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دانلود کتاب Pediatric Critical Care, 4th Edition
دانلود کتاب مراقبت های ویژه کودکان ، چاپ چهارم
مشخصات کتاب
Pediatric Critical Care, 4th Edition
ویرایش: [4th Edition]
نویسندگان: Bradley P. Fuhrman MD and Jerry J. Zimmerman PhD MD
سری:
ISBN (شابک) : 9780323073073, 0323073077
ناشر: Mosby
سال نشر: 2011
تعداد صفحات: 1745
زبان: English
فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود)
حجم فایل: 76 Mb
قیمت کتاب (تومان) : 44,000
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توجه داشته باشید کتاب مراقبت های ویژه کودکان ، چاپ چهارم 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 ، چاپ چهارم
جدیدترین مراقبت های با کیفیت برتر را برای کودکان بدحال با نسخه تمام رنگی و به روز شده مراقبت های ویژه کودکان فوهرمن و زیمرمن ارائه دهید. در حال چاپ، و اکنون آنلاین، Drs. بردلی پی فورمن و جری جی. زیمرمن از یک رویکرد جامع و سیستم‌های اندام برای کمک به مدیریت طیف کاملی از موجودیت‌های بیماری استفاده می‌کنند. اطلاعات دقیقی از موضوعاتی مانند آسیب حاد ریه، سندرم اختلال عملکرد ارگان های متعدد و موارد دیگر کسب کنید. تکنیک‌های بالینی و تست‌های تشخیصی جدید را پیاده‌سازی کنید، دیدگاه‌های مختلف شش ویراستار مرتبط با تخصص در این زمینه را بسنجید، به بیش از 1000 تصویر برای کمک به تشخیص ارجاع دهید، و با دسترسی آنلاین به سؤالات بررسی سبک هیئت مدیره، واضح باشید. این عنوان قطعی تضمین می کند که شما به طور مداوم بهترین مراقبت های ویژه را به بیماران کودکان خود ارائه می دهید. بر توسعه، عملکرد، و درمان طیف وسیعی از موجودیت‌های بیماری با رویکرد روشن، منطقی و سیستم ارگانی متن تمرکز کنید. همه اعضای تیم ICU اطفال را در مورد موضوعات مرتبط با مسئولیت های آنها به روز نگه دارید. با آخرین پیشرفت‌ها در مراقبت‌های تسکینی، تلفات جمعی/بیماری اپیدمی، نارسایی حاد تنفسی، تهویه غیرتهاجمی، مراقبت‌های عصبی، تصویربرداری عصبی، انسفالوپاتی هیپوکسیک-ایسکمیک، سکته مغزی و خونریزی داخل مغزی، سندرم پاسخ التهابی سیستمیک، آسیب‌های ریوی حاد، همراه باشید. سندرم اختلال عملکرد اندام و موارد دیگر. به سرعت اطلاعات مورد نیاز خود را با بخش هایی که به تازگی سازماندهی شده اند برای دسترسی آسان تر پیدا کنید. دیدگاه شش دستیار ویراستار خبره را در مورد تمام تحولات جدید در این زمینه به دست آورید. مفاهیم پیچیده را به سرعت و به طور قطعی با یک قالب کاملاً رنگی جدید و بیش از 1000 تصویر درک کنید. در www.expertconsult.com، متن کامل را جستجو کنید، کتابخانه تصویر را دانلود کنید، و به سوالات بررسی هیئت آنلاین با هدف هر موضوع مرتبط دسترسی پیدا کنید. مراقبت‌های حیاتی کودکان فورمن و زیمرمن آخرین پیشرفت‌ها در مراقبت‌های ویژه کودکان را پوشش می‌دهد که مراقبت از بیمار و میزان بقا را بهبود می‌بخشد.
