMARY
FUTURE DIRECTIONS
Section V ■ Immunologic Diseases
Chapter 82 The Immune System
INTRODUCTION
1 THE IMMUNE SYSTEM
2 COMPONENTS OF THE IMMUNE SYSTEM
Circulating Mediators of Inflammation
3Cells of the Innate Immune System
Cytokines
T Cells: Amplification and Regulation of Adaptive Immunity 4
5 B Cells: Antibody Production, Antigen Presentation, and Regulation?
SEPSIS IN CHILDREN 6
Balance of Proinflammatory and Antiinflammatory Response in Sepsis
7 Immunodeficiency in Pediatric Critical Care
FUTURE DIRECTIONS
Toward Precision Medicine for Sepsis?
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 83 Neurohormonal Control in the Immune System
INTRODUCTION
THE NEUROHORMONAL RESPONSE TO ACUTE STRESS
Shared Chemical Language of Neuroendocrine and Immune Systems
The Immune System as a Sensory Organ
RECENT NEUROENDOCRINE-IMMUNE MEDIATORS APPLIED TO CRITICAL ILLNESS
Adrenal Replacement Therapy May Have Immunomodulatory Effects
Treatment With Growth Hormone Increases Mortality Because of Sepsis
Vasopressin Infusion in Vasodilatory Shock
PATHWAYS OF COMMUNICATION
Efferent Signals: How the Central Nervous System Communicates With the Immune System
Humoral Efferent Pathways
Afferent Signals: Alerting the Central Nervous System to a Microbial Threat
Peripheral Responses: The Effects of Neuroimmunomodulation
IMMUNE COMPETENCE AND FAILURE IN THE PEDIATRIC INTENSIVE CARE UNIT
Neuroendocrine-Immune Failure
Immunomodulatory Effects of Intensive Care Unit Therapies
Assessment and Treatment of Immune Suppression Because of Critical Illness
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 84 The Polymorphonuclear Leukocyte in Critical Illness
INTRODUCTION
NEUTROPHIL PHYSIOLOGY
Neutrophil Localization in Infection
Opsonophagocytosis and Microbial Killing
Modulation of the Immune Response
Clearance of Neutrophils
4 DEFECTS IN NEUTROPHIL NUMBER AND/OR FUNCTION
Congenital and Developmental
NEUTROPHILS AND CRITICAL ILLNESS
Sepsis
Trauma
Acute Lung Injury
Neutropenia and the Intensive Care Unit
Critical Care Therapies and Neutrophil Function
Modulating Neutrophil Function
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 85 The Immune System and Viral Illness
INTRODUCTION
1 VIRAL ILLNESS: A MAJOR CAUSE OF CRITICAL ILLNESS IN CHILDREN
Viruses Cause Disease by Diverse Mechanisms
MUCOSAL IMMUNITY: THE FIRST BARRIER TO VIRAL INVASION
Respiratory Epithelium: How Structural and Functional Immunity Coordinate a First Line of Defense From Viral Infection 2 3
Pathogen Recognition and Activation of the Host Response to Infection
Hiding in Plain Sight: Influenza and Respiratory Syncytial Virus Subvert Early Immune Responses
Endothelial Activation: How Respiratory Infection Cascades Into Acute Respiratory Distress Syndrome
Herpes Simplex Virus Causes Sporadic Encephalitis and Disseminated Neonatal Disease
4 CIRCULATING MEDIATORS CONTRIBUTE TO EARLY ANTIVIRAL RESPONSES
Complement and Viral Infection
INNATE CELLULAR IMMUNITY IN VIRAL INFECTION 5
Monocytes, Macrophages, and “Hyperinflammation” in COVID-19-Related Disease
Natural Killer Cells: Detection and Destruction of Infected Cells
Dendritic Cells: Modulating the Evolution of the Host Immune Response
Neutrophils and Neutrophil Extracellular Traps
ADAPTIVE IMMUNITY IN VIRAL INFECTIONS
7 T Cells and Coordination of Adaptive Immunity
B Cells and Humoral Immunity
8 FUTURE DIRECTIONS
Using Genetic Data to Improve Patient Care
The Trajectory of Infection
Monoclonal Antibodies and Personalized Immunomodulation
SUMMARY
Chapter 86 Immune Modulation and Immunotherapy in Critical Illness
INTRODUCTION
TARGETING PRO-INFLAMMATION
Severe Sepsis and Septic Shock
Acute Respiratory Distress Syndrome
Other Uses of Targeted Anti-inflammatory Therapies
IMMUNOPARALYSIS
Reversal of Immunoparalysis
PATIENTS WITH OVERT IMMUNOSUPPRESSION
Patient With Neutropenia
Patient With Lymphopenia
Transplant Patient
INTRAVENOUS IMMUNOGLOBULIN
IMMUNOTHROMBOSIS
