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دانلود کتاب Fuhrman & Zimmerman's Pediatric critical care
دانلود کتاب مراقبت های ویژه کودکان فورمن و زیمرمن
مشخصات کتاب
Fuhrman & Zimmerman's Pediatric critical care
ویرایش: [6 ed.] نویسندگان: Sapna Ravi Kudchadkar (editor), Alexandre Tellechea Rotta (editor), Joseph D. Tobias (editor), Jerry J. Zimmerman (editor), Robert S. B. Clark (editor), Monica S. Relvas (editor), Bradley P. Fuhrman (editor) سری: ISBN (شابک) : 9780323672696, 0323672698 ناشر: Elsevier Inc. سال نشر: 2022 تعداد صفحات: [2609] زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 156 Mb
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توجه داشته باشید کتاب مراقبت های ویژه کودکان فورمن و زیمرمن نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب مراقبت های ویژه کودکان فورمن و زیمرمن
در زمینه بسیار تخصصی مراقبت از کودکان در PICU، مراقبت های ویژه کودکان فورمن و زیمرمن مرجع قطعی برای همه اعضای تیم مراقبت های ویژه کودکان است. دکتر جری جی. زیمرمن و الکساندر تی روتا، همراه با یک تیم متخصص از ویراستاران و همکاران از سراسر جهان، نسخه ششم این متن بسیار معتبر را به دقت به روز کرده اند تا معتبرترین و مفیدترین اطلاعات را در مورد مراقبت های ویژه کودکان امروزی به شما ارائه دهند. همه چیز از علوم پایه گرفته تا کاربردهای بالینی شامل فصول بسیار خوانا و مختصر با صدها عکس مفید، نمودار، الگوریتم و مروارید بالینی است. از یک رویکرد روشن، منطقی و سیستمی استفاده می کند که به شما امکان می دهد بر روی توسعه، عملکرد و درمان طیف گسترده ای از موجودات بیماری تمرکز کنید. دارای نویسندگان بین‌المللی بیشتر و پوشش گسترده‌ای از موضوعات جهانی از جمله بیماری‌های همه‌گیر، درمان سپسیس در جوامع محروم، نگرانی‌های خاص سلامت جهانی بر اساس منطقه. روندهای فعلی در مرگ و میر ناشی از سپسیس و مراقبت های حاد پس از سپسیس، و همچنین برنامه های کاربردی دستگاه های جدید برای بیماران اطفال را پوشش می دهد. ویدئوهای اولتراسوند و بیش از 500 پرسش و پاسخ بررسی سبک برد را در Expert Consult ارائه می دهد. نسخه کتاب الکترونیکی پیشرفته همراه با خرید. کتاب الکترونیکی پیشرفته شما به شما امکان می دهد به تمام متن ها، شکل ها و مراجع کتاب در دستگاه های مختلف دسترسی داشته باشید.
توضیحاتی درمورد کتاب به خارجی
In the highly specialized field of caring for children in the PICU, Fuhrman and Zimmerman's Pediatric Critical Care is the definitive reference for all members of the pediatric intensive care team. Drs. Jerry J. Zimmerman and Alexandre T. Rotta, along with an expert team of editors and contributors from around the world, have carefully updated the 6th Edition of this highly regarded text to bring you the most authoritative and useful information on today's pediatric critical care-everything from basic science to clinical applications Contains highly readable, concise chapters with hundreds of useful photos, diagrams, algorithms, and clinical pearls. Uses a clear, logical, organ-system approach that allows you to focus on the development, function, and treatment of a wide range of disease entities. Features more international authors and expanded coverage of global topics including pandemics, sepsis treatment in underserved communities, specific global health concerns by region. Covers current trends in sepsis-related mortality and acute care after sepsis, as well as new device applications for pediatric patients. Provides ultrasound videos and more than 500 board-style review questions and answers on Expert Consult. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
فهرست مطالب
Inside Front Cover Front Matter Fuhrman & Zimmerman’s Pediatric Critical Care Copyright Contributors Preface Contents Section I: Pediatric Critical Care: The Discipline Chapter 1: History of pediatric critical care medicine Pearls Evolution of modern medicine Anatomy and physiology Resuscitation and ventilatory support Contributions of specific disciplines Pediatric anesthesiology Pediatric general surgery and pediatric cardiac surgery Neonatology Pediatric cardiology Early use of mechanical ventilation in neonates and children Poliomyelitis and creation of the first intensive care units Definitions Pediatric intensive care unit Pediatric intensivist First pediatric intensive care units Central role of critical care nursing Role of pediatric anesthesiologists and pediatricians in founding pediatric critical care medicine Growth of pediatric critical care medicine Growth in numbers of pediatric intensive care units Growth in training programs and education Cost of success in pediatric critical care medicine Around the world High-mortality countries Summary Acknowledgments Key references Chapter 2: High-reliability pediatric intensive care unit: Role of intensivist and team in obtaining optimal outcomes Pearls Pediatric intensive care unit as a system Models of critical care delivery Structure Process Outcomes Summary References Chapter 3: Critical communications in the pediatric intensive care unit Pearls Intensive care unit design Medical record Huddles Checklists Rounds Closed-loop communication Transitions of care Medical training Debriefing Team training Conclusion Key references Chapter 4: Professionalism in pediatric critical care Pearls Profession The virtuous doctor Stakes Great paradox of the medical profession Professionalism, the physician charter Pediatric intensive care unit as a site for medical education and lifelong learning References Chapter 5: Leading and managing change in the pediatric intensive care unit Pearls National change day: A case study in leading change History and development of change management Change management in healthcare Models and tools to facilitate change leadership and management Theories of change Bringing theory to practice Tools for assessing readiness for change Tools to implement change Sustaining change Conclusion Key references Chapter 6: Evolution of critical care nursing Pearls Early pediatric critical care nursing Describing what nurses do: The synergy model Patient characteristics of concern to nurses Nurse competencies important to patients and families Optimal patient outcomes Patient-level outcomes Provider-level and system-level outcomes Nightingale metrics Leadership Beacon award Professional development Staff development Orientation Continuing education Certification in pediatric nursing and pediatric critical care nursing Evolution of advanced practice registered nurses into pediatric critical care Clinical nurse specialists Pediatric nurse practitioners Nursing research Summary Key references Chapter 7: Fostering a learning healthcare environment in the pediatric intensive care unit Pearls Learning healthcare system Foundation predicated on professionalism Pillars of a learning healthcare environment Best-practice clinical care Clinical research, including quality improvement Interdisciplinary educational model Benefits of a learning healthcare environment Key references Chapter 8: Challenges of pediatric critical care in resource-poor settings Pearls Child mortality rates Current trends and health maintenance Justification for critical care in resource-poor settings State of critical and intensive care delivery in resource-limited settings Approach to basic critical care in resource-limited settings Cost considerations in critical care delivery Ethics of intensive care in resource-poor settings Strengthening critical care infrastructure Healthcare systems Pediatric critical care capacity building through education Critical illness during public health emergencies How to develop an ICU in low- to middle-income countries Importance of critical care research in limited resource settings Key references Chapter 9: Public health emergencies and emergency mass critical care Pearls How many pediatric patients could be affected in a public health emergency? What are the most likely public health emergencies? Who will make decisions during an emergency? What is the expected timeline of a public health emergency? What is a surge and what can be done to meet surge needs? How can the intensive care unit support the emergency department during a public health emergency? How can all intensive care units work together? What steps can be taken to maximize intensive care unit treatment in a disaster? Patient spaces Personnel Mechanical ventilation Manual ventilation Equipment and supplies Medications How will the intensive care unit evacuate if needed? How should pediatric patients be tracked? How will limited services be ethically rationed? What are the mental health considerations relevant to emergency mass critical care? What is the role of medical learners in public health emergencies? Conclusion Key references Chapter 10: Lifelong learning in pediatric critical care Pearls Adult learning theory in medical education Graduate medical education Accreditation council for graduate medical education core competencies, milestones, and entrustable professional activities Methods of teaching Bedside teaching Procedural training Simulation training Beyond graduate medical education Continuing medical education, board certification, and maintenance of certification New methods of assessment and future challenges Key references Section II: Pediatric Critical Care: Tools and Procedures Chapter 11: Essential concepts in clinical trial design and statistical analysis Pearls Purpose of a clinical trial Clinical trial design Getting started: Question and hypothesis Target population: Minimizing variation versus generalizability Power and sample size Randomization Blinding Outcome selection Mortality Morbidity Organ dysfunction Resource use Functional status Quality of life Composite end points Outcome-free time Surrogate end points Common trial designs Phases of clinical trials for new drug approval Statistical analysis and reporting Whom to analyze? Hypothesis testing and determining the study result Inference and estimate of effect 95% confidence interval P values Additional sources and mitigation of bias Additional methods of exploring study results Negative studies Conclusions Key references Chapter 12: Prediction of short-term outcomes during critical illness in children Pearls Historical perspective Methods Conceptual framework Statistical issues Current prediction tools for assessment of mortality risk Neonatal intensive care unit prediction methods Pediatric intensive care unit prediction tools Cardiac intensive care unit prediction tools Additional algorithms in the public domain Next generation: Morbidity and mortality prediction—trichotomous outcome Morbidity assessment Application of prediction tools in pediatric intensive care Future directions: Predictive analytics and tools for decision support Key references Chapter 13: Pediatric critical care transport Pearls Pediatric transport systems Specialized teams improve outcome Components of a specialized interfacility transport team Communications Staffing Equipment Safety and quality improvement Stresses of the transport environment Referring hospital responsibilities Summary Key references Chapter 14: Pediatric vascular access and centeses Pearls Intraosseous infusion Indications Contraindications Supplies and equipment Technique Maintenance Complications Summary Arterial catheter placement Indications Contraindications Procedure Technique Maintenance of an arterial catheter Complications Summary Central venous line placement Indications and contraindications Technique Internal jugular vein cannulation Subclavian vein cannulation Femoral vein cannulation Use of ultrasound for central venous line placement Complications Peripherally inserted central venous catheters Ultrasound-assisted peripheral venous access Venous cutdown Umbilical arterial catheter and umbilical venous catheter placement Supplies and equipment Technique Umbilical arterial cannulation Umbilical venous cannulation Proper placement of umbilical arterial and venous catheters Maintenance Removal Complications Umbilical arterial cannulation Umbilical venous cannulation Summary Pulmonary artery catheterization Contraindications Procedure and equipment Maintenance Complications Summary Thoracentesis Indications Contraindications Preparation Technique Complications Interpretation Summary Tube thoracostomy Contraindications Supplies and equipment Technique Maintenance Complications Summary Pericardiocentesis Indications Contraindications Procedure Monitoring for pericardiocentesis Technique Maintenance Complications Summary Abdominal paracentesis Indications Contraindications Procedure Technique Complications Interpretation Summary Key references Chapter 15: Ultrasonography in the pediatric intensive care unit Pearls Ultrasound physics and basics of image optimization Transducers Procedural guidance Venous access Arterial and peripheral intravenous access Umbilical access Drainage procedures Lumbar puncture Diagnostic modalities Pulmonary ultrasound Abdominal ultrasound Right upper quadrant (fig. 15.18a) Left upper quadrant (fig. 15.18b) Pelvis (figs. 15.18c and 15.18d) Subcostal cardiac (fig. 15.18e) Cardiac ultrasound Pericardiocentesis Left ventricular function Right ventricular function Cardiac arrest Neurosonology Translation to practice Conclusion Key references Section III: Pediatric Critical Care: Psychosocial and Societal Chapter 16: Patient- and family-centered care in the pediatric intensive care unit Pearls Definition of “family” Historical evolution of patient- and family-centered care Fundamental needs of patients and families in the intensive care unit Core principles of patient- and family-centered care1,12 Honoring differences and respecting each child and family Maintaining flexibility in practice and procedures to deliver healthcare within the context of the family Geography of the intensive care unit Admission process and visiting hours Creating a “personalized” room Sibling participation Parental presence during cardiopulmonary resuscitation and invasive procedures Transition points and follow-up care, including bereavement Sharing information using collaborative communication Elements of high-quality communication Family-centered rounds Structured transdisciplinary care conferences Providing transdisciplinary support for the family unit Collaborating and building partnerships with patients and families Empowering patients and families to facilitate shared medical decision-making Patient- and family-centered care improves outcomes for all stakeholders Overcoming barriers and challenges to patient- and family-centered care in the intensive care unit Summary Key references Chapter 17: Pediatric critical care ethics Pearls Defining bioethics Examples of ethical issues in the pediatric intensive care unit Domains of bioethics Value-based decision-making State and national laws and legal precedence Professional codes and healthcare organization policies and regulations Communication, negotiation, and mediation Prevailing ethical theories and norms Who should address ethical issues in the pediatric intensive care unit? Critical care team Ethics consultant Ethics committee Approach to bioethics dilemmas in the pediatric intensive care unit Recognition and clarification of ethical issues Information gathering Analysis of ethical issues Consequentialism Deontology Principalism Virtue-based ethics Casuistic ethics Care ethics Narrative ethics Communitarian ethics Communication of recommendations Support Address staff distress Support the patient and family Ethics of patient and surrogate decision-making Patient decision-making Doctrine of informed consent Emergency exception to informed consent Advance directives Child and adolescent decision-making Shared decision-making Surrogate decision-making Surrogate decision-making for previously competent patients Surrogate decision-making for never-competent patients Parents as surrogate decision-makers Limits of parental refusals Limits of parental demands Other ethical issues in the pediatric intensive care unit Research ethics Resource allocation Ethical issues at the end of life Limits to clinician refusals Medical training Use of unproven medical therapies Global health Medical errors Relationship boundaries Preventive ethics Goals for the ethical practice of the intensivist Key references Chapter 18: Ethical issues around death and dying