Rogers’ Textbook of Pediatric Intensive Care

 

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