IMMUNONUTRITION
GENETIC INFLUENCES
IMPACT OF CRITICAL ILLNESS ON INFLAMMATION
Transfusions
Cardiopulmonary Bypass
SUMMARY
FUTURE DIRECTIONS
Chapter 87 Immune Deficiency Disorders
PRIMARY OR CONGENITAL IMMUNE DEFICIENCY DISORDERS
DISORDERS PREDOMINANTLY AFFECTING IMMUNOGLOBULINS
X-Linked Agammaglobulinemia
Common Variable Immunodeficiency
Transient Hypogammaglobulinemia of Infancy
Hyper-IgM Syndrome
DISORDERS PREDOMINANTLY AFFECTING CELLULAR FUNCTION
22q11.2 Deletion Syndrome
Defects in the IFN-γ–IL-12 Axis
IMMUNODEFICIENCY WITH CYTOTOXIC DEFECTS
IMMUNODEFICIENCY WITH COMBINED ANTIBODY AND CELLULAR DEFECTS
Severe Combined Immunodeficiency
Combined Immunodeficiency Disease
Deficiencies in Antigen Presentation Pathways
Deficiencies in Apoptosis and Tolerance
Deficiencies in Activation and Differentiation
DISORDERS AFFECTING PHAGOCYTE FUNCTION
Disorders Associated With Primary Neutropenia
Disorders of Neutrophil Function
COMPLEMENT DEFICIENCY
Complement Regulation
Deficiencies and Disease
INNATE IMMUNE SIGNALING DEFECTS
IMMUNODEFICIENCY AND CANCER PREDISPOSITION
IMMUNOLOGIC EFFECTS OF CANCER AND ITS TREATMENT
IMMUNE DYSFUNCTION ASSOCIATED WITH HEMATOPOIETIC STEM CELL TRANSPLANT
Innate Immunity Recovery
Adaptive Immunity Recovery
FUTURE DIRECTIONS
Section VI ■ Infectious Diseases
Chapter 88 Bacterial Sepsis
INTRODUCTION AND DEFINITION
Definitions
Epidemiology
Etiology
MECHANISM OF DISEASE: CORE PATHOPHYSIOLOGY
Environmental Risk Factors
CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS
Hemodynamic Data
Laboratory Abnormalities
Differential Diagnosis
Diagnosis
CLINICAL MANAGEMENT/TREATMENT
Guidelines for Early Clinical Management
Subacute Management
Other Therapies for Acute Management of Sepsis
PREVENTION OF SEPSIS
High-Risk Patient Populations
Prophylaxis
QUALITY IMPROVEMENT THROUGH BUNDLED MANAGEMENT ALGORITHMS
OUTCOMES
SUMMARY AND FUTURE DIRECTIONS
Chapter 89 Principles of Antimicrobial Therapy
INTRODUCTION
General Approach to Antibiotics in the Pediatric Intensive Care Unit
Pitfalls of Antibiotic Overuse
INITIATION OF EMPIRIC ANTIBIOTIC THERAPY AND LABORATORY CONSIDERATIONS IN THE PEDIATRIC INTENSIVE CARE UNIT
Risk Factors for Antibiotic Resistance
Combination Strategies for Antibiotic-Resistant Infections
DE-ESCALATION/DISCONTINUATION AND DEFINITIVE THERAPY
ANTIBIOTIC STEWARDSHIP STRATEGIES IN THE PEDIATRIC INTENSIVE CARE UNIT
BIOMARKERS OF INFECTION
Molecular Diagnostic Tests
PHYSIOLOGIC CHANGES IN CRITICALLY ILL PATIENTS—IMPACT ON DOSING
Volume Status
End-Organ Function
Obesity
APPLICATION OF PHARMACOKINETICS-PHARMACODYNAMICS
Therapeutic Drug Monitoring 2
Area Under the Curve of the Unbound Drug to the Minimum Inhibitory Concentration (ƒAUC0-24/MIC)
Cumulative Percentage of a Dosing Interval That the Antimicrobial Concentration Exceeds the Minimum Inhibitory Concentration (%ƒT > MIC)
Ratio of the Maximal Unbound Drug Concentration to the Minimum Inhibitory Concentration (ƒCmax/MIC)
Postantibiotic Effect
Bacteriostatic/Bactericidal Properties
MODIFIED DOSING STRATEGIES
Standard/Bolus Dosing, Prolonged Intermittent Infusion, and Continuous Infusion
Extended-Interval Aminoglycoside Dosing (EIAD)
ANTIBACTERIAL AGENTS
Adverse Drug Reactions
Drug-Drug Interactions
Aminoglycosides
Glycopeptides
Oxazolidinones
Lipopeptides (Daptomycin)
Clindamycin
Fluoroquinolones
Macrolides and Related Drugs
Tetracyclines and Glycylcyclines
ANTIFUNGAL AGENTS
Polyenes
Azoles
Echinocandins
Flucytosine
Combination Antifungal Therapy
ANTIVIRAL AGENTS (NON-HIV)
Mechanisms of Action
Resistance
Spectrum of Activity
Clinical Practice
ANTIVIRAL AGENTS (INFLUENZA)
ANTI-INFECTIVES FOR MYCOBACTERIUM TUBERCULOSIS
Isoniazid
Rifamycins
Pyrazinamide
Streptomycin
Ethambutol
ANTIMALARIAL DRUGS
Quinidine
Artesunate
Chapter 90 Dengue and Other Hemorrhagic Viral Infections
DENGUE INFECTIONS
Epidemiology
Virus
Transmission
PATHOGENESIS AND PATHOPHYSIOLOGY
Pathology
Classification