توضیحاتی درمورد کتاب به خارجی
Provide the latest in superior quality care for critically ill children with the full-color, updated 4th Edition of Fuhrman and Zimmerman's Pediatric Critical Care. In print, and now online, Drs. Bradley P. Fuhrman and Jerry J. Zimmerman use a comprehensive, organ-systems approach to help you manage a full range of disease entities. Get up-to-the-minute knowledge of topics such as acute lung injury, multiple organ dysfunction syndrome, and more. Implement new clinical techniques and diagnostic tests, weigh the varying perspectives of six associate editors with expertise in the field, reference 1,000+ illustrations to aid diagnosis, and keep sharp with online access to board-style review questions. This definitive title will ensure that you consistently deliver the very best intensive care to your pediatric patients. Focus on the development, function, and treatment of a wide range of disease entities with the text's clear, logical, organ-system approach. Keep all members of the pediatric ICU team up to date with coverage of topics particularly relevant to their responsibilities. Keep current with the latest developments in palliative care, mass casualty/epidemic disease, acute respiratory failure, non-invasive ventilation, neurocritical care, neuroimaging, hypoxic-ischemic encephalopathy, stroke and intracerebral hemorrhage, systemic inflammatory response syndrome, acute lung injury, multiple organ dysfunction syndrome, and much more. Quickly find the information you need with sections newly reorganized for easier access. Gain the perspectives of six expert associate editors on all the new developments in the field. Understand complex concepts quickly and conclusively with a brand new full-color format and more than 1,000 illustrations. Search the full text, download the image library, and access online board review questions targeting every relevant topic, all at www.expertconsult.com. Fuhrman and Zimmerman's Pediatric Critical Care covers the latest developments in pediatric critical care that improve patient care and survival rates.
فهرست مطالب
Cover Copyright Contributors Preface Section I: Pediatric Critical Care: The Discipline Chapter 1 - History of Pediatric Critical Care Definitions Definition of a Pediatric Intensive Care Unit Definition of Pediatric Intensivist History of Critical Care Resuscitation and Ventilation Anesthesia Anatomy and Physiology History of Pediatric Critical Care Pediatric Anesthesiology Pediatric General and Cardiac Surgery Neonatology Pediatric Cardiology Poliomyelitis Nursing Pediatric Critical Care Getting Started The Present The Cost of Success Around the World Canada Africa Asia: Japan India Australia and New Zealand Europe Israel Latin America Our Heroes Acknowledgments Chapter 2 - The Intensivist in the New Hospital Environment: Patient Care and Stewardship of Hospital Resources Organization and Quality Issues Manpower Issues Summary Chapter 3 - The Nurse in Pediatric Critical Care Describing What Nurses Do: The Synergy Model Patient Characteristics of Concern to Nurses Nurse Competencies Important to Patients and Families Clinical Judgment Clinical Inquiry Caring Practices Response to Diversity Advocacy/Moral Agency Facilitator of Learning Collaboration Systems Thinking Optimal Patient Outcomes Patient Level Outcomes Provider Level Outcomes System Level Outcomes Nightingale Metrics Leadership Beacon Award Professional Development Staff Development Orientation In-Service Education Continuing Education Certification in Pediatric Critical Care Nursing Summary Chapter 4 - Research in Pediatric Critical Care Research Areas Wellsprings of Research Collective Needs Individual Motivation Doing Research The Null Hypothesis Medical Research Research Design Independent Variable Dependent Variable Nuisance Variables Design Efficacy Randomization Validity Statistics: A Word Type I and Type II Errors Neoempiricism, Data Mining, and Knowledge Discovery in Databases Research Funding Obtaining