Pearls Decision-making at the end of life Requests for potentially inappropriate treatments in the intensive care unit Withholding and withdrawing of life-sustaining treatments Administration of analgesics and sedatives in end-of-life care Is there a role for neuromuscular blockade in end-of-life care? Artificial hydration and nutrition Key references Chapter 19: Palliative care in the pediatric intensive care unit Pearls Palliative care consults in the pediatric intensive care unit Communication Suboptimal communication in the intensive care unit Families with limited english proficiency Family meeting as an intensive care unit “procedure” Communication pearls Phrases to avoid Limitation of interventions Do not attempt resuscitation orders Hospice support in the home Compassionate extubation Pain and symptom management Medication management Opioids Methadone Other pharmacologic agents Symptom management Pain Dyspnea Agitation and anxiety Nausea and vomiting Seizures Bowel obstruction Palliative sedation Care of family and staff after a child’s death Key references Chapter 20: Organ donation process and management of the organ donor Pearls Process of organ donation Role of the pediatric intensivist and critical care team in the process of organ donation Determination of neurologic death Testing for apnea Ancillary studies Brain death physiology Pediatric donor management Treatment of hemodynamic instability Hormonal replacement therapy Management of pulmonary issues for the potential pediatric organ donor Fluid and electrolyte disturbances Diabetes insipidus Oliguria Coagulation abnormalities Thermoregulatory instability Medical examiner and coroner issues and organ donation for children Donation after circulatory death Contraindications to organ donation Evolving areas of transplantation Summary Key references Chapter 21: Long-term outcomes following critical illness in children Pearls Post–intensive care syndrome Health-related quality of life Assessing change from baseline Summary of outcomes in general pediatric intensive care unit populations Hospital readmission and late mortality Health-related quality of life Functional status Neurocognitive status Mental health Family functioning Outcomes for common pediatric intensive care unit illness categories Respiratory failure Sepsis Trauma Extracorporeal life support Examples of postdischarge outcomes in pediatric interventional trials Strategies to assess long-term outcomes Strategies to improve follow-up Follow-up programs for intensive care unit survivors Other initiatives Potential targets for interventions Conclusion Key references Chapter 22: Burnout and resiliency Pearls Burnout and compassion fatigue in pediatric critical care providers Critical care societies work to address burnout Strategies for building resilience Promoting a healthy work environment Summary Key references Section IV: Pediatric Critical Care: Cardiovascular Chapter 23: Structure and function of the heart Pearls Anatomic development and structure Segmental anatomy Innervation of the heart Ductus arteriosus Development of the human heart Microscopic anatomy Cardiomyocyte Contractile apparatus Sarcolemma and sarcoplasmic reticulum Cytoplasm Cytoskeleton and extracellular matrix Physiologic development and function Myocardial mechanics: Cardiac sarcomere function Excitation-contraction coupling Sarcomere length-tension relationships Myocardial mechanics: Myocardial receptors and responses to drugs Myocardial mechanics: Integrated muscle function Relationship between muscle strips and intact ventricles Pressure-volume loops Assessing myocardial contractility: Systolic ventricular function Isovolumic phase indices Ejection phase indices Assessing myocardial relaxation: Diastolic ventricular function Pericardial function Ventricular interactions Neural control of the heart Cardiac output Myocardial metabolism: Normal myocardial energy metabolism Basic metabolic processes Determinants of myocardial oxygen consumption Myocardial oxygen demand-supply relationship Effects of myocardial ischemia on cardiac function and metabolism Systemic vasculature General anatomy Physiologic mechanisms General features Control of vascular tone Autoregulation Key references Chapter 24: Regional peripheral circulation Pearls General features General anatomy Basic physiology Venous return and cardiac output Critical closing pressure Autoregulation Distensibility and compliance Vascular resistance Vascular impedance Local regulatory mechanisms Innervation and neural processes Circulating endocrine and neuroendocrine mediators Local metabolic products Blood gas composition Endothelial-derived factors Myogenic processes Regional circulations Pulmonary circulation Normal fetal circulation Changes in the pulmonary circulation at birth Regulation of postnatal pulmonary vascular resistance Cerebral circulation Coronary circulation Myocardial oxygen demand-supply relationship Gastrointestinal circulation Renal circulation Conflicting needs of regional circulations Key references References Chapter 25: Endothelium and endotheliopathy Pearls Normal endothelial function Endothelial cell heterogeneity Endothelial progenitor cells Coagulation and fibrinolysis Anticoagulant mechanisms Procoagulant mechanisms Endothelium-derived vasodilators Nitric oxide Prostacyclin Endothelium-derived hyperpolarizing factor Endothelium-derived vasoconstrictors Endothelins (endothelium-derived contracting factors) Reactive oxygen species Vasoconstrictor prostaglandins Endothelium and blood cell interactions Interactions of leukocytes with the vessel wall Platelet adhesion Endothelial permeability Endothelial cell dysfunction Ischemia-reperfusion injury Sepsis Hemolytic-uremic syndrome Vasculitic disorders Biomarkers of endothelial activation Conclusions Key references Chapter 26: Principles of invasive cardiovascular monitoring Pearls Role of invasive hemodynamic monitoring Indications for invasive hemodynamic measurements Principles of measurement Signal analysis Measurement systems Errors in measurement Calibration Frequency response Impedance Invasive techniques Central venous catheters Indications Interpretation of waveforms Mixed venous oxygen saturation Arterial pressure catheters Indications Interpretation of waveforms Pulmonary artery catheters History and controversy Indications Monitoring techniques with the pulmonary artery catheter Catheter placement Indirectly measured variables Measurement of cardiac output Fick method Thermodilution method Calculation of oxygen delivery and consumption Interpretation of waveforms Resistance Calculation of intracardiac shunt Novel monitoring strategies Conclusions Key references Chapter 27: Assessment of cardiovascular function Pearls Cardiovascular function Quantity of therapy Variables that determine tissue oxygenation Monitoring tissue oxygenation Qualitative assessment of cardiac output Physical examination Chest radiography Quantitative assessment of cardiac output Thermodilution technique Fick method Doppler echocardiography Pulse oximetry Other measures of oxygen delivery Acid-base status Blood lactate Serum biomarkers Gastric tonometry Urine output Near-infrared spectroscopy Systemic arterial blood pressure Invasive blood pressure monitoring Noninvasive blood pressure monitoring Central venous or intracardiac pressure monitoring High-frequency physiologic data capture and streaming analytics Assessing variables that affect the quantity of therapy Ventricular systolic function Ventricular diastolic function Rhythm disturbance Abnormal systemic vascular resistance Increased pulmonary vascular resistance Inefficient circulation Vascular integrity Pulmonary function Physiology of the patient with a single ventricle Key references Chapter 28: Cardiac failure and ventricular assist devices Pearls Pediatric heart failure Low cardiac output syndrome Definitions Assessment Specific treatments to improve cardiac function Broad treatment strategies Mechanical circulatory support in pediatric patients Extracorporeal life support Extracorporeal membrane oxygenation indications and contraindications Myocarditis and extracorporeal life support Postcardiopulmonary bypass Extracorporeal cardiopulmonary resuscitation Bridge to transplantation Malignant dysrhythmias Contraindications Critical care management during extracorporeal life support Cardiac output Troubleshooting Hypovolemia Hypertension Cardiac stun Echocardiography and cardiac catheterization Single ventricle Anticoagulation strategies Ventilation strategies Fluid, nutrition, and renal Analgesia and sedation Infection Intrahospital transport Ventricular assist devices Pulsatile ventricular assist devices Continuous-flow ventricular assist devices Short- to medium-term ventricular assist device support Long-term ventricular assist device support Total artificial heart Device selection Indications and management Basic management of ventricular assist device patients Anticoagulation and antiplatelets Antibiotic prophylaxis Care of the drive line and cannulas Ventricular assist device—congenital heart disease and single-ventricle physiology Outcomes Intraaortic balloon pump and impella device Current perspective and future directions Conclusions Key references Chapter 29: Echocardiographic imaging Pearls Components of the examination Modalities Transthoracic echocardiography Transesophageal echocardiography Fetal echocardiography Intracardiac echocardiography Cross-sectional imaging Point-of-care ultrasound Structural congenital heart disease and intracardiac shunting Valve anatomy and function Ventricular function Assessing volume status Assessing diastolic function Assessing systolic function Left ventricular systolic function Right ventricular systolic function Systolic function: Strain Pulmonary hypertension Pericardial effusion Intracardiac vegetations and thrombi Kawasaki disease and coronary artery anomalies Intravascular catheters Balloon atrial septostomy Extracorporeal membrane oxygenation and ventricular assist devices Key references Chapter 30: Diagnostic and therapeutic cardiac catheterization Pearls Catheterization laboratory environment Diagnostic cardiac catheterization Oxygen saturation Pressure assessment Flow calculations Estimating shunts Resistance calculations Angiography Indications Pulmonary vascular resistance and vasoreactivity testing Therapeutic cardiac catheterization Pericardiocentesis Atrial septostomy Pulmonary balloon valvuloplasty Balloon aortic valvuloplasty Balloon dilation of pulmonary arteries Occlusion device insertion Native and recurrent coarctation of the aorta Ductal stenting Hybrid stage I palliation for hypoplastic left heart syndrome Transcatheter pulmonary valve replacement Risks and complications Preprocedural risk stratification Cardiac catheterization and extracorporeal membrane oxygenation Conclusion Key references Chapter 31: Pharmacology of the cardiovascular system Pearls Mechanisms of response Adrenergic receptors Signal transduction β-adrenergic receptors α-receptors Receptor downregulation Polymorphisms Vasopressin receptors V1 receptors Phosphodiesterase regulation of cyclic adenosine monophosphate Atpase inhibition Developmental issues Sympathomimetic amines Dopamine Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Adverse effects Preparation and administration Interactions Summary Norepinephrine Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Adverse effects Preparation and administration Interactions Summary Epinephrine Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Preparation and administration Adverse effects Interactions Summary Isoproterenol Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Preparation and administration Adverse effects Interactions Summary Dobutamine Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Preparation and administration Adverse effects Interactions Summary Vasopressin Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Dosing and administration Adverse effects Interactions Summary Bipyridines Milrinone Clinical pharmacology Pharmacokinetics Clinical role Preparation and administration Adverse effects Summary Digitalis glycosides Basic pharmacology Clinical pharmacology Pharmacokinetics Clinical role Preparation and administration Adverse effects Interactions Summary Conclusion Key references Chapter 32: Cardiopulmonary interactions Pearls Effects of ventilation on circulation Right ventricular filling and stroke volume Systemic venous return Right ventricular preload and stroke volume Positive pressure ventilation and right ventricular preload Critical illness and the effects of positive pressure breathing on rv preload Respiration and right ventricular afterload Lung volume Alveolar pressure Regulation of pulmonary vascular resistance Direct effects of airway pressure on pulmonary vascular tone Respiration and left ventricular preload Ventricular interdependence Respiration and left ventricular afterload Cardiac contractility Preload dependence versus afterload dependence Fluid responsiveness during positive pressure ventilation Pulsus paradoxus in respiratory distress Positive-pressure ventilation and right ventricular output in acute respiratory distress syndrome Effects of cardiovascular function on respiration Shock states and respiratory function Elevated work of breathing and the circulation Congestive heart failure/critical heart failure and shock Cardiomyopathies and congenital heart disease Glenn and fontan procedures Key references Chapter 33: Disorders of cardiac rhythm Pearls Classification of arrhythmias Bradycardias Appropriate versus normal heart rate Sinus bradycardia and sinus pauses Atrioventricular block Escape rhythms and accelerated rhythms Tachycardias Tachycardia mechanisms Supraventricular tachycardias Atrioventricular reciprocating tachycardias (AV reentry) Atrioventricular nodal reentrant tachycardia Primary atrial tachycardias Junctional ectopic tachycardia Ventricular tachycardias Approach to diagnosis Monitoring and general assessment Surface electrocardiogram and bedside monitoring Bradycardias Extrasystoles Tachycardias with normal QRS Tachycardias with prolonged QRS Assessment of atrial activation Diagnostic uses of adenosine Treatment of rhythm disturbances Bradycardia therapies Pharmacologic treatment of bradycardias Temporary and permanent pacing for bradycardias Principles of pacing Temporary pacing Setting temporary pacing parameters Permanent pacing—indications and selection Other indications for pacing Tachycardia therapies Vagal maneuvers Acute pharmacologic therapies Adenosine Antiarrhythmic agents Procainamide. Lidocaine. β-blocking agents. Amiodarone. Other QT prolonging (class III) antiarrhythmic drugs Intravenous sotalol. Ibutilide. Calcium channel–blocking agents Magnesium sulfate Digoxin Dexmedetomidine Ivabradine Cardioversion and defibrillation Approach to therapy Extrasystoles Sustained tachycardias Unstable patients Treatment failure Errors in diagnosis Unrecognized termination and reinitiation Improper technique Specific arrhythmias Primary arrhythmias Orthodromic reciprocating tachycardia in infancy Tachycardia-induced cardiac dysfunction Chaotic atrial tachycardia Long QT syndromes Idiopathic ventricular tachycardias in healthy patients Bidirectional polymorphic ventricular tachycardias Secondary rhythm disturbances Postoperative arrhythmias Postsurgical atrioventricular block Junctional ectopic tachycardia Late postoperative arrhythmias Metabolic derangements Electrolyte disturbances Endocrine disorders (thyroid) Central nervous system injury Hypothermia and hyperthermia Acute myocardial infarction Arrhythmias resulting from drug toxicity Digoxin Cocaine Tricyclic antidepressants and phenothiazine Infections Key references Chapter 34: Shock states Definition and physiology Functional classification and common underlying etiologies Hypovolemic shock Cardiogenic shock or congestive heart failure Obstructive shock Distributive shock Septic shock Endocrine Mitochondrial Multisystem effects of shock Respiratory Renal Coagulation Hepatic Gastrointestinal Endocrine