CLINICAL MANIFESTATIONS AND NATURAL COURSE
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
Diagnosis of Dengue Hemorrhagic Fever
Laboratory Investigations
CONFIRMATION TESTS FOR DENGUE
MANAGEMENT
Febrile Phase
Indications for Hospitalization
Monitoring
Critical Phase or Leakage Phase
Monitoring
Principle of Hemodynamic Monitoring in Dengue Shock Syndrome
VOLUME REPLACEMENT
Fluid Administration for Nonshock Patients (DHF Grades I and II)
Fluid Administration for Shock Patients (DHF Grade III)
Fluid Administration for Profound Shock Patients (DHF Grade IV)
Indication for the Use of Hyperoncotic Colloids
Blood/Blood Component Transfusion
Indications for Blood Transfusion
Transfusion Blood Volume
Blood Transfusion Rate
Platelet Transfusion
Special Investigations and Management in Patients With DHF/DSS Who Do Not Respond to the Conventional IV Fluid Management
Convalescence Phase
Future Directions: Prevention and Vaccines
Hints for Management of Dengue
VIRAL HEMORRHAGIC FEVERS
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Prognosis and Prognostic Factors
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 91 Critical Viral Infections
INTRODUCTION
SEVERE INFLUENZA INFECTIONS
Epidemiology
Virus
Transmission
Importance to Intensivist
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnosis
Management
Prognosis
HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN THE CRITICALLY ILL CHILD
Epidemiology
HIV-1 and HIV-2
Transmission
Pathogenesis
Clinical Manifestations
Spectrum of Diseases in the Pediatric Intensive Care Unit
Respiratory Diseases Complicating HIV Infection
Gastrointestinal Diseases
Neurologic Diseases
Cardiovascular Involvement
Renal Involvement
Diagnosis
Antiretroviral Therapy
Outcome
Prevention of Transmission in the Pediatric Intensive Care Unit
Conclusions and Future Directions
MEASLES
Description of Organism
Transmission
Pathogenesis and Pathophysiology
Clinical Features
Pneumonia
Neurologic Involvement
Differential Diagnosis
Diagnosis
Treatment
Prognosis
Conclusions and Future Directions
NONPOLIO ENTEROVIRAL INFECTIONS
Pathogenesis
Clinical Features
Laboratory Diagnosis
Treatment
Conclusions and Future Directions
SEVERE VARICELLA INFECTIONS
Description of Virus
Clinical Features
Bacterial Superinfection
Pneumonia
Encephalitis
Disseminated Varicella and Zoster
Conclusions and Future Directions
SEVERE HERPES SIMPLEX VIRUS INFECTIONS
Description of the Virus
Pathogenesis
Clinical Features
Infections of the Central Nervous System
Pneumonia
Disseminated Involvement
Neonatal Herpes
Diagnosis
Management
Prognosis
Conclusions and Future Directions
SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2
COVID-19 INFECTION (COVID-19)
Virus
Transmission
Pathogenesis
Clinical Manifestations
Laboratory Diagnosis
Management
Prognosis
MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN
Definitions
Epidemiology
Pathogenesis
Clinical Features
Diagnostic Evaluation
Treatment
Outcome
Chapter 92 Central Nervous System Infections
INTRODUCTION
Pathogenesis
Clinical Presentation
Diagnosis
Management
BACTERIAL MENINGITIS
Epidemiology
Pathogenesis
Nasopharyngeal Colonization and Vascular Invasion
Meningeal Invasion
Inflammation of the Subarachnoid Space
Pathophysiology
Neuropathology
Clinical Presentation
Differential Diagnosis
Diagnosis
Laboratory Diagnosis
Complications
Neuroimaging
Treatment
Prognosis
Prevention
ASEPTIC MENINGITIS
Etiology
TUBERCULAR MENINGITIS
Etiology
Epidemiology
Pathogenesis
Clinical Presentation
Diagnosis
Neuroimaging
Treatment
Prognosis
ENCEPHALITIS AND MYELITIS
Etiology
Epidemiology
Pathogenesis
Clinical Manifestations
Differential Diagnosis
Diagnosis
Neuroimaging
Treatment
Prognosis
HERPES ENCEPHALITIS
Epidemiology
Pathogenesis
Clinical Presentation
JAPANESE ENCEPHALITIS
Etiology
Pathophysiology
Clinical Presentation
Differential Diagnosis
Diagnosis
Neuroimaging
Treatment
Prognosis
Prevention and Control