Financial Support Sources of Research Funding Intramural Funding Extramural Funding National Institutes of Health Writing the Grant Application Hypothesis-Driven Research-Specific Aims Significance Preliminary Studies Experimental Plan Presentation Page Limitations Your Chances: Money Your Chances: Cultures in Conflict Research Ethics Acknowledgment Chapter 5 - Proving the Point: Evidence-Based Medicine in Pediatric Critical Care The Evidence-Based Medicine Process Study Types Interventional Studies Observational Studies Research Summaries Levels of Evidence Apply the Evidence Challenges to Evidence-Based Medicine Conclusion Chapter 6 - Outcomes in Pediatric Critical Care Medicine: Implications for Health Services Research and Patient Care What Is Health Services Research? A System of Care Organizing Health Systems Microsystems and Macrosystems Microsystems Macrosystems The Macrosystem: Pediatric Critical Care Access Quality Structure Process Outcomes Neonatal Intensive Care Unit Mortality Scores. Pediatric Intensive Care Unit Mortality Scores. The Microsystem: Pediatric Intensive Care Unit Patient Level Intensive Care Unit Level Beyond the Pediatric Intensive Care Unit Conclusion Chapter 7 - Safety and Quality Assessment in the Pediatric Intensive Care Unit A Brief Consideration of the Relationship Between Safety and Quality State of Safety and Quality in Pediatric Intensive Care Units Fundamentals of Quality Improvement and Patient Safety: Systems Thinking Quality Improvement and Value Quality Improvement Methods Variation and Display of Data over Time Other Quality Improvement Tools Fundamentals of Patient Safety Errors, Injuries, Systems, and Risks Improvement in the Pediatric Intensive Care Unit Culture Teams and Teamwork Technology Patient Safety in the Pediatric Intensive Care Unit: Past, Present, and Future Conclusions Chapter 8 - Information Technology in Critical Care The Electronic Health Record Data Acquisition Data Access Data Storage Clinical Decision Support Patient Safety Automated Adverse Event Detection Promises and Limitations New Kinds of Errors Increased Work for Clinicians Unfavorable Alteration of Workflow Untoward Changes in Communication Patterns High System Demands and Frequent Changes Persistence of Paper Overdependence on Technology Human Factors Engineering Continued Promise Design and Implementation Health Information Exchange Data Exchange Within a Single Health Care Organization Data Exchange Among Multiple Health Care Organizations Protected Health Information Clinical Tools Smart Infusion Pumps Bar Coding in Health Care Virtual Care and Telemedicine Medical Knowledge Bases The Internet and the Patient Research Databases Virtual Pediatric Intensive Care Unit Systems Security Firewalls Wireless Networks Virtual Private Network Authentication Viruses or Malware User Privacy Spyware Cookies Web Bugs Profiles and Privacy Policies Electronic Mail Conclusion Chapter 9 - Family-Centered Care in the Pediatric Intensive Care Unit Caring and Compassion Humanitarianism and Defining the Family Family-Centered Care Core Concepts Challenges for the Team and Family Culturally Sensitive Care Professional Boundaries Personalizing Care Communication Daily Communication Respectful Language When English Is not the Primary Family Language Access to Information Technology Rounds Shift Report Disclosing Medical Errors Multidisciplinary Team Social Worker Chaplain/Spiritual Care Child Life Specialist Pet Therapist Parent Advisory Council/Family as Consultant Parent Support Group Volunteers Financial Services Ethicist Palliative Care Access Concepts Admission Process Sibling Participation Family Space Participation in Care Procedures Resuscitation Transferring out of the Pediatric Intensive Care Unit Compassion Fatigue Chapter 10 - Ethics in Pediatric Intensive Care Moral Theory Consequentialism Deontology Prevailing Principles Beneficence Nonmaleficence Autonomy Justice Health Care Decision Making: Consent Competency Information Understanding