Monitoring Fick equation for oxygen consumption Contemporary cardiac output monitoring in pediatric shock Treatment General principles Intubation and mechanical ventilation Fluid resuscitation Vasoactive infusions Age-related therapy concerns Specific shock state therapy considerations Hypovolemic shock Cardiogenic shock Obstructive shock Distributive shock Septic shock Other therapies Summary Key references Chapter 35: Pediatric cardiopulmonary bypass Pearls Background History Surgical team Equipment and preparation for cardiopulmonary bypass Heart-lung machine console and pumps Cardiopulmonary bypass circuit Oxygenators Tubing Hemoconcentrators Circuit prime Anticoagulation Cannulation Cardiopulmonary bypass Pediatric VS. adult considerations Initiation of cardiopulmonary bypass Determining and monitoring effective perfusion flow rate Arterial pressure Arterial and venous oxygen saturation Near-infrared spectroscopy Methods to optimize physiologic management Target hematocrit and ultrafiltration Hypothermia Deep hypothermic circulatory arrest VS antegrade cerebral perfusion Ph and partial pressure of arterial carbon dioxide strategy Myocardial protection Inflammatory response to cardiopulmonary bypass Termination of cardiopulmonary bypass Key references Chapter 36: Critical care after surgery for congenital cardiac disease Pearls Neonatal considerations Preoperative care Severe hypoxemia Excessive pulmonary blood flow Obstruction of left heart outflow Ventricular dysfunction Postoperative care Assessment Monitoring Low cardiac output syndrome Volume adjustments Preserving and creating right-to-left shunts Other strategies Mechanical cardiac support Right ventriculotomy and restrictive physiology Diastolic dysfunction Pharmacologic support Managing acute pulmonary hypertension in the intensive care unit Pulmonary vasodilators Management of postoperative bleeding Cardiac tamponade Diaphragmatic dysfunction, effusions, and pulmonary issues Chylothorax Separating from mechanical ventilation Central nervous system Renal function and postoperative fluid management Gastrointestinal issues Infection Hyperglycemia Critical care management of selected specific lesions Single-ventricle anatomy and physiology Neonatal preoperative management Postoperative management Bidirectional cavopulmonary anastomosis Fontan procedure Complications after the fontan procedure Pleuropericardial effusions Rhythm disturbances Premature closure of the fenestration Persistent hypoxemia Low cardiac output state Patent ductus arteriosus Pathophysiology Critical care management Atrial septal defect Pathophysiology Critical care management Ventricular septal defect Pathophysiology Critical care management Critical care management for late postoperative care Atrioventricular canal defects Pathophysiology Critical care management Truncus arteriosus communis Pathophysiology Critical care management Critical care management for late postoperative care Total anomalous pulmonary venous connection Pathophysiology Critical care management Critical care management for late postoperative care Transposition of the great arteries Pathophysiology Atrial switch procedure (mustard and senning) Arterial switch operation (jatene procedure) Ventricular switch (rastelli procedure) Critical care management Late complications Tetralogy of fallot Pathophysiology Critical care management for the early postoperative course Critical care management for late postoperative care Pulmonary atresia Pathophysiology Critical care management Critical care management for late postoperative care Tricuspid atresia Pathophysiology Critical care management Left-sided obstructive lesions Pathophysiology Aortic stenosis Coarctation of the aorta Interrupted aortic arch Hypoplastic left heart syndrome Pathophysiology Critical care management Postoperative management Evolution of treatment strategies. Specific considerations for the norwood operation. Hybrid approach. Summary Acknowledgment Key references Chapter 37: Cardiac transplantation Pearls Background Indications for transplant Transplant evaluation Panel reactive antibody Transplant listing Management of the potential heart transplant recipient Anticoagulation Abo-incompatible listing and transplantation Critical care management of the orthotopic heart transplant recipient Intraoperative considerations Early perioperative management Management of early heart allograft dysfunction Immunosuppression and heart allograft rejection Complications of immunosuppression in heart transplant recipients that occur in the pediatric intensive care unit Infection Renal function Diabetes mellitus Future management strategies for critical care of infants and children with cardiopulmonary failure Key references Chapter 38: Physiologic foundations of cardiopulmonary resuscitation Pearls Mechanisms of blood flow Cardiac versus thoracic pump mechanism Rate and duty cycle Chest geometry Effects of cardiopulmonary resuscitation on intracranial pressure Newer cardiopulmonary resuscitation techniques Abdominal binding Open-chest cardiopulmonary resuscitation Cardiopulmonary bypass and extracorporeal cardiopulmonary resuscitation Transcutaneous cardiac pacing Pharmacology Adrenergic agonists Vasopressin High-dose epinephrine Atropine Sodium bicarbonate Other alkalinizing agents Calcium Glucose Management of ventricular fibrillation Defibrillation Antiarrhythmics Postresuscitation care Future directions Key references Chapter 39: Performance of cardiopulmonary resuscitation in infants and children Pearls Four phases of cardiac arrest Prearrest No-flow/low-flow Postarrest Epidemiology of pediatric cardiac arrest Optimizing blood flow during cardiopulmonary resuscitation Pediatric cardiopulmonary resuscitation targets Chest compression depth Chest compression rate Chest compression fraction/minimizing interruptions Duty cycle Airway and breathing management during cardiopulmonary resuscitation Physiologic targets Arterial blood pressure End-tidal carbon dioxide Medications used to treat cardiac arrest Vasopressors Epinephrine Vasopressin Antiarrhythmics Amiodarone versus lidocaine Other medications Calcium Sodium bicarbonate Postarrest interventions Targeted temperature management Anticipation and prevention of hypotension Postarrest oxygenation and ventilation management Monitoring for and treating seizures Other considerations Contemporary methods to improve cardiopulmonary resuscitation quality Intra-arrest cardiopulmonary resuscitation quality monitoring technology Point-of-care bedside training Extracorporeal cardiopulmonary resuscitation Controversies in pediatric cardiac arrest management Airway management Ventilation during pediatric cardiopulmonary resuscitation Ventricular fibrillation and pulseless ventricular tachycardia Pediatric automated external defibrillators Summary Key references Section V: Pediatric Critical Care: Pulmonary Chapter 40: Structure and development of the upper respiratory system Pearls Developmental anatomy of the upper airway Anatomy and physiology of the upper airway Nasal passages Mouth (oral cavity) and pharynx Larynx Trachea and bronchi Acknowledgment Key references Chapter 41: Structure and development of the lower respiratory system Pearls Lower respiratory system Overview of the lungs Airways Definitions of special lung unit and alveolar formation Alveolar-capillary unit Lung circulation Pulmonary vascular system Bronchial vascular system Pulmonary lymphatics and bronchus-associated lymphoid tissue Diaphragm Summary Key references Chapter 42: Physiology of the respiratory system Pearls Physiology of the respiratory system Boyle’s law Equation of motion of the respiratory system Transmural pressures Central nervous system control Respiratory centers and efferent nerve transmission to the respiratory muscles Receptors and feedback to the respiratory centers Higher states Extrathoracic upper airways Anatomic considerations for the pediatric upper airway Ohm’s law and poiseuille’s law Turbulent versus laminar flow (reynolds number) Transmural pressure (collapse of upper airway) Inspiratory flow limitation Intrathoracic compartment Flow resistance of the respiratory system Anatomic considerations for pediatric lower airways Reactivity of lower airways Transmural pressure in the presence of lower airway obstruction Identifying expiratory flow limitation Administration of positive end expiratory pressure to prevent collapse Time constants Elastic properties of the respiratory system Respiratory system and lung compliance End-expiratory lung volume and compliance Functional residual capacity, closing capacity, and age Work of breathing Extrathoracic space Gas exchange Ventilation-perfusion relationships Hypoxemia Hypercarbia Diffusion of oxygen and carbon dioxide Key references Chapter 43: Noninvasive respiratory monitoring and assessment of gas exchange Pearls Pulse oximetry Principles of pulse oximetry Validation Sources of error Probe placement Tissue oximetry Near-infrared spectroscopy Capnometry and capnography Operating principles of capnometry Clinical and technical issues Gas sampling issues Physiologic basis Dead space ventilation Differential diagnosis of abnormal capnograms Gradually decreasing end-tidal carbon dioxide concentration Sustained low end-tidal carbon dioxide concentrations without plateaus Sustained low end-tidal carbon dioxide concentration with good plateaus Exponential decrease in end-tidal carbon dioxide Gradual increase in both baseline and end-tidal carbon dioxide Clinical applications Transcutaneous monitoring Oxygen monitoring Carbon dioxide monitoring Conclusion Key references Chapter 44: Overview of breathing failure Pearls Physiology of breathing Controls of breathing Respiratory pump Diaphragm Intercostal muscles Accessory muscles of respiration Breathing failure Failure of respiratory controls Recognizing depressed respiratory drive Failure of neural control Structural brain lesions Nonstructural acquired disorders Chronic respiratory failure Structural brain lesions Nonstructural congenital disorders Nonstructural acquired chronic disorders Respiratory pump failure Respiratory plegia, paralysis, and tetany Muscle exhaustion Failure of mechanics of breathing Terminal failure of respiratory control and mechanics Restrictive versus obstructive respiratory disease Compensatory mechanisms in breathing failure Compensatory mechanisms in restrictive lung disease Compensatory mechanisms with obstructive lung disease Special conditions Infancy Sleep Thoracic dysfunction Altered nutritional states: Malnutrition and obesity Conclusion Acknowledgments Key references Chapter 45: Ventilation/perfusion inequality Pearls Distribution of ventilation Distribution of perfusion Fractal model of pulmonary blood flow and ventilation Va/q abnormalities in pulmonary disease Hypoxemia Pediatric acute respiratory distress syndrome Pneumonia Pleural effusion Asthma Pulmonary embolism Primary pulmonary hypertension Therapeutic considerations Positive end-expiratory pressure Prone positioning Nitric oxide Measuring pulmonary ventilation/perfusion Key references Chapter 46: Mechanical dysfunction of the respiratory system Pearls Pump dysfunction and failure Pressures Lung volumes and capacities Flow/volume relationships Equation of motion Resistive forces Static and dynamic compliance Airway dynamics Time constant Work of breathing Clinical manifestations of mechanical dysfunction Effectors of the respiratory pump Accessory muscles of respiration Chest wall Disease of the chest wall Therapeutic maneuvers to improve mechanical dysfunction of the respiratory system Positive end-expiratory pressure/continuous positive airway pressure Rate Tidal volume Inspiratory and expiratory times Inspiratory flow patterns Key references Chapter 47: Diseases of the upper respiratory tract Pearls Anatomy and physiology Diagnosis and management Congenital malformations of the upper airway Choanal atresia Laryngomalacia Laryngeal webs and atresia Laryngeal cysts Laryngeal clefts Vocal cord paralysis Vascular compression of the trachea Neoplasms of upper airway disease Laryngeal papillomatosis Hemangiomas Other tumors of the larynx and upper airway Croup Epiglottitis Bacterial tracheitis Peritonsillar abscess Retropharyngeal abscess Iatrogenic and acquired disorders of the upper airway Laryngotracheal (subglottic) stenosis Pediatric tracheostomy Foreign body aspiration Burn injury to the upper airway Airway trauma Key references Chapter 48: Pediatric acute respiratory distress syndrome and ventilator-associated lung injury Key words: Pearls Clinical features: Pathophysiology Definition Epidemiology Pathobiology Exudative phase Direct injury Indirect injury Alveolar fluid clearance Leukocytes and inflammation Surfactant Coagulation Apoptosis Fibrosis and repair phase Ventilator management Considerations for ventilator mode Tidal volume Peak or plateau pressure Positive end-expiratory pressure Nonconventional ventilation strategies Ventilator-associated lung injury Pulmonary ancillary therapies Exogenous surfactant Preclinical or adult data Pediatric data Nitric oxide Physiologic rationale Preclinical and adult studies Pediatric Nonpulmonary therapies Prone positioning Physiologic rationale Adult data Pediatric data Monitoring Noninvasive support Extracorporeal life support Key references Chapter 49: Acute viral bronchiolitis Key words: Pearls Microbiology Epidemiology and risk factors Pathophysiology Clinical features and diagnosis Prevention Treatment Hypertonic saline Inhaled bronchodilators Corticosteroids Hydration and nutritional support Other inhaled therapies Other systemic therapies Respiratory support High-flow nasal cannula Continuous positive airway pressure Invasive mechanical ventilation Other respiratory support Complications Key references Chapter 50: Asthma Pearls Epidemiology and risk factors Pathophysiology Clinical assessment History Physical examination Radiography Laboratory data Arterial blood gas analysis Electrolytes and complete blood cell count Muscle enzymes Electrocardiography Spirometry Treatment Initial management in the emergency department Admission criteria Management in the intensive care unit General Oxygen Fluids Corticosteroids β-agonists Albuterol Terbutaline Anticholinergic agents Magnesium sulfate Methylxanthine agents Helium-oxygen mixtures Ketamine Mechanical ventilation Indications Noninvasive ventilation Intubation Ventilator settings Ventilatory monitoring Analgesia, sedation, and muscle relaxation Inhalational anesthetic agents Antibiotics Bronchoscopy Extracorporeal life support Prognosis Key references Chapter 51: Neonatal pulmonary disease Pearls Acute respiratory disorders Transient tachypnea of the newborn Surfactant-deficient respiratory distress syndrome Pulmonary air leak syndromes Pulmonary hemorrhage Pneumonia Meconium aspiration syndrome Immature respiratory control Biological maturational considerations Apnea of prematurity Therapeutic options Pulmonary malformations Pulmonary hypoplasia Congenital diaphragmatic hernia Congenital pulmonary airway malformation Bronchogenic cysts Pulmonary parenchymal cysts Pulmonary sequestrations Congenital lobar emphysema Pulmonary agenesis and aplasia Congenital defects of the lymphatics Nonpulmonary causes of respiratory distress Choanal atresia/stenosis Laryngomalacia Vocal cord paralysis Airway vascular tumors/malformations Tracheobronchomalacia Tracheoesophageal fistula Vascular compression Phrenic nerve paralysis Eventration of the diaphragm Pleural effusion Congenital anomalies of the chest wall Persistent pulmonary hypertension of the neonate Hyperviscosity syndrome Congenital heart disease Metabolic disorders Intestinal or renal bicarbonate wasting Neonatal chronic lung disease of prematurity: Bronchopulmonary dysplasia Neonatal chronic lung disease: Primary ciliary dyskinesia Acknowledgment Key references Chapter 52: Pneumonitis and interstitial disease Pearls Pathogenesis Pathophysiology Diagnosis Laboratory diagnosis Bacterial pneumonitis Definition Pathophysiology Clinical features Radiographic features