CORONAVIRUS DISEASE 2019 NERVOUS SYSTEM INFECTION
Etiology
Epidemiology
Pathogenesis
Clinical Manifestations
Diagnosis
Neuroimaging
Treatment
Prognosis
ACUTE DISSEMINATED ENCEPHALOMYELITIS
Pathogenesis
Epidemiology
Clinical Presentation
Differential Diagnosis
Diagnosis
Neuroimaging
Treatment
Prognosis
BRAIN AND SPINAL CORD ABSCESS
Etiology
Pathogenesis
Clinical Presentation
Diagnosis
Neuroimaging
Treatment
Prognosis
SUBDURAL EMPYEMA
Etiology
Pathogenesis
Clinical Presentation
Diagnosis
Treatment
Prognosis
EPIDURAL ABSCESS
Etiology
Pathophysiology
Clinical Presentation
Diagnosis
Treatment
Prognosis
CEREBROSPINAL FLUID SHUNT INFECTION
Etiology
Epidemiology
Pathogenesis
Clinical Presentation
Diagnosis
Treatment
Prevention
FUNGAL INFECTIONS OF THE CENTRAL NERVOUS SYSTEM
Etiology
Epidemiology
Pathogenesis
Pathology
Clinical Features
Diagnosis
Neuroimaging
Treatment
Prognosis
Prevention
PARASITIC INFECTIONS
Etiology
Epidemiology
Pathogenesis
Clinical Presentation
Diagnosis
Neuroimaging
Treatment
NEUROCYSTICERCOSIS
Etiology
Epidemiology
Pathogenesis
Clinical Manifestations
Diagnosis
Neuroimaging
Other Tests
Differential Diagnoses
Treatment
Prognosis
Prevention
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENTS
Chapter 93 Nosocomial Infections in the Pediatric Intensive Care Unit
DEFINITIONS
OVERVIEW AND EPIDEMIOLOGY
General Risk Factors
2 Isolation Precautions
Hand Hygiene Compliance
Surveillance Cultures 3
Infection Prevention and the COVID-19 Pandemic
CATHETER-RELATED BLOODSTREAM INFECTIONS
DEFINITIONS
EPIDEMIOLOGY
Diagnosis and Treatment of Catheter-Related Infections
Prevention of Catheter-Related Infections
Central-Line Choice and Antimicrobial/Antiseptic-Impregnated Catheters
Central-Line Replacement
NOSOCOMIAL RESPIRATORY INFECTIONS
Ventilator-Associated Pneumonia
Diagnosis of Ventilator-Associated Pneumonia
Prevention of Ventilator-Associated Pneumonia 5
Sinusitis
Respiratory Syncytial Virus
Influenza and Other Respiratory Viruses
NOSOCOMIAL URINARY TRACT INFECTIONS
NOSOCOMIAL GASTROINTESTINAL INFECTIONS
SURGICAL SITE INFECTIONS
Nosocomial Central Nervous System Infections
Selected Surgical Site Infections
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 94 International and Emerging Infections
International Infections
Typhoid
Chagas Disease
Human African Trypanosomiasis
Leptospirosis
Hantavirus
EMERGING INFECTIONS
Avian Influenza
Ebola Virus Disease
ACKNOWLEDGMENTS
Chapter 95 Toxin-Related Diseases
INTRODUCTION
TETANUS
Epidemiology
The Pathogen
Pathogenesis
Clinical Features
Diagnosis and Differential Diagnosis
Complications of Tetanus
Management
Outcome and Prognosis
Prevention
Conclusions and Future Directions
DIPHTHERIA
Epidemiology
The Pathogen
Pathogenesis
Clinical Manifestations
Complications
Diagnosis and Differential Diagnosis
Laboratory Diagnosis
Management
Outcome and Prognosis
Prevention and Treatment for Contacts and Carriers
Conclusions and Future Directions
BOTULISM
Toxin Mechanism
Infant Botulism
Foodborne Botulism
Adult (Intestinal) Botulism
TOXIC SHOCK SYNDROME
Staphylococcal Toxic Shock Syndrome
Streptococcal Toxic Shock Syndrome
CONCLUSION AND FUTURE DIRECTION
Chapter 96 Opportunistic Infections
INTRODUCTION
DEFECTS IN THE IMMUNE SYSTEM AND OPPORTUNISTIC PATHOGENS
APPROACH TO THE PATIENT WITH SUSPECTED OPPORTUNISTIC INFECTION
OPPORTUNISTIC INFECTIONS IN PEDIATRIC INTENSIVE CARE SETTINGS
OPPORTUNISTIC INFECTIONS DUE TO VIRUSES
Varicella Zoster Virus Infection
Herpes Virus Type 6
FUNGAL INFECTIONS
Pneumocystis jirovecii
Invasive Aspergillosis
Mucormycosis
Cryptococcosis
Histoplasmosis
MYCOBACTERIAL INFECTIONS
Nontuberculous Mycobacteria
Mycobacterium Tuberculosis
PARASITIC INFECTIONS
CRYPTOSPORIDIUM INFECTION
Clinical Features
Diagnosis
Management
Prevention
CONCLUSIONS AND FUTURE DIRECTIONS
Section VII ■ Nutritional and Gastrointestinal Disorders
Chapter 97 Principles of Gastrointestinal Physiology, Nutrition, and Metabolism