Voluntariness Shared Decision Making Surrogate Decision Making: Parental Rights and Obligations Conscientious Objection to Participation in Proposed Interventions Pediatric Intensive Care and “Experimentation” Chapter 11 - Ethical Issues in Death and Dying Withholding and Withdrawing Life Support Active Versus Passive Euthanasia Withholding Food and Water Competence, Incompetence, and Baby Doe Legal Implications of Withholding or Withdrawing Life Support Futility Hospital Ethics Committees Caring for the Terminally Ill Definition of Death and Organ Retrieval Brain Death Organ Retrieval Chapter 12 - Palliative Care What Is Pediatric Palliative Care? Issues of Concern in Palliative Care Communication Palliation of Symptoms or Relief of Suffering? Spiritual and Environmental Needs Support of Clinicians Practical Aspects of Care at the End of Life The Anticipatory Clinical Team Meeting What Treatments May Be Withheld or Withdrawn? Where and When Will Mechanical Ventilation Be Withdrawn? How Should Mechanical Ventilation Be Withdrawn? Preparation and Support of the Family Determining Who Will Care for the Patient at This Time Determining How Signs of Apparent Discomfort Will Be Treated Neuromuscular Blockade and the Withdrawal of Mechanical Ventilation Consideration of the Level of Sedation and Analgesia to Be Used The Goal of Using Sedatives and Analgesics in This Context Issues After Death Essential Basic Documentation Support of the Caregivers Chapter 13 - The Process of Organ Donation and Pediatric Donor Management Role of the Pediatric Intensivist and Critical Care Team in the Process of Organ Donation Determination of Brain Death Brain Death Physiology Treatment of Hemodynamic Instability Hormonal Replacement Therapy Management of Pulmonary Issues for the Potential Pediatric Organ Donor Fluid and Electrolyte Disturbances Diabetes Insipidus Oliguria Glucose, Potassium, and Calcium Derangements Coagulation Abnormalities and Thermoregulatory Instability Medical Examiner/Coroner Issues and Organ Donation for Children Donation After Circulatory Determination of Death Summary Chapter 14 - Pediatric Transport: Shifting the Paradigm to Improve Patient Outcome The Problem: An Adult-Oriented Retrieval System Focused on Rapid Movement Critical Pediatric Physiology Relevant to Transport Medicine Rapid Transfer, Goal-Directed Therapy, and the Golden Hour Specialized Teams Improve Outcome The Solution: A Retrieval System Focused on Improving Outcome Responsibility of the Retrieval System Communications Staffing Equipment Safety Referring Hospital Responsibilities Summary Chapter 15 - Pediatric Vascular Access and Centeses 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 Pericardiocentesis Indications Contraindications Procedure Equipment Technique Maintenance Complications Interpretation Summary Umbilical Arterial Catheter and Umbilical Venous Catheter Placement Umbilical Artery Cannulation Supplies and Equipment Technique Maintenance Complications Summary Umbilical Vein Cannulation Equipment Technique Maintenance 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 Venous Cutdown Peripherally Inserted Central Venous Catheters Pulmonary Artery Catheterization Contraindications Procedure and Equipment Information Acquisition Maintenance Interpretation Complications Summary Thoracentesis and Tube Thoracostomy Thoracentesis Indications Contraindications Preparation Procedure Technique Complications Interpretation Summary Tube Thoracostomy Contraindications Supplies and Equipment Technique Maintenance Complications Summary Paracentesis Indications Contraindications Procedure Supplies Technique Complications Interpretation Summary Chapter 16 - Pediatric Intensive Care in Developing Countries Why Lower Child Mortality Rates? Expenditure on Health Child Mortality, Infections, and Intensive Care Role of Intensive Care Ethical Dilemma Causes of Death Pneumonia Antibiotic Treatment Oxygen and Ventilation Fluid Therapy Feeding Gastroenteritis Shock Fluid and