Diagnosis Specific pathogens Group b streptococci Streptococcus pneumoniae Haemophilus influenzae Staphylococcal pneumonia Mycoplasma pneumonia Gram-negative bacteria Legionella pneumophila Anaerobic bacteria Complications Therapy Viral pneumonitis Pathophysiology Diagnosis Radiographic findings Specific pathogens Respiratory syncytial virus Parainfluenza virus Adenovirus Influenza Measles Human immunodeficiency virus Complications Diagnosis Prevention and treatment Vaccination Chemoprophylaxis Therapy Fungal pneumonitis Primary pulmonary fungi Pathogenesis Histoplasmosis Diagnosis Complications Treatment Blastomycosis Diagnosis Complications Treatment Coccidioidomycosis Diagnosis Complications Treatment Opportunistic pulmonary mycoses Pulmonary aspergillosis Diagnosis Complications Treatment Pulmonary candidiasis Pathogenesis Diagnosis Complications Treatment Pneumocystis jirovecii pneumonia Clinical features Diagnosis Complications Treatment Chemical pneumonitis Aspiration pneumonia Pathophysiology Clinical findings Treatment Inhalation injury Pathogenesis Clinical findings Treatment Prognosis Ingestion/injection of pharmacologic agents Diagnosis/clinical findings Idiopathic interstitial lung disease Pediatric pulmonary hemorrhage Definition Pathophysiology Etiology Diffuse/nonimmune pulmonary hemorrhage Diffuse/immune pulmonary hemorrhage Focal pulmonary hemorrhage Treatment General Specific Summary Key references Chapter 53: Diseases of the pulmonary circulation Pearls Definition and classification Pathology of pulmonary hypertension Diagnostic evaluation of pulmonary hypertension/pulmonary vascular disease Pharmacotherapy Prostacyclin (pgi2) analogs Endothelin receptor antagonists Phosphodiesterase 5 inhibitors Calcium channel blockers Pulmonary hypertension in the context of specific diseases Group 1 pulmonary arterial hypertension Isolated pulmonary arterial hypertension Autoimmune disorders Infectious diseases Group 2 pulmonary arterial hypertension (cardiac disease) Group 3 pulmonary arterial hypertension (intrinsic pulmonary diseases) Pulmonary arterial hypertension due to parenchymal lung disease Pulmonary hypertension secondary to bronchopulmonary dysplasia Diagnostic ph evaluation in BPD Bpd-specific therapies Congenital diaphragmatic hernia General management of cdh Ph-specific therapy in cdh Cystic fibrosis Diffuse lung disease Pulmonary hypertension secondary to acute respiratory distress syndrome Group 5 pulmonary hypertension Chronic hemolytic anemia Acute pulmonary hypertension crisis/right ventricular failure Right ventricular dysfunction in pulmonary hypertension Adaptive versus maladaptive right ventricular hypertrophy Sympathetic activation in pulmonary arterial hypertension Right ventricle ischemia Metabolism in right ventricular hypertrophy Right ventricle inflammation and fibrosis Recent advances in molecular mechanisms and novel therapeutic targets in pulmonary hypertension Genetic predisposition Growth factors and apoptosis resistance Inflammation Noncalcium ion channels Transcription factors and transcriptional coregulators Metabolic reprogramming and mitochondrial dysfunction Epigenetic modifications Long-term outcomes of patients with pulmonary vascular disease Future directions and perspectives Key references Chapter 54: Mechanical ventilation and respiratory care Pearls Applied respiratory physiology Lung volumes and capacities Lung inflation and deflation Time constant Work of breathing Determinants of gas exchange Indications for mechanical ventilation Respiratory failure Other indications for mechanical ventilation Design and functional characteristics of ventilators Phases of a breath Initiating breaths Patterns of gas flow Limit Cycling of breaths Continuous positive airway pressure and positive end-expiratory pressure Ventilator modes and phase variables Selection of parameters for mandatory breaths Dual-control modes Automatic tube compensation Nontraditional modes of ventilation Airway pressure release ventilation Proportional assist ventilation Neurally adjusted ventilatory assist Ventilation for selected underlying pathophysiology Primary respiratory muscle failure (“respiratory pump failure”) Obstructive lung diseases Restrictive lung diseases Unilateral lung disease or severely differential lung disease Heart failure and postoperative management of congenital heart disease Diseases with abdominal distention Neurologic and neuromuscular diseases Patient-ventilator asynchrony Asynchrony associated with breath triggering Asynchrony during inspiration (flow asynchrony) Asynchrony during cycling Use of neuromuscular blockade High-frequency ventilation Mechanism of gas flow in high-frequency ventilation in the normal lung High-frequency jet ventilation High-frequency oscillatory ventilation High-frequency percussive ventilation Adverse effects of mechanical ventilation Airway injury Effects on the lung Effects on the circulatory system Specialty gases Inhaled nitric oxide Helium-oxygen mixture Altering pulmonary vascular resistance with adjusted inspired oxygen and carbon dioxide concentrations Respiratory care during mechanical ventilation Pulmonary hygiene Humidification systems Aerosol therapy Weaning from mechanical ventilation and extubation Extubation readiness trial Extubation Key references Chapter 55: Noninvasive ventilation in the pediatric intensive care unit Pearls Epidemiology Physiology and application of noninvasive ventilation High-flow nasal cannula Noninvasive positive-pressure ventilation Negative-pressure ventilation Negative-pressure ventilation use in chest physiotherapy and secretion clearance Vibration mode Cough mode Neurally adjusted ventilatory assist Patient selection Bronchiolitis Asthma Pediatric acute respiratory distress syndrome Immunocompromised patients Neuromuscular disease Patient monitoring and complications Sedation during noninvasive ventilation Failure of noninvasive ventilation Long-term use of noninvasive ventilation Key references Chapter 56: Extracorporeal life support Pearls A trip around the extracorporeal membrane oxygenation circuit Cannulation techniques Venoarterial extracorporeal membrane oxygenation (fig. 56.1a) Venous cannulation Arterial access Left heart decompression Venovenous extracorporeal membrane oxygenation Venoarteriovenous extracorporeal membrane oxygenation Arteriovenous Percutaneous cannulation Extracorporeal membrane oxygenation circuit Venous reservoir and venous saturation monitor Priming Types of pumps and oxygenators Roller head pumps Centrifugal pumps Negative inlet pressure Membrane lung Hollow-fiber membrane lung Patient populations treated with extracorporeal life support Neonatal cardiopulmonary failure Pediatric patients Trauma patients Extracorporeal membrane oxygenation and high-risk diseases Poisonings Bridge to lung transplant Why use extracorporeal membrane oxygenation? Extracorporeal membrane oxygenation for cardiac dysfunction Extracorporeal membrane oxygenation for resuscitation Extracorporeal membrane oxygenation and septic shock Patient selection criteria Physiology of extracorporeal life support: Gas exchange and oxygen delivery Oxygenation Carbon dioxide exchange Oxygen delivery Recirculation Transport Patient management on extracorporeal membrane oxygenation Initiation of extracorporeal life support Patient management during extracorporeal life support General principles Anticoagulation monitoring Nutritional support Fluid and renal replacement therapy Ventilator management Sedation and analgesia Weaning from extracorporeal membrane oxygenation Decannulation When to stop extracorporeal membrane oxygenation support Complications from extracorporeal membrane oxygenation Bleeding Infection Vascular injury Other management tidbits Right ventricular failure Outcomes from extracorporeal life support Medical outcomes Neurodevelopmental outcomes Long-term neurologic implications Future of extracorporeal membrane oxygenation Key references Chapter 57: Pediatric lung transplantation Pearls Indications Contraindications Survival and outcomes Evaluation of the donor Surgical approach Presurgical management in the intensive care unit Postsurgical management Immunosuppression Immunobiology Rejection Antibody-mediated rejection Chronic lung allograft dysfunction Treatment options for clad Summary Key references Section VI: Pediatric Critical Care: Neurologic Chapter 58: Structure, function, and development of the nervous system Pearls Major cell types Intercellular communication in the nervous system Electrical synapses Chemical synapses Neuromuscular junction Chemical synapses in the central nervous system Neurotransmitter systems Neurotransmitters Acetylcholine Catecholamines Serotonin Amino acids Adenosine, peptides, and nitric oxide Neurotransmitter receptors Nicotinic acetylcholine receptors Muscarinic acetylcholine receptors Glutamate receptors Gabaa and gabab receptors Major anatomic organization of the nervous system Central nervous system Spinal cord Medulla Pons Midbrain Reticular formation Cerebellum Diencephalon Basal ganglia Cerebral hemispheres Peripheral nervous system Somatic peripheral nervous system Visceral or autonomic peripheral nervous system Sympathetic nervous system Parasympathetic autonomic nervous system Meninges Blood-brain barrier Anatomy Selectivity Blood-brain barrier–deficient areas Ventricles and cerebrospinal fluid Ventricular system Cerebrospinal fluid production and flow Cerebrospinal fluid composition and function Vasculature in the central nervous system Brain vasculature Spinal cord vasculature Regulation of cerebral blood flow Perfusion pressure–related autoregulation Oxygen-related autoregulation Hydrogen ion–related autoregulation Metabolic coupling Emerging characterization of the “lymphatic” circulation in the central nervous system Developmental processes relevant to pediatric critical care medicine Cell origin and differentiation Synaptogenesis and synaptic pruning Neurotransmitter system maturation Myelination Development of cerebrovasculature and blood-brain barrier Developmental aspects of cerebral blood flow, autoregulation, and cerebral metabolism New insights in neurodevelopment relevant to pediatric critical care Excitatory amino acid inhibition and neurodevelopmental apoptosis Microbiome and neurodevelopment and function Conclusion Key references Chapter 59: Critical care considerations for common neurosurgical conditions Pearls Hydrocephalus Background Pathophysiology Clinical presentation Causes Diagnosis Management Arachnoid cysts Background Clinical presentation Diagnosis Management Chiari malformations Chiari I malformation Chiari II malformation Other chiari malformations Dandy-walker complex Encephalocele and meningocele Spinal dysraphism Conclusions Key references Chapter 60: Neurologic assessment and monitoring Pearls Nursing role in the recognition of neurologic complications of critical illness Anticipatory planning for new neurologic deficits History and assessment of risk factors Iatrogenic complications of pharmacotherapy Vital signs General physical exam Importance of observation in the neurologic exam Assessment of level of consciousness and mental status Fundoscopic examination Cranial nerve examination Approach to the motor exam Reflexes Cerebellar function and gait evaluation Sensory examination Abnormal movements or altered sensorium in the child with static encephalopathy Distinguishing functional deficits from nonorganic pathology in the pediatric intensive care unit Goals of the neurologic examination in the pediatric intensive care unit Neuroimaging Intracranial pressure monitoring Electroencephalography monitoring Transcranial doppler measurement of cerebral blood flow Near infrared spectroscopy Brain tissue oxygen monitoring Optic nerve sheath diameter measurement Tympanometry Cerebral microdialysis Integrating neurologic monitoring data Key references Chapter 61: Neuroimaging Pearls Imaging modality overview Radiography Ultrasound Computed tomography Magnetic resonance imaging Advanced magnetic resonance imaging techniques Magnetic resonance angiography Catheter angiograms Myelography Nuclear medicine Hypoxic ischemic injury and germinal matrix hemorrhage in the neonate Imaging of neurovascular disorders Ischemic stroke Vasculopathy/vasculitis Intracranial hemorrhage and vascular malformations Venous infarct Posterior reversible encephalopathy syndrome Central nervous system infection Demyelinating disease Trauma Hydrocephalus Tumor Seizures Conclusion Key references Chapter 62: Coma and depressed sensorium Pearls Definitions Epidemiology Relevance Physiology/pathophysiology Etiology Initial treatment of the comatose child Prehospital care Initial stabilization Airway Breathing Circulation History Timing of the onset of symptoms Antecedent events Associated signs or symptoms Preexisting conditions and comorbidities Physical examination Focused neurologic examination Respiratory pattern Eye examination Cranial nerve examination Motor examination Herniation syndromes Diagnostic evaluation Laboratory tests Imaging and other studies Treatment goals: Initial and ongoing Prognosis and outcomes Key references Chapter 63: Intracranial hypertension and monitoring Pearls Clinical background Physiology of the intracranial vault Intracranial pressure Utility of hydrodynamic and electrical analog models of intracranial pressure Cerebral vasodilation and cerebral spinal fluid pressure Cerebral perfusion pressure and cerebral autoregulation Measurement of intracranial pressure Invasive monitoring devices Noninvasive diagnostic tests of intracranial pressure Pressure gradients and compartments Clinical analysis of intracranial pressure Normal values in intracranial pressure Choice of type of invasive intracranial pressure monitoring Choice of whether to use intracranial pressure monitoring Clinical targets in intracranial pressure and cerebral perfusion pressure levels Supplementing intracranial pressure monitoring with other monitoring modalities Mechanism of brain injury in intracranial hypertension Intracranial pressure monitoring and the postinsult natural history of injury Key references Chapter 64: Status epilepticus Pearls Definition of status epilepticus Outcome of status epilepticus Status epilepticus classification Seizure types and classification Febrile seizures and febrile status epilepticus Seizures in the pediatric intensive care unit Chemically induced seizures Dialysis disequilibrium syndrome Hepatic mechanisms Hypertensive encephalopathy Posttraumatic epilepsy Renal failure Transplantation Autoimmune status epilepticus Neurophysiology and pathology Cardiorespiratory failure in status epilepticus Other organ systems Evaluation and electroencephalography in status epilepticus Management of status epilepticus General supportive care Monitoring and termination of status epilepticus First- and second-line pharmacotherapy Current practice protocols First-line benzodiazepines: Diazepam, lorazepam, or midazolam Second-line fosphenytoin and phenobarbital Other therapies Medications for established status epilepticus Management of refractory status epilepticus and other forms of treatment-resistant status epilepticus Super-refractory status epilepticus Fever-induced refractory epileptic encephalopathy and febrile infection-related epilepsy syndrome Therapeutic strategies in the rse-srse-norse-fires spectrum Immunotherapies Infusions and anesthesia for seizure control Midazolam Midazolam infusions for refractory status epilepticus Ketamine Ketamine infusions for refractory status epilepticus High-dose barbiturates Treatment and dosing strategy with pentobarbital Ceeg monitoring Complications of pentobarbital Concurrent antiseizure medications with pentobarbital Inhalational anesthetics for (super) refractory status epilepticus Hypothermia for (super) refractory status epilepticus Ketogenic diet for (super) refractory status epilepticus Surgical options Changing goals of therapy in prolonged srse/fires Key references Chapter 65: Hypoxic-ischemic encephalopathy Pearls Epidemiology Mechanisms of hypoxic-ischemic