INTRODUCTION
GASTROINTESTINAL TRACT ANATOMY AND PHYSIOLOGY
Small Intestine
Large Intestine
Physiology of Absorption
Neural Control of the Gastrointestinal Tract
Gastrointestinal Perfusion
Neuroendocrine Control of the Gastrointestinal Tract and Metabolism
GUT AS AN IMMUNE SYSTEM
Immunonutrition
ENERGY EXPENDITURE AND METABOLISM
Respiratory Quotient
Indirect Calorimetry
KEY NUTRIENTS
Macronutrients
Micronutrients
Trace Elements and Minerals
Refeeding Syndrome
BODY COMPOSITION
ENTERAL VERSUS PARENTERAL NUTRITION
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 98 Nutritional Support
NUTRITIONAL ASSESSMENT
HISTORY AND PHYSICAL EXAMINATION
ANTHROPOMETRIC EXAMINATION
NUTRITIONAL STATUS
Metabolic Response to Stress
Starvation
Refeeding Syndrome
Obesity
NUTRITIONAL MANAGEMENT
Developing an Optimal Nutrition Plan—Component Requirements
Energy Intake
Electrolyte Intake
Micronutrient Intake
NUTRITIONAL DELIVERY
Enteral Nutrition for Premature Newborns
Enteral Nutrition for Children Aged 1 to 10 Years
Enteral Nutrition for Children Older Than 10 Years
Challenges and Complications With Enteral Nutrition
Parenteral Nutrition
Optimal Timing for Parenteral Nutrition Combined With Enteral Nutrition
NUTRITIONAL MONITORING
Serum Protein
Other Inflammatory Markers
Plasma Triglyceride Concentrations
Measured Energy Expenditure (Indirect Calorimetry)
Body Composition and Prognosis
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 99 Secretory and Motility Issues of the Gastrointestinal Tract
INTRODUCTION
DIARRHEA
ETIOLOGIES OF DIARRHEA IN ICU PATIENTS
Noninfectious Diarrhea Causes
Infectious Diarrhea Causes
EVALUATION AND MANAGEMENT
INTESTINAL HYPOMOTILITY (ILEUS)
MANAGEMENT
PROGNOSIS
GASTROESOPHAGEAL REFLUX
ETIOLOGY
MANAGEMENT
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 100 Gastrointestinal Bleeding
INTRODUCTION AND EPIDEMIOLOGY
ANATOMIC LOCATION
DEFINITIONS AND CLINICAL PRESENTATION
ETIOLOGY
DIAGNOSTIC EVALUATION
The Nasogastric Tube
Laboratory Tests
Radiologic and Nuclear Medicine Imaging
MEDICAL MANAGEMENT
Endoscopic Evaluation
SPECIFIC CONDITIONS
Ulcers and Gastritis
Hematopoietic Stem-Cell Transplant/Immunosuppressed Patients
Inflammatory Bowel Disease
Variceal Bleeding
SUMMARY AND FUTURE DIRECTIONS
Chapter 101 Abdominal Compartment Syndrome
INTRODUCTION
DEFINITIONS
CONTINUUM OF DISEASE SEVERITY
ETIOLOGY/RISK FACTORS
PATHOPHYSIOLOGY
Pathophysiologic Derangements in Anatomy and Physiology
CLINICAL MANIFESTATIONS
DIAGNOSIS
MANAGEMENT
Diagnostic/Treatment Strategy
FUTURE DIRECTIONS
CONCLUSIONS
Chapter 102 The Acute Abdomen
INTRODUCTION
CLASSIFICATION
INITIAL MANAGEMENT OF THE CHILD WITH AN ACUTE ABDOMEN
CRITICAL ABDOMINAL PATHOLOGY
Ileus
Bowel Obstruction
Intestinal Ischemia
Abdominal Infections
Pseudomembranous Colitis
Toxic Megacolon
Neutropenic Enterocolitis and Typhlitis
Enteritis
Acute Pancreatitis
Necrotizing Enterocolitis
ACUTE ABDOMINAL MANIFESTATION OF SYSTEMIC DISEASES
FUTURE DIRECTIONS
Chapter 103 Diagnostic Imaging of the Abdomen
INTRODUCTION
PLAIN RADIOGRAPHS
2 Abnormal Plain Film Findings
CONTRAST STUDIES
ULTRASOUND
Color and Spectral Doppler
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
DIFFERENTIAL DIAGNOSIS AND IMAGING OF ABDOMINAL PATHOLOGY
Infectious and Inflammatory
Masses
Trauma
SUMMARY
FUTURE DIRECTIONS
Chapter 104 Acute Liver Failure and Liver Transplantation
ACUTE LIVER FAILURE
Definition and Classification of Acute Liver Failure
Causes of Acute Liver Failure
Diagnosis of Acute Liver Failure
Complications of Acute Liver Failure
Management of Acute Liver Failure
LIVER TRANSPLANTATION
Main Indications and Preoperative Evaluation for Pediatric Liver Transplantation
Intraoperative Care of Children Undergoing Liver Transplantation
Postoperative Care of Children After Liver Transplantation
Results and Outcomes After Pediatric Liver Transplantation