Electrolyte Abnormalities Sodium Abnormalities. Hypokalemia. Hypophosphatemia. Metabolic Acidosis. Low Birth Weight Neonatal Asphyxia Malaria Diagnosis Initial Treatment Antimalarial Drugs Other Treatment Measles Diagnosis Infection Control General Measures Human Immunodeficiency Virus Pertussis Diagnosis Treatment Tetanus Treatment Tuberculosis Pathophysiology Diagnosis Presentation to the Intensive Care Unit Lower Airway Obstruction Bronchoesophageal Fistula Laryngeal Tuberculosis Tuberculous Meningitis Tuberculous Pericarditis Miliary and Abdominal Tuberculosis Treatment Regimens Diphtheria Course During the First Week Subsequent Course Diagnosis Antibiotics Antitoxin Supportive Care Cardiac Prevention of the Spread of Disease Dengue Fluid Therapy Other Treatment Malnutrition Conclusion Chapter 17 - Educating the Intensivist Requirements The American Board of Pediatrics The Accreditation Council for Graduate Medical Education ACGME Core Competencies Duty Hours Adult Learning The Dreyfus and Dreyfus Model of Skill Acquisition Methods of Teaching Teaching at the Patient’s Bedside Procedural Training Simulation Training Web-Based Education Evaluation and Assessment of Competency Milestones Education in Research, Scholarship, and Leadership Mentorship Establishing and Maintaining Competency Chapter 18 - Critical Care in Public Health Emergencies Basic Concepts National Response Framework and Incident Command System Ordinary Surge and Mass Critical Care Pediatric Critical Care Needs and Resources in a Public Health Emergency When the PICU Is Notified of a Sudden-Impact Public Health Emergency Emergency Department Phase Triage Decontamination Infection Control Keeping Families Together, Identifying and Tracking Children, Child Safety Intensive Care Unit Phase PICU Operations in a Gradual Onset and Sustained Public Health Emergency Space Personnel Mechanical Ventilation Manual Ventilation Equipment and Supplies Medications Critical Care in Specific Types of Public Health Emergencies Rationing Section II: Cardiovascular System Chapter 19 - Structure and Function of the Heart Anatomic Development and Structure Gross Anatomy Microscopic Anatomy Myocyte Contractile Apparatus Sarcolemma and Sarcoplasmic Reticulum Cytoplasm Cytoskeleton and Extracellular Matrix Nerves and Receptors Ductus Arteriosus 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 Isovolumic Phase Indices. Ejection Phase Indices. Ventricular Function Curves Pericardial Function Ventricular Interaction Diastolic Ventricular Function 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 Autoregulation Chapter 20 - Regional Circulation 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 Chapter 21 - Principles of Invasive Monitoring 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 Pressure Catheters Indications Interpretation of Waveforms Continuous Mixed Venous Oxygen Saturation Arterial Pressure Catheters Indications Interpretation of Waveforms Pulmonary Artery Catheters History and Controversy Indications Catheter Ports Measurement of Cardiac Output Fick Method Thermodilution Method Calculation of Oxygen Delivery and Consumption Interpretation of Waveforms Resistance Calculation of Intracardiac Shunt Directly and Indirectly Measured Variables Conclusions Chapter 22 - Assessment of Cardiovascular Function 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 DO2 Acid-Base Status Blood Lactate 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 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 Chapter 23 - Echocardiography and Noninvasive Diagnosis Diagnosis of Congenital Heart Disease Cardiac Function Assessment Structure-Oriented Approach Segmental Analysis: Situs Diagnosis Segmental Analysis: Atrioventricular Connection Segmental Analysis: Ventriculoarterial Connection Ventricular and Atrial Septa Atrial Septum Ventricular Septum Segmental Analysis: Valves Atrioventricular Valves Semilunar Valves Segmental Analysis: Veins Systemic Venous Connections Systemic Venous Anomalies