brain injury Energy failure Selective vulnerability Cell death mechanisms Neuronal death pathophysiology Reperfusion injury Anoxia, ischemia, reperfusion pathophysiology Excitotoxicity and calcium accumulation Protease activation Oxygen radical formation Membrane phospholipid hydrolysis and mediator formation Endogenous defenses Clinical pathophysiology Cerebral blood flow and metabolism after resuscitation Histopathology of hypoxic-ischemic encephalopathy Clinical outcome and prognostication after pediatric cardiac arrest Response of the immature brain to cardiac arrest Treatment after cardiac arrest Field interventions Supportive care in the intensive care unit Current and novel therapies and interventions Postresuscitative targeted temperature management Improving quality of cardiopulmonary resuscitation Achieving high-quality cardiopulmonary resuscitation Therapies optimizing postresuscitative cerebral blood flow Phenotype-directed management Cognitive rehabilitation after the intensive care unit Futuristic approaches Mitochondria targeting strategies Targeted temperature management in a syringe Erythropoietin Stem cell therapy Extracorporeal life support Summary Acknowledgment Key references Chapter 66: Pediatric stroke and intracerebral hemorrhage Pearls Significance Arterial ischemic stroke Etiologies and risk factors Cerebral arteriopathy Sickle cell disease Congenital and acquired heart disease Hypercoagulable states Pathophysiology Presentation Neuroimaging Laboratory evaluation Initial laboratory studies in child with possible acute stroke Other tests of hypercoagulability (etable 66.1) Treatment Supportive therapy Recanalization therapies Antithrombotic therapy Cerebral sinus venous thrombosis Etiologies and risk factors Neuroimaging Laboratory evaluation Treatment Prognosis Spontaneous intracranial hemorrhage Arteriovenous malformations Aneurysms Cavernous malformation Coagulation disorders General care of the child with intracerebral hemorrhage Prognosis Conclusion Key references Chapter 67: Central nervous system infections and related conditions Pearls Bacterial meningitis Epidemiology Epidemiology of common organisms causing pediatric meningitis Pathogenesis Clinical manifestations Laboratory diagnosis Treatment Supportive care Adjunctive therapy Outcomes Prevention Subdural empyema Brain abscess Viral meningoencephalitis Epidemiology Pathophysiology/pathogenesis of viral meningoencephalitis Clinical evaluation Laboratory manifestations Neuroimaging Clinical presentation and course Treatment Prognosis Acute disseminated encephalomyelitis Key references Chapter 68: Acute neuromuscular disease and disorders Pearls Guillain-barré syndrome Myasthenia gravis Congenital and transient neonatal myasthenia gravis Tick paralysis Periodic paralyses Botulism Diphtheria Acute intermittent porphyria Spinal muscular atrophy Poliomyelitis Polio-like syndromes Organophosphate and carbamate poisoning Key references Chapter 69: Acute rehabilitation and early mobility in the pediatric intensive care unit Pearls Rehabilitation team members in the pediatric intensive care unit Role of physical therapy in the pediatric intensive care unit Role of occupational therapy in the pediatric intensive care unit Role of speech-language pathology in the pediatric intensive care unit Important considerations for mobility in the pediatric intensive care unit Pediatric intensive care unit environment Cardiac and pulmonary status and complications Sedation Intensive care unit–acquired weakness Facilitating infant neurodevelopment during critical illness Communication Acute rehabilitation across the intensive care unit continuum Patient selection: Age-based factors Patient selection: Acuity of illness Equipment Positioning equipment Sitting equipment Standing or ambulation equipment Other equipment Resource utilization Implementation of acute rehabilitation in the pediatric intensive care unit: Evidence and strategies Evidence in support of early mobilization in the pediatric intensive care unit Early mobilization: The “e” in the abcdef ICU liberation bundle Implementation of a pediatric intensive care unit early mobility program: Strategies for success Step 1: Form an interdisciplinary team Step 2: Summarize the evidence Step 3: Identify local barriers to implementation Step 4: Establish performance measures Step 5: Ensure that all patients receive the intervention—the 4 e’s Summary Key references Section VII: Pediatric Critical Care: Renal Chapter 70: Renal structure and function Pearls Renal anatomy Renal development Renal vasculature Vascular anatomy Vascular function Vascular development The nephron Nephron development Glomerulus Glomerular anatomy Glomerular function Tubular anatomy Proximal tubule Loop of henle Distal nephron Tubular function Proximal tubule Loop of henle Distal tubule Collecting duct Interstitium Development Structure and function Summary Key references Chapter 71: Fluid and electrolyte issues in pediatric critical illness Pearls Sodium Hyponatremia Pathophysiology and etiology Decreased total body sodium Renal sodium losses Cerebral salt wasting Increased total body sodium Congestive heart failure Cirrhosis Nephrotic syndrome Renal failure Normal total body sodium Signs and symptoms Treatment Prevention Therapy Hypernatremia Pathophysiology and etiology Low total body sodium Normal total body sodium Increased total body sodium Signs and symptoms Treatment Potassium Causes of hypokalemia Hypokalemia without potassium deficit Hypokalemia with potassium deficit Renal losses Gastrointestinal losses Signs and symptoms Treatment Hyperkalemia Causes Artifactual Redistribution Increased load Impaired elimination Manifestations of hyperkalemia Treatment Magnesium Hypomagnesemia Causes Signs and symptoms Treatment Hypermagnesemia Cause Signs and symptoms Treatment Calcium Regulation of calcium Hormonal regulation of calcium Hypocalcemia Clinical and laboratory concerns Treatment Hypercalcemia Treatment Phosphorus Hypophosphatemia Causes of severe hypophosphatemia Signs and symptoms Treatment Hyperphosphatemia Causes of hyperphosphatemia Signs and symptoms Treatment Key references Chapter 72: Acid-base disorders Pearls Overview of acid-base physiology Defining acids and bases Role of water Principles of electroneutrality Acids, bases, and buffers Tools for interpreting acid-base disorders Henderson-hasselbalch equation Base excess and standard base excess Bicarbonate-based approach Anion gap and corrected anion gap Serum osmolar gap Strong ion difference Urinary anion gap Summary Clinical approach to disorders of acid-base balance Is abnormal ph dangerous? Blood gases: Arterial, central venous, or capillary samples? Evaluation of acid-base disorders Metabolic acidosis Elevated anion gap acidoses Lactic acidosis Ketoacidosis Toxic compounds that directly provoke acidosis Other forms of metabolic acidosis with an increased anion gap Hyperchloremic acidosis: Nonanion gap metabolic acidosis Exogenous chloride load Postpyloric gastrointestinal fluid losses Renal tubular acidosis and drug-mediated tubulopathies Urinary reconstruction using bowel segments Treating metabolic acidosis Sodium bicarbonate Alternative alkalinizing agents Dialysis management of metabolic acidosis Metabolic alkalosis Treating metabolic alkalosis Respiratory acid-base derangements Respiratory acidosis Treating respiratory acidosis Respiratory alkalosis Mixed acid-base derangements Summary Key references Chapter 73: Tests of kidney function in children Pearls Assessment of glomerular function and injury Renal clearance techniques Renal inulin clearance compared with other glomerular filtration rate measurement techniques Plasma markers Creatinine Cystatin c Estimating equations Summary of recommendations regarding use of glomerular filtration rate estimating equations Neonatal renal function Biomarkers of acute kidney injury and the next generation Tubular function Urine Urine electrolytes (sodium and chloride) Urine concentration capacity Serum blood urea nitrogen/creatinine ratio Urine microscopy Proteinuria Renal acidification Potassium regulation Generalized proximal tubulopathy Integration of kidney function assessment in critical care Key references Chapter 74: Glomerulotubular dysfunction and acute kidney injury Key words: Pearls Physiology of glomerular filtration Normal renal physiology and response of the kidney during stress Pathogenesis of reduced glomerular filtration rate in acute kidney injury Morphologic changes in renal injury Mechanisms of renal cell injury Alterations in cell membranes Cellular calcium homeostasis Production of free radicals Tubular cell energy metabolism Glomerulotubular dysfunction Hemodynamically mediated acute kidney injury Treatment of acute kidney injury Prevention/attenuation of acute kidney injury Diuretics Calcium entry blockers Prostaglandins Renin-angiotensin antagonists Adenosine and adenosine triphosphate Atrial natriuretic factor Free radical scavengers Thyroxine Glycine and alanine Acute kidney injury: Clinical impact Hyperkalemia Severe hypertension Plasma and extracellular volume expansion Severe metabolic acidosis Hypocalcemia/hyperphosphatemia Uremia Renal disposition of endogenous and exogenous compounds Specific kidney diseases that may lead to acute kidney injury Hemolytic uremic syndrome Pathophysiology Clinical signs Complications Therapy Prognosis Acute glomerulonephritis Acute postinfectious (streptococcal) glomerulonephritis Clinical signs Laboratory findings Treatment Prognosis Systemic lupus erythematosus Clinical signs Treatment Prognosis Other glomerulonephritides Nephrotic syndrome and acute kidney failure Tubulointerstitial disease Acute tubulointerstitial nephritis Cardiorenal syndrome Cardiac surgery–related acute kidney injury Tumor lysis syndrome Management Rasburicase Role of renal replacement therapy Pigment nephropathy Pathophysiology Hypocalcemia Drug-induced nephrotoxicity Aminoglycoside nephrotoxicity Amphotericin b Vancomycin Calcineurin inhibitors Nonsteroidal antiinflammatory drugs Contrast-induced nephropathy Acute renal failure after stem cell transplantation Urinary tract obstruction Conclusions Key references References Chapter 75: Pediatric renal replacement therapy in the intensive care unit Pearls Basic physiology of dialysis and ultrafiltration Peritoneal dialysis Physiology Indications Technique Disadvantages and complications Intensive care unit issues Intermittent hemodialysis Physiology Indications Technique Disadvantages and complications Intensive care unit issues Continuous renal replacement therapy Physiology Indications Technique Anticoagulation Dialysate and infused fluids Clearance Disadvantages and complications Intensive care unit issues Extended dialysis Outcomes of renal replacement in critically ill children Advances in pediatric renal replacement therapies Summary Key references Chapter 76: Pediatric renal transplantation Pearls Donor source: Living donor versus deceased donor Living donor transplantation Deceased donor transplantation Timing of transplantation Histocompatibility Abo blood group considerations Hla matching Pretransplantation crossmatch testing Sensitized recipient Surgical procedure Multiorgan transplantation Immediate arrival to the pediatric intensive care unit (boxes 76.1, 76.2, and 76.3) Posttransplantation monitoring Hemodynamics and tissue perfusion Fluid and electrolytes Urine output Recovery of renal function Immunosuppression Infection surveillance and prevention Posttransplantation complications Acute kidney injury Vascular complications Urologic complications Rejection Urinary tract infection Other infections Recurrence of primary renal disease Focal segmental glomerulosclerosis References Chapter 77: Renal pharmacology Pearls Kidney function and drug disposition Drug dosing in kidney disease Drug dosing in dialysis Kidney as a therapeutic target: Diuretics and agents regulating renal excretion Carbonic anhydrase inhibitors Mechanism and sites of action Efficacy on urinary excretion and therapeutic uses Adverse effects Osmotic diuretics Mechanism and sites of action Efficacy on urinary excretion and therapeutic uses Adverse effects Loop diuretics Mechanism and site of action Pharmacokinetics Effects on urinary excretion and adverse effects Therapeutic uses Thiazide and thiazide-like diuretics Mechanism and site of action Pharmacokinetics Effects on urinary excretion and therapeutic uses Adverse effects Potassium-sparing diuretics Mechanism and site of action Effects on urinary excretion and therapeutic uses Adverse effects Vasopressin antagonists Mechanism of action and therapeutic uses Adverse effects Diuretic resistance Medications for the prevention/reversal of acute kidney injury Key references Chapter 78: Acute severe hypertension Pearls Terminology Etiology Pathophysiology Endothelial homeostasis Sympathetic nervous system activation Renin-angiotensin-aldosterone system Nitric oxide Volume overload Clinical presentation Patient evaluation and monitoring Blood pressure measurement and other monitoring Diagnostic evaluation Pharmacologic therapy General considerations Clonidine Esmolol Hydralazine Isradipine Labetalol Nicardipine Sodium nitroprusside Other available agents Special situations Preeclampsia Pheochromocytoma Summary Key references Section VIII: Pediatric Critical Care: Metabolic and Endocrine Chapter 79: Cellular respiration Pearls Pathways of cellular respiration Glycolysis (anaerobic respiration) Fatty acid β-oxidation Protein catabolism Krebs cycle Mitochondrial oxidative phosphorylation Oxygen toxicity Impaired cellular respiration in critical illness Clinical assessment of oxygen utilization Lactate Venous oxygen saturation Microdialysis Near-infrared spectroscopy Optical spectroscopy Tissue oxygen tension Magnetic resonance spectroscopy Blood mitochondrial DNA Mitochondrial- and bioenergetic-targeted therapy in critical illness Antioxidants Glycemic control Substrate provision Mitochondrial biogenesis and mitophagy Membrane stabilizers Hibernation Mitochondrial transplantation Conclusions Key references Chapter 80: Biology of the stress response Key words: Pearls Definitions and background Stress system primary elements Stress response Central activation and integration Peripheral responses Cellular responses Stress response in critical illness Recommendations and conclusions Key references Chapter 81: Inborn errors of metabolism Pearls Pathophysiology of inborn errors of metabolism Inheritance of inborn errors of metabolism Signs and symptoms of inborn errors of metabolism Laboratory evaluation of suspected inborn errors of metabolism Postmortem evaluation of a child with suspected inborn errors of metabolism Emergency treatment of children with suspected inborn errors of metabolism Classification of inborn errors of metabolism by clinical presentation Group 2 inborn errors of metabolism: Impaired energy production Group 3 inborn errors of metabolism: Intoxication Summary Metabolic acidosis Hypoglycemia Cardiomyopathy and inborn errors of metabolism Metabolic myopathies and rhabdomyolysis Neonatal screening Conclusions Key references Chapter 82: Progress towards precision medicine in critical illness Pearls Genetic variation and critical illness Genetic variation and sepsis Genetic variation and acute respiratory distress syndrome Transcriptomics and critical illness Plasma biomarkers and critical illness Plasma biomarkers and sepsis Plasma biomarkers and acute respiratory distress syndrome Summary Key references Chapter 83: Molecular foundations of cellular injury Pearls Caspase-dependent forms of regulated cell death Apoptosis Animal studies on apoptosis Pyroptosis Caspase-independent forms of regulated cell death Necroptosis Animal studies—necroptosis Autophagy Mitochondrial permeability transition–mediated regulated necrosis Ferroptosis Parthanatos Netosis Cell death as a therapeutic target Key references References Chapter 84: Endocrine emergencies Pearls Hypothalamic-pituitary-adrenal axis Cortisol biochemistry and biology Actions of cortisol Immunity