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 105 Pediatric Intestinal and Multivisceral Transplantation
INTRODUCTION
INDICATIONS
CLINICAL MANAGEMENT OF THE PRETRANSPLANT CHILD IN THE PEDIATRIC INTENSIVE CARE UNIT
Parenteral Nutrition Dependence
Liver Failure
THE TRANSPLANT OPERATION
Recipient Operations
Isolated Small Bowel
Liver-Small Bowel
Multivisceral Transplantation
POSTTRANSPLANT MANAGEMENT
Postoperative Care
Management of Complications
OUTCOMES
FUTURE DIRECTIONS
Allograft Size Reduction
Live Donor Intestinal and Combined Liver and Intestinal Allografts
Liver-Alone Transplantation in Patients With Intestinal Failure
Utility of the Colon and Stomach
Optimization of Immunosuppression
Bioartificial Neointestine
SUMMARY
Section VIII ■ Renal, Endocrine, and Metabolic Disorders
Chapter 106 Adrenal Dysfunction
INTRODUCTION
1 BIOLOGY OF ADRENAL FUNCTION
Adrenal Cortex
The Effects of Stress on Adrenocortical Function
Adrenal Medulla
2 ADRENOCORTICAL INSUFFICIENCY
Pituitary Disease and Adrenocorticotropic Hormone Deficiency (Secondary Adrenal Insufficiency)
Hypothalamic Disease and Corticotropin-Releasing Hormone Deficiency (Tertiary Adrenal Insufficiency)
RELATIVE ADRENAL INSUFFICIENCY (CRITICAL ILLNESS–RELATED CORTICOSTEROID INSUFFICIENCY) 3
Clinical Diagnosis of Relative Adrenal Insufficiency in the Intensive Care Unit
4 ADRENOPAUSE
5 ADRENAL HYPERFUNCTION
Virilizing Tumors
6 STEROID SUPPLEMENTATION DURING STRESS OR IN THE PERIOPERATIVE PERIOD
THERAPEUTIC GUIDELINES/STEROID PREPARATIONS 7
OUTCOME
Chapter 107 Disorders of Glucose Homeostasis
DIABETIC KETOACIDOSIS IN CHILDREN
Definition and Pathophysiology
Clinical Presentation and Differential Diagnosis
Clinical Management
Outcomes
Conclusions and Future Directions—Diabetic Ketoacidosis
HYPERGLYCEMIC HYPEROSMOLAR SYNDROME
Epidemiology
Pathophysiology
Clinical Presentation and Diagnosis
Treatment
Outcomes
Conclusions and Future Directions—Hyperglycemic Hyperosmolar Syndrome
HYPERGLYCEMIA IN CRITICALLY ILL CHILDREN
Epidemiology of Hyperglycemia
Normal Glucose Homeostasis
Glucose Control During Critical Illness
Pathologic Effects of Hyperglycemia
Management of Hyperglycemia Associated With Critical Illness
Conclusions and Future Directions—Hyperglycemia
HYPOGLYCEMIA IN CHILDREN
Pathophysiology
Clinical Presentation
Diagnosis of Hypoglycemic Disorders
Outcomes
Conclusions and Future Directions—Hypoglycemia
Chapter 108 Disorders of Water, Sodium, and Potassium Homeostasis
INTRODUCTION
Normal Physiology and Pathophysiology 2
Renal Handling of Water and Solutes—An Overview
Water Homeostasis
Sodium Homeostasis
Cellular Responses to Disturbances in Plasma Osmolality
Potassium Homeostasis
CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS
3 Physical Examination
Laboratory and Technical Studies
Disorders of Sodium Balance
Disorders of Potassium Balance
4 Management of Sodium and Potassium Disorders
Management
OUTCOMES: MORBIDITY AND MORTALITY
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 109 Disorders of Calcium, Magnesium, and Phosphate
DISTRIBUTION OF CALCIUM, MAGNESIUM, AND PHOSPHATE
REGULATION OF CALCIUM, MAGNESIUM, AND PHOSPHATE
Calcium Homeostasis
Magnesium Homeostasis
Phosphate Homeostasis
Hormonal Regulation
Parathyroid Hormone
Vitamin D
Calcitonin
Physiologic Factors Affecting Calcium, Magnesium, and Phosphate
DISORDERS OF CALCIUM, MAGNESIUM, AND PHOSPHATE HOMEOSTASIS
Normal Values
Hypocalcemia
Hypocalcemia in Critical Illness
Hypercalcemia
Hypercalcemia in Critical Illness
Hypomagnesemia
Hypomagnesemia in Critical Illness
Hypermagnesemia
Hypophosphatemia
Hypophosphatemia in Critical Illness
Hyperphosphatemia
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 110 Thyroid Disease
INTRODUCTION
1 NORMAL PHYSIOLOGY
Critical Nonthyroidal Illness 2
HYPOTHYROIDISM
Clinical Manifestations
Diagnosis
Treatment
HYPERTHYROIDISM (THYROTOXICOSIS)
Clinical Manifestations
Diagnosis
Treatment
CRITICAL HYPOTHYROIDISM: “MYXEDEMA COMA” 4