Pulmonary Veins Segmental Analysis: Coronary Arteries Segmental Analysis: Aorta Systemic Arteriovenous Fistulas Pulmonary Arteries Ventricular Function Assessment and Hemodynamics Contrast Echocardiography Transesophageal Echocardiography Specific Lesions Shunts Complex Heart Defects Left Heart Lesions Right Heart Lesions Special Considerations after Chest Trauma Safety of Ultrasound Costs and Benefits Trends Chapter 24 - Diagnostic and Therapeutic Cardiac Catheterization Catheterization Laboratory Environment Hemodynamic and Oxygen Saturation Data Assessment of Critical Illness Transcatheter Radiofrequency Ablation Congenital Heart Disease Therapeutic Interventions in the Newborn Atrial Communication Procedures Pulmonary Balloon Valvotomy Aortic Balloon Valvotomy Perioperative Interventional Procedures Risks and Complications Balloon Dilation of Pulmonary Arteries Occlusion Device Insertion Cardiac Catheterization and Extracorporeal Membrane Oxygenation Chapter 25 - Pharmacology of the Cardiovascular System Mechanisms of Response Adrenergic Receptors Signal Transduction β-Adrenergic Receptors α Receptors Receptor Downregulation Polymorphisms Vasopressin Receptors V1 Receptors Receptor Downregulation Polymorphisms Phosphodiesterase Regulation of cAMP 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 Adverse Effects Preparation and Administration Adverse Effects Interactions Summary Vasopressin Basic Pharmacology Clinical Pharmacology Pharmacokinetics Clinical Role Preparation and Administration Adverse Effects Interactions Summary Terlipressin Basic Pharmacology Clinical Pharmacology and Adverse Effects Bipyridines Inamrinone Clinical Pharmacology Pharmacokinetics Clinical Role Preparation and Administration Adverse Effects Interactions Milrinone Clinical Pharmacology Pharmacokinetics Clinical Role Preparation and Administration Adverse Effects Summary Nesiritide Basic Pharmacology Clinical Pharmacology Pharmacokinetics Preparation and Administration Adverse Effects Drug Interactions Clinical Role Digitalis Glycosides Basic Pharmacology Clinical Pharmacology Pharmacokinetics Clinical Role Preparation and Administration Adverse Effects Interactions Summary Conclusion Chapter 26 - Cardiopulmonary Interactions Effects of Ventilation on Circulation Right Ventricular Filling and Stroke Volume Venous Return Right Ventricular Preload and Stroke Volume Positive Pressure Mechanical Ventilation and Right Ventricular Preload Critical Illness and Effects of Positive Pressure Breathing on the Right Heart Pulmonary Circulation Lung Volume Alveolar Pressure Regulation of Pulmonary Vascular Resistance Direct Effects of Airway Pressure on Pulmonary Vascular Tone Left Ventricular Preload Decreased Venous Return Ventricular Interdependence Cardiac Crowding Left Ventricular Afterload Cardiac Contractility Preload Dependence Versus Afterload Dependence Fluid Responsiveness During Positive Pressure Ventilation Elevated Work of Breathing and the Circulation Pulsus Paradoxicus in Respiratory Distress Effects of Breathing on Measurement of Hemodynamic Parameters Effects of Cardiovascular Function on Respiration Shock States and Respiratory Function Congestive Heart Failure Cardiac Disease as a Cause of Blood Gas Abnormalities Hypercyanotic Spells Glenn and Fontan Procedures Pulmonary Hypertension Vascular Impingement on the Lungs Effect of Initiating Mechanical Ventilation Chapter 27 - Myocardial Dysfunction, Ventricular Assist Devices, and Extracorporeal Life Support Myocardial Dysfunction Low Cardiac Output Syndrome Therapeutic Considerations Decreasing Oxygen Consumption Increasing Oxygen Delivery Pharmacologic Treatment of Pediatric Heart Failure Mechanical Circulatory Support Historical Perspective Mechanical Support Devices Short-Term Mechanical Support Devices Extracorporeal Life Support Extracorporeal Life Support Circuit Extracorporeal Life Support Physiology Extracorporeal Life Support Indications and Contraindications Myocarditis Postcardiopulmonary Bypass