Metabolism Hemodynamics Assessing the cortisol stress response Free cortisol Adrenal insufficiency in the intensive care unit Primary adrenal insufficiency Secondary adrenal insufficiency Treatment of adrenal insufficiency Corticosteroid side effects Alterations of glucose homeostasis Glucose homeostasis in health Hyperglycemia Stress hyperglycemia and outcomes Pathophysiology of stress hyperglycemia Mechanisms of stress hyperglycemia adverse outcomes Clinical trials examining management of critical illness hyperglycemia Glucose measurement Hypoglycemia Clinical manifestations Pathogenesis Fasting adaptation Hypoglycemia treatment Alterations of thyroid hormone in critical illness Thyroid biochemistry Thyroid hormone actions Hyperthyroidism Hypothyroidism Euthyroid sick syndrome in critical illness Thyroid hormone supplementation in the picu Key references Chapter 85: Diabetic ketoacidosis Pearls Etiology, definition, and presentation Epidemiology Frequency of diabetic ketoacidosis at diagnosis Frequency of diabetic ketoacidosis in children and adolescents after diagnosis Morbidity and mortality associated with diabetic ketoacidosis Management guidelines (fig. 85.1) Fluids Insulin Electrolytes Correction of acidosis Monitoring Diabetic ketoacidosis–associated complications Hyperglycemic hyperosmolar syndrome Thrombotic complications Other complications Neuropsychologic sequelae Healthcare costs associated with diabetic ketoacidosis Key references Section IX: Pediatric Critical Care: Hematology and Oncology Chapter 86: Structure and function of the hematopoietic organs Pearls Normal peripheral blood values Structure of the bone marrow Function of the bone marrow: Hematopoiesis Regulators of hematopoiesis: Growth factors Erythropoiesis Granulopoiesis Megakaryocyte and platelet production Lymphopoiesis Spleen Key references Chapter 87: The erythron Pearls Oxygen transport Carbon dioxide transport Biophysical factors influencing gas transport Blood rheology Red blood cell aggregation and adhesion Red blood cell deformability Regulation of blood flow distribution by red blood cells Role of red blood cell–nitric oxide interactions in vasoregulation Metabolism of endothelium-derived nitric oxide by red blood cells: Historical view Metabolism of endothelium-derived nitric oxide by red blood cells: Contemporary view Processing and export of s-nitrosothiols by red blood cells Metabolism of nitrite by red blood cells Vasoregulation by red blood cell-derived adenosine triphosphate Red blood cell energetics and consequences of antioxidant system failure Acquired red blood cell injury, eryptosis, and clearance Influence of red blood cells on hemostasis Summary Key references References Chapter 88: Hemoglobinopathies Pearls Globin gene loci Sickle cell disease Molecular description and epidemiology Sickle cell trait Spectrum of sickle cell disease genotypes and natural history Laboratory and diagnostics Pathophysiology Hemoglobin polymerization Red cells, inflammation, hemolysis, and the endothelium Clinical manifestations Pain Pathophysiology, diagnosis, and presentation Management Sepsis. Pathophysiology and etiology Management Acute chest syndrome Presentation Management Stroke. Natural history Diagnosis Management Aplastic crisis Splenic sequestration Pulmonary hypertension Pathophysiology and etiology Diagnosis Management Multiorgan failure Renal conditions Iron overload Sleep conditions and depression and suicide in sickle cell disease Surgery and anesthesia Disease-modifying and curative therapies for sickle cell disease Hydroxyurea Transfusion Choice of product Type and goals of transfusion Transfusion reactions and hyperhemolysis Hematopoietic stem cell transplantation, gene therapy, and novel therapies for sickle cell disease Thalassemia Molecular description and epidemiology Laboratory and diagnostics Pathophysiology Forms and variations α-thalassemia β-thalassemia Hbe/β0-thalassemia Natural history Assessment of iron overload Spectrum of disease Anemia Transfusion-related complications Cardiac complications Assessments Management Hepatic and renal dysfunction in thalassemia Thrombosis and pulmonary emboli Pulmonary hypertension Endocrine Hematopoietic stem cell transplantation, gene therapy, and novel therapies for thalassemia Key references Chapter 89: Coagulation and coagulopathy Pearls Overview of hemostasis Role of platelets and von willebrand factor in hemostasis Role of endothelial cells in hemostasis Crosstalk between coagulation and inflammation Hypercoagulability and thrombophilia Approach to the patient with an identified or suspected coagulation disorder Clinical history Physical examination Basic tests of hemostasis Platelet function testing Thromboelastography and thromboelastometry Abnormal hemostasis in critical illness Disseminated intravascular coagulation and other microangiopathic consumptive disorders Pathogenesis Clinical presentation and diagnosis Meningococcal purpura fulminans Management Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome Thrombocytopenia associated multiorgan failure Abnormal hemostasis in liver disease and hepatic insufficiency Presentation Management Vitamin k deficiency Management Circulating anticoagulants Iatrogenic coagulopathy Massive transfusion syndrome Management Anticoagulant overdose Warfarin Management Heparin Management New oral anticoagulants Management Platelet disorders Quantitative platelet disorders Heparin-induced thrombocytopenia Qualitative platelet disorders Management Defects associated with acquired vwf defects Uremia Thrombocytopenia-associated multiorgan failure Cardiac-induced hemostatic disorders Systemic diseases associated with factor deficiencies Thrombophilia and immunothrombosis Summary Key references Chapter 90: Thrombosis in pediatric critical care Pearls Developmental hemostasis Etiology and epidemiology Central venous access devices Arterial access Cardiac surgery Thrombophilia Heparin-induced thrombocytopenia Clinical features Diagnosis Venous thrombosis Pulmonary embolus Arterial thrombosis Intracardiac thrombosis Management Unfractionated heparin in children Thromboprophylaxis in the pediatric intensive care unit Conclusions Key references Chapter 91: Transfusion medicine Pearls Red blood cells Red blood cell transfusion: Why and why not Anemia and oxygen delivery Oxygen delivery in the critically ill Adaptive mechanisms with anemia Oxygen kinetics in the critically ill Regulation by red blood cells of oxygen delivery to tissue Risks of anemia Transfusion of red blood cells: Indications (when) Hemorrhagic shock or severe bleeding (node 1) Picu patients with severe anemia without severe bleeding (node 2) Hemoglobin less than 5 or between 5 and 7 g/dl (node 2) Hemodynamically unstable patients without serious bleeding (node 3) Hemodynamically stable noncardiac patients (node 4) Cardiac patients (node 5) Prevention of anemia and red blood cell transfusion Pre–pediatric intensive care unit anemia Pediatric intensive care unit–associated anemia Post–pediatric intensive care unit anemia Types of red blood cell units Standard red blood cell units Other types of red blood cell units Leukocyte-reduced red blood cell units Washed red blood cell units Irradiated red blood cell units Cytomegalovirus-negative red blood cell units Directed red blood cell units Autologous red blood cell units Transfusion of red blood cells: How Blood types Volume and number of red blood cell units Length of storage Perfusion, warming, and filtration Plasma Types of plasma Transfusion of plasma: Indications (when) Transfusion of plasma: How Platelets Types of platelet products Standard platelet products Special platelet concentrates Leukocyte-reduced platelets Irradiated platelets Cytomegalovirus-negative platelets Cryopreserved platelets Pathogen-reduced platelets Platelet transfusion (why) Transfusion of platelets: Indications (when) Transfusion of platelets: How Whole blood Whole blood: Type of product Whole blood: Indications Whole blood: How Cryoprecipitate Transfusions reactions and complications Transfusion reactions Immediate transfusion reactions Other acute transfusion reactions Delayed transfusion reactions Complications related to massive transfusion Transfusion-transmitted infections Transfusion-related immunomodulation Other transfusion-related complications Reactions and complications more frequent with plasma transfusion Reactions and complications more frequent with platelet transfusion Treatment of transfusion reactions and complications Conclusion Key references Chapter 92: Hematology and oncology problems Pearls Hematologic emergencies Anemia Hemorrhagic anemia Anemia secondary to decreased production Hemolytic anemia Thrombocytopenia related to decreased platelet production Thrombocytopenia-related immune-mediated consumption Thrombocytopenia related to nonimmune consumption Bleeding in uremia Oncologic emergencies Tumor lysis syndrome Hyperkalemia Hyperphosphatemia/hypocalcemia Hyperuricemia Hyperleukocytosis Spinal cord compression Acute airway compromise in anterior mediastinal tumors Superior vena cava syndrome Hemophagocytic lymphohistiocytosis Anthracycline-induced cardiac dysfunction Posterior reversible encephalopathy Chimeric antigen receptor t cell–mediated toxicity Key references Chapter 93: Critical illness in children undergoing hematopoietic progenitor cell transplantation Pearls Sources of hematopoietic progenitor cells and identification of donors Indications and outcomes Transplant procedure Conditioning regimen Stem cell harvesting/collection/cryopreservation Reinfusion Recovery period Complications Cardiac complications Pulmonary complications Early pulmonary complications Periengraftment respiratory distress syndrome Pulmonary cytolytic thrombi Diffuse alveolar hemorrhage Idiopathic pneumonia syndrome Late pulmonary complications Bronchiolitis obliterans syndrome/bronchiolitis obliterans organizing pneumonia Pulmonary venoocclusive disease Critical care for pulmonary complications Mechanical ventilatory support Adjunctive therapies Conclusion Dilemmas in the diagnosis of pulmonary complications Hepatic complications Colitis and other gastrointestinal complications Myelosuppression and hematologic complications Myelosuppression and immune dysregulation Infectious complications Graft failure Hematologic complications Iron overload Graft-versus-host disease Neurologic complications Chimeric antigen receptor t cells Key references Section X: Pediatric Critical Care: Gastroenterology and Nutrition Chapter 94: Gastrointestinal structure and function Pearls Intestinal structure, digestion, absorption of nutrients, water, and electrolytes Water and solute transport across intestinal epithelium Digestion of carbohydrates Digestion of proteins Digestion of lipids Fat digestion Intestinal lymphatics Regulation of electrolyte and water movement Electrolyte transport Gastric acid Intestinal motility Pancreas Pancreatic exocrine secretory function Hepatobiliary system Examination Anatomy, structure, and function Portal circulation Hepatic function Degradation and elimination by the liver Enterohepatic circulation Hepatic regulatory function Storage function Host-defense mechanisms of the gut: Immunology and microbiology Immunologic processing in the gut Gastrointestinal and hepatobiliary testing in the intensive care unit Key references References Chapter 95: Disorders and diseases of the gastrointestinal system Pearls Gastrointestinal evaluation of the critically ill child Abdominal examination Gastrointestinal endoscopy Gastroesophageal reflux monitoring Use of colorants to identify aspiration in the intensive care unit Radiologic procedures Plain films Contrast radiography Ultrasonography, computed tomographic scanning, and magnetic resonance scanning Radionuclide scanning Testing for occult blood loss Stool ph and reducing substances Intensive care unit as a satellite laboratory facility Life-threatening complications of gastrointestinal disorders Systemic Central line–associated bloodstream infection Esophagus Congenital esophageal anomalies Caustic injury to the esophagus Esophageal foreign bodies Gastroesophageal reflux Stomach and duodenum Gastric volvulus Gastric ulcer Duodenal ulcers Small intestine and colon Malrotation Necrotizing enterocolitis Low cardiac output syndrome Food allergy Hemolytic uremic syndrome Inflammatory bowel disease Distal intestinal obstruction syndrome Hirschsprung disease Acute colonic pseudo-obstruction Abdominal compartment syndrome Acute and chronic pancreatitis Acute and chronic liver failure Key references Chapter 96: Acute liver failure Pearls Acute liver failure Background, definitions, etiology, outcomes Etiologies Prognostic assessment Diagnosis and workup Specific treatments for particular causes of pediatric acute liver failure Acetaminophen toxicity Amanita poisoning Autoimmune hepatitis Wilson disease Metabolic disease Pediatric intensive care unit complications and management Neurologic complications: Hepatic encephalopathy and cerebral edema Cerebral edema Management of hepatic encephalopathy and cerebral edema Ventilation Glucose, electrolytes, and fluid balance Ascites Renal function Coagulopathy Infection prophylaxis and treatment Liver support Decision-making for liver transplantation for acute liver failure Key references Chapter 97: Hepatic transplantation Pearls Current state of pediatric liver transplantation Indications for liver transplant Liver transplant evaluation Pretransplant considerations Transplant considerations Donor considerations Liver transplant procedure Complications of liver transplantation Primary graft nonfunction Vascular complications Bleeding Biliary complications Rejection Infection Posttransplant lymphoproliferative disorder Posttransplant management in the intensive care unit Drains and vascular access Fluid and electrolytes Graft function Anticoagulation Respiratory support Sedation Infection prophylaxis Immunosuppression Liver transplant outcomes Patient and graft survival Retransplantation Key references References Chapter 98: Acute abdomen Pearls Anatomic and physiologic considerations Peritoneum Visceral blood flow Physical examination of the abdomen Laboratory tests Imaging options Ultrasonography Abdominal plain radiographs Computed tomography Magnetic resonance imaging Abdominal conditions requiring treatment in the intensive care unit Perforated viscera Ischemia Neutropenic enterocolitis Pancreatitis Hemorrhage Other specific conditions Cholecystitis Spontaneous bacterial peritonitis Abdominal compartment syndrome Intraabdominal abscess Intestine as a source of sepsis Surgical intervention Key references Chapter 99: Nutrition of the critically ill child Pearls Malnutrition in the pediatric critically ill patient Assessment of nutritional status Body composition Biochemical assessment Metabolic consequences of critical illness Underfeeding and overfeeding in the pediatric intensive care unit Indirect calorimetry Protein requirements Lipid requirements Micronutrient requirements Refeeding syndrome Enteral nutrition in critically ill children Parenteral nutrition Carbohydrates Amino acids Lipids Electrolytes/minerals and trace elements Biochemical monitoring Obese critically ill children Revised guidelines for pediatric critical care nutrition Conclusions Key references References Section XI: Pediatric Critical Care: Immunity and Infection Chapter 100: Innate immunity Pearls Components of innate immune system Innate immune stimulus: Danger hypothesis Signal recognition Signal transduction Effector pathways Soluble mediator response Cellular response Crosstalk between systems Regulation of the innate immune response Clinical manifestations of the innate immune response in the intensive care unit Therapeutic targets of the innate immune system Therapeutic questions arising from the innate immune system Conclusion Key references References Chapter 101: Adaptive immunity Pearls Lymphocytes develop to recognize specific antigens B-cell activation leads to antibody secretion: The humoral immune response Effector t cells direct