Clinical Manifestations
Diagnosis
Treatment
CRITICAL HYPERTHYROIDISM: “THYROID STORM”
Clinical Manifestations
Diagnosis
Treatment
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 111 Acute Kidney Injury
DEFINITION OF ACUTE KIDNEY INJURY
EPIDEMIOLOGY
ESTIMATION OF GLOMERULAR FILTRATION RATE
Creatinine
Cystatin C
Biomarkers and Clinical Risk Prediction Tools of Acute Kidney Injury 5
Acute Kidney Injury Risk Stratification Scores
EVALUATION OF ACUTE KIDNEY INJURY
Prerenal Acute Kidney Injury
INTRINSIC RENAL ACUTE KIDNEY INJURY
Glomerular Disease
Tubular Disease: Acute Tubular Necrosis
Postrenal Acute Kidney Injury
PREVENTION AND TREATMENT OF ACUTE KIDNEY INJURY
Prevention
Fluid Management
Diuretics
Vasoactive Agents
Electrolyte and Acid-Base Balance
Dosing of Medications
Hypertension
Nutritional Support
Kidney Replacement Therapy
PROGNOSIS
Long-term Outcomes
CONCLUSIONS
FUTURE DIRECTIONS
Chapter 112 Chronic Kidney Disease, Dialysis, and Kidney Transplantation
DEFINITION AND RISK FACTORS FOR DEVELOPING CHRONIC KIDNEY DISEASE
MANIFESTATIONS OF CHRONIC KIDNEY DISEASE
Impact of Chronic Kidney Disease on the Cardiovascular System
Hematological and Immune Responses in Chronic Kidney Disease
DIALYSIS AS A KIDNEY REPLACEMENT THERAPY 3
Hemodialysis
CONTINUOUS RENAL REPLACEMENT THERAPY
Peritoneal Dialysis
5 KIDNEY TRANSPLANTATION
Surgical Considerations and Management
Postoperative Hemodynamic, Fluid, and Electrolyte Management
Immunosuppression
Pain Management
Posttransplant Complications
Other Postoperative Issues
FUTURE DIRECTIONS
ACKNOWLEDGMENTS
Chapter 113 Hypertensive Crisis
INTRODUCTION AND DEFINITIONS
Hypertensive Emergency
Hypertensive Urgency
PATHOPHYSIOLOGY
Cerebral Autoregulation
EPIDEMIOLOGY
CLINICAL PRESENTATION
Blood Pressure
Neurologic Manifestations
Cardiovascular Manifestations
Renal Manifestations
CLINICAL EVALUATION
Monitoring
TREATMENT
Pharmacologic Therapy
PARENTERAL ANTIHYPERTENSIVE AGENTS
ORAL ANTIHYPERTENSIVE AGENTS
Captopril
Enalapril
CONCLUSION AND FUTURE DIRECTIONS
Chapter 114 Inborn Errors of Metabolism
GENERAL APPROACH TO INBORN ERRORS
Clinical Presentation and Differential Diagnosis
Clinical Management Principles
Impact of Neonatal Screening
DISORDERS ASSOCIATED WITH LACTIC ACIDOSIS
METABOLIC ACIDOSIS WITHOUT INCREASED LACTATE
Novel Therapies 12
HYPOGLYCEMIA
HYPERAMMONEMIA
LIVER FAILURE
NONMETABOLIC CRITICAL ILLNESS IN INBORN ERRORS OF METABOLISM
Novel Therapies
CONCLUSIONS AND FUTURE DIRECTIONS
Section IX ■ Oncologic and Hematologic Disorders
Chapter 115 Cancer Therapy: Mechanisms and Toxicity
INTRODUCTION
MECHANISM OF ACTION OF CHEMOTHERAPEUTICS
Alkylating Agents
Antimetabolites
Topoisomerase Inhibitors
Antimicrotubule Agents
Other Cytotoxic Drugs
BASICS OF RADIATION THERAPY
General Principles of Radiation Therapy
Types of External-Beam Radiation
Targeted Radiation Therapy
BIOLOGICAL THERAPY
Differentiation Therapy
Antibody-Based Therapy
Immunotherapies
Small-Molecule Kinase Inhibitors
TOXICITIES
Toxicities of the Central Nervous System
Cardiac Toxicities
Pulmonary Toxicities
Retinoic Acid Syndrome
Pancreatitis
Urinary Tract Toxicities
Radiation Recall
Management of Chemotherapy Overdose
FUTURE DIRECTIONS
Chapter 116 Oncologic Emergencies and Complications
INTRODUCTION
SHOCK IN THE CHILD WITH CANCER
Septic Shock
Fluid Therapy
Cardiac Dysfunction
Pericardial Effusion and Cardiac Tamponade
HEMATOLOGIC EMERGENCIES
Hyperleukocytosis
ABNORMAL HEMOSTASIS IN CANCER
Bleeding in Childhood Cancer
Thrombosis in Childhood Cancer
WATER, ELECTROLYTE, AND METABOLIC EMERGENCIES
Tumor Lysis Syndrome
Hypercalcemia
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Cerebral Salt-Wasting Syndrome
Diabetes Insipidus
NEUROLOGIC EMERGENCIES
Spinal Cord Compression
Increased Intracranial Pressure
Seizures
Stroke
Coma
Posterior Reversible Encephalopathy Syndrome
RESPIRATORY EMERGENCIES
Mediastinal Masses
Superior Vena Cava Syndrome and Superior Mediastinal Syndrome