Extracorporeal Cardiopulmonary Resuscitation Myocardial Failure: Bridge to Transplantation Malignant Dysrhythmias Refractory Respiratory Failure Contraindications Critical Care Management During Extracorporeal Life Support Cardiac Output Troubleshooting Cardiac Stun Diagnostic and Therapeutic Uses of Cardiac Catheterization Patients with a Single Ventricle Anticoagulation Strategies Ventilation Strategies Fluid, Nutrition, and Renal Strategies Analgesia and Sedation Infection Intrahospital Transport Ventricular Assist Devices Centrifugal Ventricular Assist Devices Intraaortic Balloon Pump Long-Term Mechanical Support Devices Pulsatile-Type Devices Berlin Heart Ventricular Assist Device or EXCOR The Medos Ventricular Assist Device Thoratec Ventricular Assist System The Abiomed BVS 5000 VAD Rotary/Axial-Type Devices MicroMed DeBakey and HeartAssist 5 Jarvik 2000 HeartMate II Total Artificial Heart Next Generation Levitated Devices Ethics Future Directions Conclusion Chapter 28 - Disorders of Cardiac Rhythm Classification of Arrhythmias Bradycardias Appropriate Versus Normal Heart Rate Sinus Bradycardia and Sinus Pauses Conduction Abnormalities Escape Rhythms Tachycardias Classification by Mechanism Classification by Site Supraventricular Tachycardias Atrioventricular Reciprocating Tachycardias Atrioventricular Nodal Reentrant Tachycardia Primary Atrial Tachycardias Junctional Ectopic Tachycardia Ventricular Tachycardias Approach to Diagnosis Monitoring and General Assessment Surface Electrocardiogram Bradycardias Extrasystoles Tachycardias with Normal QRS Tachycardias with Prolonged QRS Monitoring of Atrial Depolarization 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 Newer Indications for Pacing Tachycardia Therapies Vagal Maneuvers Acute Pharmacologic Therapies Antiarrhythmic Procainamide. Lidocaine. β-Blocking Agents. Amiodarone. Calcium Channel–Blocking Agents. Magnesium Sulfate. Digoxin. Cardioversion and Defibrillation Approach to Therapy Extrasystoles Sustained Tachycardias Unstable Patients Treatment Failure Errors in Diagnosis Unrecognized Reinitiation Improper Technique Specific Arrhythmias Primary Arrhythmias Orthodromic Reciprocating Tachycardia in Infancy Tachycardia-Induced Cardiac Dysfunction Congenital Atrioventricular Block Chaotic Atrial Tachycardia Long QT Syndromes Genetic Arrhythmias Ventricular Tachycardia in Ostensibly Healthy Patients Secondary Rhythm Disturbances Postoperative Arrhythmias Junctional Ectopic Tachycardia. JET immediately following cardiac surgery may be mistaken for third-degree AV block, but on rewa... Late Postoperative Arrhythmias Metabolic Derangements Endocrine Disorders (Thyroid). Central Nervous System Injury. Hypothermia and Hyperthermia. Acute Myocardial Infarction. Arrhythmias Resulting from Drug Toxicity Cocaine. Tricyclic Antidepressants and Phenothiazine. Infections Chapter 29 - Shock States Definition and Physiology Recognition and Assessment of the Shock State Treatment of Shock General Principles Intubation and Mechanical Ventilation Fluid Resuscitation Vasoactive Infusions Other Therapies Multisystem Effects of Shock Respiratory Renal Coagulation Hepatic Gastrointestinal Endocrine Functional Classification and Common Underlying Etiologies Hypovolemic Shock Etiology and Pathophysiology Therapy Cardiogenic Shock or Congestive Heart Failure Etiology and Pathophysiology Clinical Assessment Therapy Myocardial Contractility: Inotropic Agents Afterload Reduction: Vasoactive Drugs Surgical Intervention Specific Etiologies Cardiomyopathy Hypoxic-Ischemic Injury Cardiac Injury in Trauma Obstructive Shock Etiology and Pathophysiology Specific Etiologies Cardiac Tamponade Coarctation/Interrupted Arch Distributive Shock Etiology and Pathophysiology Septic Shock Etiology and Pathophysiology Therapy Cardiovascular Support Nutrition Experimental/Unproved Therapies Summary Chapter 30 - Cardiac Bypass for Repair of Congenital Heart Disease in Infants and Children Cardiopulmonary Bypass in Infants Versus