cell-mediated immunity T-cell activation requires interaction with innate immune cells T-cell activation requires a second signal Cd8+ t cells differentiate into cytotoxic t cells Cd4+ t cells differentiate into multiple t helper cell subtypes Th1 cells Th2 cells Th17 cells T follicular helper (tfh) cells Th9 cells Regulatory t cells (treg) Additional t-cell subtypes Adaptive immunity in the intensive care unit Summary Key references Chapter 102: Critical illness and the microbiome Pearls General concepts in the field of microbiome science Commensal, pathogenic, and keystone species Site specificity Dysbiosis Studying the microbiome Development of the microbiome in children Development of intensive care unit dysbiosis in children Known and potential clinical consequences of intensive care unit dysbiosis Microbiome-based therapeutics in the intensive care unit Probiotics Fecal microbiota transplantation Selective gut decontamination Supplementing/repleting microbial metabolites Targeted interventions against enterobacteriaceae Monitoring the intensive care unit microbiome Future of microbiome science Key references Chapter 103: Congenital immunodeficiency Pearls Basic framework for understanding the immune system Compartment 1: Complement Clinical presentations Compartment 2: Phagocytes Clinical presentations Compartment 3: B cells and antibodies Clinical presentations Compartment 4: T cells Clinical presentations Specific disorders likely to be encountered in the pediatric intensive care unit Specific disorders: Complement C1 inhibitor deficiency Early pathway defects (c1, c2, c3, c4) Late pathway components: Membrane attack complex defects (c5, c6, c7, c8, c9) Complement regulatory protein defects (factor h, factor I, mcp) Specific disorders: Phagocytes Severe congenital neutropenia Leukocyte adhesion deficiency Whim syndrome Chronic granulomatous disease Specific disorders: B cells and antibodies X-linked agammaglobulinemia Hyperimmunoglobulin m syndromes B-cell activation Pneumocystis jirovecii and cryptosporidium parvum infections among patients with hyperimmunoglobulin m and cd40l mutations Common variable immunodeficiency syndromes Genetic defects associated with a common variable immunodeficiency phenotype Selective immunoglobulin a deficiency Specific disorders: T cells 22q11 deletion syndrome (digeorge syndrome) Severe combined immunodeficiency X-linked severe combined immunodeficiency Pathogenesis of selected genotype/phenotypes of scid Adenosine deaminase– and purine nucleotide phosphorylase–deficient severe combined immunodeficiency Specific disorders: Other complex or combined immunodeficiencies Wiskott-aldrich syndrome Genotype/phenotype correlations of mutations in wiscott aldrich syndrome Cartilage-hair hypoplasia Radiation-sensitive disorders: Ataxia telangiectasia and nijmegen breakage syndrome Susceptibility to hemophagocytic lymphohistiocytosis and severe epstein-barr virus infection Toll-like receptors and innate signaling pathway defects Chronic mucocutaneous candidiasis syndromes Autoimmune lymphoproliferative syndrome Laboratory evaluation of the immune system Diagnostic testing: Complement Diagnostic testing: Phagocytes Diagnostic testing: B cells and antibodies Diagnostic testing: T cells Treatment of immune system disorders Treatment: Complement Treatment: Phagocytes Treatment: B cells and antibodies Immunoglobulin replacement Prophylactic antibiotics Treatment: T cells Key references References Chapter 104: Acquired immune dysfunction Pearls Immune dysfunction during sepsis, malnutrition, hiv/aids, and other critical illness states Sepsis and immune dysfunction Immunosuppression in sepsis Malnutrition and immune dysfunction HIV infection and AIDS Pulmonary complications and respiratory failure Pneumocystis jirovecii pneumonia Cytomegalovirus pneumonitis Other viral pathogens Mycobacterial pathogens Fungal infections Lymphocytic interstitial pneumonitis Upper airway obstruction Cardiovascular complications Abdominal complications Hematologic and malignancy complications Central nervous system complications Occupational human immunodeficiency virus exposure Other selected causes of secondary immune dysfunction Immunosuppressive medications Transfusions Uremia Neonatal period Key references Chapter 105: Immune balance in critical illness Pearls Innate and adaptive immunity Innate immunity Adaptive immunity Proinflammatory and antiinflammatory responses Systemic inflammatory response syndrome in critical illness Compensatory antiinflammatory response syndrome in critical illness Temporal aspects of the systemic inflammatory response syndrome/compensatory antiinflammatory response syndrome response Cars and clinical outcomes Immunomodulation in the pediatric intensive care unit Targeted innate immunostimulation Targeted adaptive immunostimulation Unintended immunomodulation Immune monitoring in the intensive care unit Conclusion Key references Chapter 106: Pediatric rheumatologic disease Pearls Rheumatologic diseases: Overview Rheumatologic diseases: Clinical presentation, diagnosis, and treatment Juvenile idiopathic arthritis Systemic juvenile idiopathic arthritis Key points Clinical presentation Laboratory studies Management Systemic lupus erythematosus Key points Clinical presentation Mucocutaneous manifestations Musculoskeletal manifestations Pulmonary manifestations Pleuritis and pleural effusion Pulmonary hemorrhage Pulmonary embolism Interstitial lung disease Pulmonary hypertension Cardiovascular manifestations Pericarditis and pericardial tamponade Myocarditis Valvular disease Arrhythmias Acute coronary syndrome Renal manifestations Central nervous system manifestations Hematologic involvement Thrombotic thrombocytopenic purpura Immune dysfunction Acute abdominal manifestations: Peritonitis, serositis, pancreatitis, and intestinal perforation Laboratory studies Auto-antibody testing Management Neonatal systemic lupus erythematosus Raynaud phenomenon Antiphospholipid syndrome Key points Clinical presentation Laboratory studies Management Juvenile dermatomyositis Key points Clinical presentation Laboratory studies Imaging Management Systemic vasculitis Key points Small-vessel vasculitis Immune-complex small-vessel vasculitis Henoch-schönlein purpura Treatment of hsp Pauci-immune small-vessel vasculitis (antineutrophil cytoplasmic antibody–associated vasculitis) Granulomatosis with polyangiitis Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis Treatment of anca-associated vasculitis Medium-vessel vasculitis Kawasaki disease Treatment of kd Polyarteritis nodosa Large-vessel vasculitis Takayasu arteritis Primary vasculitis of the central nervous system Autoinflammatory syndromes Key points Rheumatologic diseases: Conditions and complications in the intensive care unit Macrophage activation syndrome Key points Airway compromise Organ-specific complications Treatment-related complications of rheumatologic diseases Corticosteroids Gastrointestinal side effects Infectious side effects Summary Key references Chapter 107: Bacterial and fungal infections Pearls Bacterial infections in the intensive care unit Gram-positive bacteria Gram-negative bacteria Anaerobic infections General considerations for antibiotic therapy Antibiotic classes β-lactam antibiotics β-lactam antimicrobial plus β-lactamase inhibitor combination Cephalosporins Carbapenems Monobactams Aminoglycosides Glycopeptides Macrolides Fluoroquinolones Miscellaneous Clindamycin Linezolid Metronidazole Colistin Doxycycline Trimethoprim-sulfamethoxazole Tigecycline Daptomycin Antibiotic resistance and treatment of multidrug-resistant pathogens Antibiotic resistance mechanisms Treatment of multidrug-resistent pathogens Fungal infections and antifungal agents Candida Aspergillus and other invasive molds Antifungal agents Amphotericin Triazoles Echinocandins Flucytosine Combination antifungals Infection diagnostics Antimicrobial stewardship Summary Key references Chapter 108: Life-threatening viral diseases and their treatment Pearls Myocarditis Epidemiology and etiology Clinical presentation Diagnosis and management Acute liver failure Epidemiology and etiology Clinical presentation Diagnosis and management Viral pneumonia/pneumonitis Epidemiology and etiology Clinical presentation Diagnosis and management Central nervous system infections Epidemiology and etiology Clinical presentation Diagnosis and management Emerging viral diseases Key references Chapter 109: Healthcare-associated infections Pearls Epidemiology Risk factors Pathogen transmission and isolation practices Infection prevention strategies Care bundles Hand hygiene Personal protective equipment Antimicrobial resistance and antimicrobial stewardship Visitation policies Specific healthcare-associated infections in the pediatric intensive care unit Bloodstream infections Hospital-acquired lower respiratory tract infections (lrtis) Viral lower respiratory tract infections Ventilator-associated pneumonia Urinary tract infections Surgical site infections Ventriculostomy-related infections Healthcare-associated diarrhea Key references Chapter 110: Pediatric sepsis Pearls Epidemiology Definitions Clinical presentation Pathogenesis Pathogen recognition and signal transduction Cytokines as principal mediators of the sepsis response Adhesion molecules Nitric oxide Coagulation cascade Peroxisome proliferator-activated receptor-γ pathway Myeloid-derived suppressor cells Paradigm of sepsis as an adaptive immune problem Genomic medicine and sepsis Genetic influence and septic shock Genome-wide expression profiling in children with septic shock Treatment strategies Initial resuscitation Invasive monitoring Elimination of pathogens Maintenance of oxygen delivery Additional management considerations Immunomodulation The case for more effective stratification in pediatric septic shock Conclusion Key references References Chapter 111: Multiple-organ dysfunction syndrome Pearls Pathophysiology and targeted therapies Mitochondrial dysfunction Innate and adaptive immune response Microcirculatory dysfunction, ischemia-reperfusion injury Epithelial dysfunction Neurohumoral response Multiple-organ dysfunction syndrome phenotypes Multiple-organ dysfunction syndrome definitions Multiple-organ dysfunction syndrome scoring Epidemiology Time course and outcomes Conclusions and research perspectives Key references Section XII: Pediatric Critical Care: Environmental Injury and Trauma Chapter 112: Bites and stings Pearls Snakebites Epidemiology Venomous snakes in the united states Pathophysiology and clinical presentation Emergency and critical care Prehospital care Assessment, stabilization, and disposition Antivenin considerations Antivenin administration Other supportive care Recurrence and therapeutic complications Follow-up Prognosis Pitfalls Resources Spider bites Epidemiology Widow spiders Recluse spiders Pathophysiology and clinical presentation Widow spider envenomation (latrodectism) Recluse spider envenomation (loxoscelism) Emergency and critical care Latrodectism management Loxoscelism management Therapeutic complications Follow-up Prognosis Pitfalls Future directions Resources Scorpion stings Epidemiology Clinical presentation Emergency and critical care Hymenoptera stings (bees, wasps, and ants) Massive envenomation Emergency and critical care Prognosis Key references Chapter 113: Hyperthermic injury Pearls Definitions Epidemiology Pathophysiology of heat-related illnesses Acclimatization Acute-phase response Clinical features of heat stroke Central nervous system Cardiovascular Pulmonary Renal Gastrointestinal Metabolic Hematologic Infectious Treatment Key references References Chapter 114: Accidental hypothermia Pearls Physiology Central nervous system Cardiovascular Respiratory Renal Coagulation Treatment Resuscitation Rewarming Outcome Key references Chapter 115: Drowning Pearls Definitions Epidemiology Pathophysiologic considerations Type of aspirated fluid Pulmonary effects Cardiovascular effects Central nervous system effects Effects on other organ systems Mammalian diving reflex Preexisting associated conditions Cold water drowning Management Management at the scene Emergency department evaluation and stabilization Management in the intensive care unit Prognosis Key references Chapter 116: Burn and inhalation injury Pearls Types of burns Flame burn Scald burn Electrical burn Chemical burn Normal skin anatomy Depth and size of burn Superficial burns Superficial partial-thickness burns Deep partial-thickness burns Full-thickness burns Zones of injury Estimating the extent of the burn Prehospital and early management Transfer to burn centers Pain management Resuscitation Colloid resuscitation Complications of resuscitation Treatment of burn wounds Topical therapy Surgery (excision and grafting) Inhalation injury Pathophysiology of inhalation injury Diagnosis of inhalation injury Management of inhalation injury Ventilator support Airway clearance and extubation criteria Therapeutic adjuncts Nutrition Calculating and monitoring nutritional requirements Enteral support Parenteral support Nutritional adjuncts Rehabilitation Reconstructions Prevention Key references Chapter 117: Evaluation, stabilization, and initial management after trauma Pearls Prehospital care and trauma team activation Trauma resuscitation Primary survey Overview Establish an airway with cervical spine stabilization (a) Breathing (b) Circulation (c) Disability (d) Exposure/environment (e) Secondary survey Diagnostic assessment Laboratory studies Radiographic imaging Emergency department thoracotomy Stabilization and definitive care Conclusions Key references Chapter 118: Traumatic brain injury Pearls Epidemiology Pathophysiology Posttraumatic ischemia Excitotoxicity Delayed neuronal death cascades Cerebral swelling Cerebral blood volume Edema Axonal injury History Signs and symptoms Initial resuscitation Rapid-sequence induction and intubation Circulatory stabilization Herniation Transition from the emergency department to the pediatric intensive care unit: Computed tomographic scan and intracranial ... Diagnostic studies and monitoring modalities Computed tomography Magnetic resonance imaging Intracranial pressure monitoring Advanced monitoring techniques Monitoring cerebral blood flow Monitoring cerebral metabolism Treatment in the pediatric intensive care unit Intracranial pressure and cerebral perfusion pressure thresholds Baseline care Treatment of intracranial hypertension: First-tier therapies Ventricular cerebrospinal fluid drainage Osmolar therapy Sedation analgesia and neuromuscular blockade Head position Treatment of intracranial hypertension: Second-tier therapies Barbiturates Hyperventilation Hypothermia Decompressive craniectomy Other therapies for refractory intracranial hypertension Miscellaneous Linking rehabilitation and acute care Outcomes Conclusion Key references Chapter 119: Pediatric thoracic trauma Pearls Epidemiology and prevention Anatomic and physiologic considerations Initial resuscitation and diagnosis Chest wall injury Lung and airway injury Traumatic asphyxia Cardiac injuries Esophageal injury Chylothorax Diaphragmatic injury Conclusions Key references Chapter 120: Pediatric abdominal trauma Key words: Pearls Mechanisms and patterns of injury Penetrating abdominal trauma Recreational and sports injury Wartime trauma Evaluation and resuscitation Physical examination Laboratory tests Radiographic assessment Computed tomography Sonography Additional assessment tools Diagnostic peritoneal lavage Diagnostic laparoscopy Management of specific abdominal injuries Nonoperative management of solid-organ injuries Embolization of solid-organ injuries Injury to the spleen Injury to the liver Injury to the small bowel Injury to the duodenum Injury to the pancreas Blunt abdominal aortic injury Renal trauma Bladder injuries Pelvic fractures Key references Chapter 121: Child abuse Pearls Case example Abuse VS. accident? Epidemiology Medical VS. forensic assessment Sentinel injuries Case example Specific syndromes Abusive head trauma Presentation Diagnosis Retinal hemorrhage