Massive Hemoptysis
ABDOMINAL EMERGENCIES
Acute Appendicitis
Bowel Obstruction
Intussusception
Sinusoidal Obstruction Syndrome/Veno-occlusive Disease
SUMMARY
FUTURE DIRECTIONS
Chapter 117 Hematologic Emergencies
INTRODUCTION
RED BLOOD CELL ABNORMALITIES
Hemoglobinopathies
Erythrocytosis
WHITE BLOOD CELL ABNORMALITIES (NONMALIGNANT)
Leukocytosis
PLATELET ABNORMALITIES
Thrombocytopenia
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 118 Critical Illness Following Hematopoietic Cell Transplantation
OVERVIEW OF HEMATOPOIETIC STEM CELL TRANSPLANTATION IN CHILDREN AND ADOLESCENTS
Respiratory failure
Noninfectious Causes
Infectious Causes
Management of the HSCT Patient With Respiratory Failure
CARDIOVASCULAR COMPLICATIONS
ENDOTHELIOPATHIES
TRANSPLANT ASSOCIATED THROMBOTIC MICROANGIOPATHY (TA-TMA)
GRAFT VERSUS HOST DISEASE
RENAL COMPLICATIONS
NEUROLOGIC DYSFUNCTION
CYTOKINE RELEASE SYNDROME (CRS), CAR-T–RELATED ENCEPHALOPATHY SYNDROME (CRES), AND CAR-T–RELATED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH)
SUPPORTIVE CARE FOR TRANSPLANT PATIENTS 9
SUMMARY, OUTCOMES, AND FUTURE DIRECTIONS
Chapter 119 Coagulation Issues in the Pediatric Intensive Care Unit(s)
OVERVIEW OF COAGULATION
Interaction of Coagulation and Inflammation
The Role of the Protein C System
Developmental Hemostasis
LABORATORY EVALUATION OF THE PATIENT WITH AN ACTUAL OR SUSPECTED COAGULATION DISORDER
Blood Sample Preparation
Laboratory Results in Suspected Bleeding Disorders
Laboratory Results in Suspected Thrombotic Disorders
CONDITIONS ASSOCIATED WITH SERIOUS BLEEDING, A HIGH PROBABILITY OF BLEEDING, OR SERIOUS HEMOSTATIC SEQUELAE
Meningococcal Purpura Fulminans
Disseminated Intravascular Coagulation Management
Microangiopathies With Microvascular Thrombosis
Liver Disease and Hepatic Insufficiency
Management of Abnormal Hemostasis in Liver Disease
Vitamin K Deficiency
Management of Vitamin K Deficiency
IATROGENIC COAGULOPATHY
Management of Coagulopathy in Massive Transfusion Syndrome
ANTICOAGULANT USE AND MANAGEMENT OF OVERDOSE
Heparin Overdose
Management of Heparin Overdose
Parenteral Direct Thrombin Inhibitors
Novel Direct Oral Anticoagulants
Management of Oral and Parenteral Direct Oral Anticoagulant Overdose
Warfarin Use and Overdose
Management of Warfarin Overdose
Thrombolytic Therapy Use and Overdose
PLATELET DISORDERS
Quantitative Platelet Disorders
Qualitative Platelet Disorders
Management of Platelet Disorders
Uremia
THROMBOTIC SYNDROMES
Immunothrombosis
Management of Thrombosis
SELECTED DISORDERS
CONCLUSIONS AND FUTURE DIRECTIONS
Chapter 120 Sickle Cell Disease
INTRODUCTION
NORMAL HEMOGLOBIN STRUCTURE AND FUNCTION
PATHOPHYSIOLOGY OF SICKLE CELL DISEASE
Erythrocytes and Hemoglobin
Endothelium
Leukocytes
Platelets
Coagulation Cascade
Nitric Oxide Metabolism, Oxidative Stress, and Ischemia-Reperfusion Injury
Sterile Inflammation
Perioperative and Physiologic Precipitants of Sickle Cell Disease
Vaso-occlusion
ACUTE COMPLICATIONS OF SICKLE CELL DISEASE
Transfusion Therapy in Patients With Sickle Cell Disease
Vaso-occlusive Crisis
Acute Chest Syndrome
Stroke
Acute Splenic Sequestration Crisis
Aplastic Crisis
Sepsis
CHRONIC COMPLICATIONS OF SICKLE CELL DISEASE
Cardiovascular Complications
Chronic Injury of the Respiratory System
Chronic Injury to the Central Nervous System
Chronic Injury to the Kidney
PERIOPERATIVE CARE OF PATIENTS WITH SICKLE CELL DISEASE
OUTCOMES
NEW CONCEPTS IN UNDERSTANDING SICKLE CELL DISEASE AND FUTURE DIRECTIONS FOR RESEARCH
ACKNOWLEDGMENTS
Appendix: Common Equations Used in Pediatric Critical Care
Index
An aparitie | 6 oct 2023 |
Autor | Donald H. Shaffner MD, John J. McCloskey MD, Elizabeth Anne Hunt, Robert C. Tasker MBBS, MD, FRCP. |
Dimensiuni | 213 x 276 mm |
Editura | LWW |
Format | Hardcover |
ISBN | 9781975174217 |
Limba | Engleza |
Nr pag | 2288 |
Versiune digitala | DA |
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