Imaging Intensive care unit/surgical considerations Abdominal trauma Alternative explanations of injuries Birth Subdural hematoma or retinal hemorrhage with valsalva Brief resolved unexplained event Cerebral venous sinus thrombosis Benign enlargement of subarachnoid space Other alternatives: Lumbar puncture, vaccines, bleeding, or bone mineralization disorders Mandated reporting Approach to parents Case example Multidisciplinary diagnosis Coroner cases Conclusions Key references Section XIII: Pediatric Critical Care: Pharmacology and Toxicology Chapter 122: Principles of drug disposition Pearls Clinical pharmacokinetics Clearance Volume of distribution Half-life Bioavailability Applied pharmacokinetics Clinical pharmacodynamics Determinants of effective therapy Pharmacokinetic processes Absorption Enteral absorption Sublingual/buccal absorption Transdermal absorption Intramuscular and subcutaneous absorption Rectal absorption Distribution Age-dependent maturation in protein binding Age-dependent maturation in body composition Disease-dependent changes affecting drug distribution Metabolism Hepatic phase I metabolism Cyp3a Cyp2c Cyp2d6 Cyp2b6 Other Hepatic phase II metabolism Intestinal metabolism Elimination Renal excretion Biliary excretion Pharmacodynamics changes Critical care therapeutics Antimicrobials Analgesics and sedatives Cardiovascular agents Pulmonary agents Anticoagulants Steroids Neuromuscular blockers Conclusion Key references Chapter 123: Molecular mechanisms of drug actions Pearls Targets for drug action Receptors Ion channels Enzymes Carrier proteins Receptor type and regulation G protein–coupled receptors Channel-linked receptors Enzyme-linked receptors Nuclear receptors Receptor regulation Signal transduction mechanisms: Intracellular messengers and effectors Second messengers Cyclic adenosine monophosphate Cyclic guanosine monophosphate Arachidonic acid and its metabolites Diacylglycerol and inositol triphosphate Calcium ions Phosphorylation of proteins Protein kinases Calcium-binding proteins Multiple drug targets within an organ system: The myocardium Drug response and genetic polymorphisms Genetic polymorphisms and drug disposition Genetic polymorphisms, drug targets, and signaling mechanisms Drug response and development Drug response and disease Conclusion Key references Chapter 124: Adverse drug reactions and drug-drug interactions Pearls Adverse drug reactions by organ system Renal Hepatic Cardiovascular Central nervous system Hematologic Endocrine and metabolic Dermatologic Drug-drug interactions Pharmacodynamic drug-drug interactions Drug-drug interactions by therapeutic class Cardiovascular agents Vasopressors Antiarrhythmics β-blockers Calcium channel blockers Angiotensin-converting enzyme inhibitors Nitrates Anticonvulsant medications Antiinfective and antimicrobial agents Anesthetic agents and sedatives Analgesic agents Anticoagulants Immunosuppressive agents Antineoplastic agents Key references Chapter 125: Principles of toxin assessment and screening Pearls Common agents involved in serious pediatric poisonings Resources for the clinician General assessment of the poisoned patient History Physical examination Laboratory tests and toxin screens Additional investigations Radiographic studies Diagnostic trials Summary Key references Chapter 126: Toxidromes and their treatment Pearls Opioids Sedative hypnotics Sympathomimetic agents Anticholinergic agents Cholinergic agents Methemoglobinemia Xenobiotic-induced hyperthermia Metabolic acidosis with increased anion gap Toxin-induced seizures Cardiovascular agents Acetaminophen (paracetamol) Key references Section XIV: Pediatric Critical Care: Anesthesia Principles in the Pediatric Intensive Care Unit Chapter 127: Airway management Pearls Anatomic considerations Basic airway management Nasopharyngeal airway Oropharyngeal airways Oxygen delivery devices Nasal cannulas Masks Noninvasive positive-pressure ventilation Establishing a functional airway Endotracheal intubation Indications Respiratory failure Hemodynamic instability Neuromuscular dysfunction Failure of central nervous system to regulate ventilatory drive and airway reflexes Other indications Physiologic effects of intubation Recognition of a difficult airway Process of intubation Pharmacologic agents to facilitate intubation Anticholinergic agents Sedative and analgesic agents Neuromuscular blocking agents Preoxygenation Orotracheal intubation Nasotracheal intubation Adjunctive airway approaches Laryngeal mask airway Video laryngoscopy Flexible fiberoptic bronchoscopy Cricothyrotomy, tracheostomy, and retrograde intubation Extubation Complications of endotracheal intubation Prolonged intubation Tracheostomy Special circumstances Full stomach Increased intracranial pressure and neurologic dysfunction Cervical spine instability Upper airway obstruction Facial and laryngotracheal injury Open-globe injury Key references Chapter 128: Anesthesia effects on organ systems Pearls Anesthetic agents and regional anesthesia methods Neurologic effects Cardiovascular effects Respiratory, gastrointestinal, and renal effects Key references Chapter 129: Anesthesia principles and operating room anesthesia regimens Pearls Preoperative evaluation Nothing-by-mouth guidelines Preoperative medication Monitoring Pharmacology of anesthetic agents Local anesthetic agents Intravenous anesthetic agents Opioids Volatile anesthetic agents and nitrous oxide Neuromuscular blocking agents Intraoperative anesthetic care Maintenance anesthesia Intraoperative fluid management Postoperative care Postoperative analgesia Conclusions Key references Chapter 130: Malignant hyperthermia Pearls Pathophysiology Genetics Clinical recognition of malignant hyperthermia Differential diagnosis Course of malignant hyperthermia Potential systemic complications Management of an episode of malignant hyperthermia Initial steps: Discontinue trigger agents and administer dantrolene Further management: Expert consultation and symptomatic treatment Urine and blood tests in malignant hyperthermia Testing for malignant hyperthermia susceptibility Muscle contracture testing Less invasive tests of malignant hyperthermia susceptibility Disorders associated with malignant hyperthermia Muscular diseases and malignant hyperthermia Heat illness and malignant hyperthermia susceptibility Neuroleptic malignant syndrome Malignant hyperthermia association and registry Key references Chapter 131: Neuromuscular blocking agents Pearls Neuromuscular junction Neuromuscular blocking agents: Depolarizing agents Neuromuscular blocking agents: Nondepolarizing agents Pancuronium Vecuronium Rocuronium Rapacuronium Mivacurium Atracurium Cis-atracurium Reversal of neuromuscular blockade Acetylcholinesterase inhibitors Sugammadex Monitoring neuromuscular blockade Adverse effects of neuromuscular blockade Summary: Neuromuscular blocking agents in the picu Key references Chapter 132: Sedation and analgesia Pearls Posttraumatic stress disorder Sedation scoring and assessment Opioids and analgesia in the pediatric intensive care unit Specific opioid agonists Morphine Meperidine Fentanyl Sufentanil Alfentanil Remifentanil Codeine Hydromorphone Tramadol Opiate antagonists Incidental pain syndromes in the pediatric intensive care unit Sickle cell crisis Opiate tolerance Rapid opiate detoxification Benzodiazepines Specific benzodiazepines Diazepam Midazolam Lorazepam Tolerance for and dependence on benzodiazepines Flumazenil Other agents for sedation in the pediatric intensive care unit Chloral hydrate Butyrophenones and phenothiazines Haloperidol Droperidol Chlorpromazine Lytic cocktail Neuroleptic malignant syndrome Baclofen Cannabis Dexmedetomidine Propofol Special issue regarding long-term infusion of propofol Propofol infusion syndrome Propofol tolerance and withdrawal Ketamine Etomidate Inhalational anesthetic agents Inhalation agent withdrawal syndrome Sedation for children with preexisting cognitive impairment Apoptosis and neurocognitive effects of anesthetic agents Sedation-related complications Pharmacoeconomics of analgesia and sedation in the pediatric intensive care unit Key references Chapter 133: Tolerance, dependency, and withdrawal Pearls History of tolerance and withdrawal in medical practice Clinical signs and symptoms of withdrawal Limitation of the development of tolerance and physical dependency Incidence of tolerance and physical dependency Scoring systems to identify withdrawal Weaning from sedative and analgesic agents Summary Key references Chapter 134: Pediatric delirium Pearls Background Etiology Epidemiology Risk factors Outcomes Clinical presentation Diagnosis Treatment Underlying illness Iatrogenic factors Environment Pharmacotherapy Prevention Conclusion Key references Chapter 135: Procedural sedation for the pediatric intensivist Differences between outpatient and inpatient sedation Outpatient procedural sedation training during pediatric critical care fellowship Sedation team structure Classification of sedation Equipment, monitoring, and rescue drugs Sedation prescreening Considerations in choosing commonly used medications Nonpharmacologic approach to outpatient sedation Sedation adverse events Key references Section XV: Pediatric Critical Care: Board Review Questions Chapter 136: Board review questions Chapter 1: History of pediatric critical care medicine Chapter 2: High-reliability pediatric intensive care unit: role of intensivist and team in obtaining optimal outcomes Chapter 3: Critical communication in the pediatric intensive care unit Chapter 4: Professionalism in pediatric critical care Chapter 5: Leading and managing change in the pediatric intensive care unit Chapter 7: Fostering a learning healthcare environment in the pediatric intensive care unit Chapter 8: Challenges of pediatric critical care in resource-poor settings Chapter 9: Public health emergencies and emergency mass critical care Chapter 10: Lifelong learning in pediatric critical care Chapter 11: Essential concepts in clinical trial design and statistical analysis Chapter 12: Prediction tools for short-term outcomes following critical illness in children Chapter 13: Pediatric critical care transport Chapter 14: Pediatric vascular access and centeses Chapter 15: Ultrasonography in the pediatric intensive care unit Chapter 16: Patient- and family-centered care in the pediatric intensive care unit Chapter 17: Pediatric critical care ethics Chapter 18: Ethical issues around death and dying Chapter 19: Palliative care in the pediatric intensive care unit Chapter 20: Organ donation process and management of the organ donor Chapter 21: Long-term outcomes following critical illness in children Chapter 22: Burnout and resiliency Chapter 23: Structure and function of the heart Chapter 24: Regional and peripheral circulation Chapter 25: Endothelium and endotheliopathy Chapter 26: Principles of invasive cardiovascular monitoring Chapter 27: Assessment of cardiovascular function Chapter 28: Cardiac failure and ventricular assist devices Chapter 29: Echocardiographic imaging Chapter 30: Diagnostic and therapeutic cardiac catheterization Chapter 31: Pharmacology of the cardiovascular system Chapter 32: Cardiopulmonary interaction Chapter 33: Disorders of cardiac rhythm Chapter 34: Shock states Chapter 35: Pediatric cardiopulmonary bypass Chapter 36: Critical care after surgery for congenital cardiac disease Chapter 37: Cardiac transplantation Chapter 38: Physiologic foundations of cardiopulmonary resuscitation Chapter 39: Performance of cardiopulmonary resuscitation in infants and children Chapter 40: Structure and development of the upper respiratory system Chapter 41: Structure and development of the lower respiratory system Chapter 42: Physiology of the respiratory system Chapter 43: Noninvasive respiratory monitoring and assessment of gas exchange Chapter 44: Overview of breathing failure Chapter 45: Ventilation/perfusion inequality Chapter 46: Mechanical dysfunction of the respiratory system Chapter 47: Diseases of the upper respiratory tract Chapter 48: Pediatric acute respiratory distress syndrome and ventilator-associated lung injury Chapter 49: Acute viral bronchiolitis Chapter 50: Asthma Chapter 51: Neonatal pulmonary disease Chapter 52: Pneumonitis and interstitial disease Chapter 53: Diseases of the pulmonary circulation Chapter 54: Mechanical ventilation and respiratory care Chapter 55: Noninvasive ventilation in the pediatric intensive care unit Chapter 56: Extracorporeal life support Chapter 57: Pediatric lung transplantation Chapter 58: Structure, function, and development of the nervous system Chapter 59: Critical care considerations for common neurosurgical conditions Chapter 60: Neurologic assessment and monitoring Chapter 61: Neuroimaging Chapter 62: Coma and depressed sensorium Chapter 63: Intracranial hypertension and monitoring Chapter 64: Status epilepticus Chapter 65: Anoxic ischemic encephalopathy Chapter 66: Pediatric stroke and intracerebral hemorrhage Chapter 67: Central nervous system infections and related conditions Chapter 68: Acute neuromuscular disease and disorders Chapter 70: Renal structure and function Chapter 71: Fluid and electrolyte issues in pediatric critical illness Chapter 72: Acid-base balance in critical illness Chapter 73: Tests of kidney function in children Chapter 74: Glomerulotubular dysfunction and acute kidney injury Chapter 75: Pediatric renal replacement therapy in the intensive care unit Chapter 76: Pediatric renal transplantation Chapter 77: Renal pharmacology Chapter 78: Hypertensive urgencies and emergencies Chapter 79: Cellular respiration Chapter 80: Biology of the stress response Chapter 81: Inborn errors of metabolism Chapter 82: Genetic variation in health and disease Chapter 83: Molecular foundations of cellular injury Chapter 84: Endocrine emergencies Chapter 85: Diabetic ketoacidosis Chapter 86: Structure and function of the hematopoietic organs Chapter 87: The erythron Chapter 88: Hemoglobinopathies Chapter 89: Coagulation and coagulopathy Chapter 90: Thrombosis in pediatric critical care Chapter 91: Transfusion medicine Chapter 92: Hematology and oncology problems Chapter 93: Critical illness in children undergoing hematopoietic progenitor cell transplantation Chapter 94: Gastrointestinal structure and function Chapter 95: Disorders of the gastrointestinal system Chapter 96: Acute liver failure Chapter 97: Hepatic transplantation Chapter 98: Acute abdomen Chapter 99: Nutrition of the critically ill child Chapter 100: Innate immunity Chapter 101: Adaptive immunity Chapter 102: Critical illness and the microbiome Chapter 103: Congenital immunodeficiencies Chapter 104: Acquired immune dysfunction Chapter 105: Immune balance in critical illness Chapter 106: Pediatric rheumatologic disease Chapter 107: Bacterial and fungal infections Chapter 108: Life-threatening viral diseases and their treatment Chapter 109: Healthcare-associated infections Chapter 110: Pediatric sepsis Chapter 111: Multiple organ dysfunction syndrome Chapter 112: Bites and stings Chapter 113: Hyperthermic injury Chapter 114: Hypothermic injury Chapter 115: Drowning Chapter 116: Burn and inhalation injuries in children Chapter 117: Evaluation, stabilization, and initial management after trauma Chapter 118: Traumatic brain injury Chapter 119: Pediatric thoracic trauma Chapter 120: Pediatric abdominal trauma Chapter 121: Child abuse Chapter 122: Principles of drug disposition Chapter 123: Molecular mechanisms of drug action Chapter 124: Adverse drug reactions and drug-drug interactions Chapter 125: Principles of toxin assessment and screening Chapter 126: Toxidromes and their treatment Chapter 127: Airway management Chapter 128: Anesthesia effects on organ systems Chapter 129: Anesthesia principles and operating room anesthesia regimens Chapter 130: Malignant hyperthermia Chapter 131: Neuromuscular blocking agents Chapter 132: Sedation and analgesia Chapter 133: Tolerance, dependency, and withdrawal Chapter 134: Pediatric delirium Chapter 135: Procedural sedation for the pediatric intensivist Inside Back Cover