Adults Physiology of Cardiopulmonary Bypass Hypothermia Pulsatile Versus Nonpulsatile Flow Strategies for Blood Gas Management: Alpha-Stat and pH Stat Neurologic Injury and Protection Preoperative Factors Postoperative Factors Neuromonitoring and Neuroprotection Myocardial Protection Pulmonary Effects of Cardiopulmonary Bypass Renal Function and Protection on Cardiopulmonary Bypass Endocrine Response to Cardiopulmonary Bypass Systemic Inflammation Management of Cardiopulmonary Bypass Hemodilution Circuit Miniaturization Biocompatible Circuits Circuit Design Oxygenators Initiation of Cardiopulmonary Bypass Anticoagulation Termination of Cardiopulmonary Bypass General Principles Anatomical Considerations and the Use of Transesophageal Echocardiography Hypothermia Bleeding Modified Ultrafiltration Delayed Sternal Closure Conclusions Chapter 31 - Critical Care After Surgery for Congenital Cardiac Disease Newborn Considerations Preoperative Care Physical Examination and Laboratory Data Echocardiographic and Doppler Assessment Cardiac Catheterization Magnetic Resonance Imaging and Angiography Assessment of Patient Status and Predominant Pathophysiology 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 Right Ventriculotomy and Restrictive Physiology Pharmacologic Support Catecholamines Type III Phosphodiesterase Inhibitors Thyroid Hormone Other Afterload-Reducing Agents Other Strategies Diastolic Dysfunction Managing Acute Pulmonary Hypertension in the Intensive Care Unit Pulmonary Vasodilators Cardiac Tamponade Mechanical Support of the Circulation Preoperative Stabilization Failure to Wean from Cardiopulmonary Bypass Postcardiotomy Bridge to Transplantation Resuscitation Extracorporeal Membrane Oxygenation Cannulation, Stabilization, and Evaluation Daily Management Weaning from Extracorporeal Membrane Oxygenation Cardiovascular Interactions with Other Organs Respiratory Function and Heart-Lung Interaction Special Respiratory Problems for the Cardiac Patient Weaning from Mechanical Ventilation Central Nervous System Renal Function and Postoperative Fluid Management Gastrointestinal Issues Infection Hyperglycemia Critical Care Management of Specific Lesions Single-Ventricle Anatomy and Physiology Preoperative Management Bidirectional Cavopulmonary Anastomosis Fontan Procedure Specific Complications After the Fontan Procedure Rhythm Disturbances. Atrial flutter and/or fibrillation; heart block; and, less commonly, ventricular dysrhythmia may have a sig... Premature Closure of the Fenestration. Not all patients require a fenestration for a successful, uncomplicated Fontan operation.... Persistent Hypoxemia. Arterial O2 saturation levels may vary substantially after a modified Fontan procedure. Common causes of p... Low Cardiac Output State. An elevated LA pressure after a modified Fontan procedure may reflect poor ventricular function from d... 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 Transposition of the Great Arteries Pathophysiology Critical Care Management Atrial Baffle Procedure (Mustard and Senning). Arterial Switch Operation (Jatene Procedure). Ventricular Switch (Rastelli Procedure). Late Postoperative Care Total Anomalous Pulmonary Venous Connection Pathophysiology Critical Care Management Critical Care Management for Late Postoperative Care 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 Patent Ductus Arteriosus Pathophysiology Critical Care Management Truncus Arteriosus Pathophysiology Critical Care Management Critical Care Management for Late Postoperative Care Left-Sided Obstructive Lesions Pathophysiology Aortic Stenosis Coarctation of the Aorta Interrupted Aortic Arch Hypoplastic Left Heart Syndrome Evolution of treatment strategies Specific considerations for the Norwood operation. Summary Chapter 32 - Cardiac Transplantation Critical Care of the Pediatric Patient Waiting for Heart Transplantation Management of the Potential Heart Transplant Recipient Inotropic Support Mechanical Support Anticoagulation Management of the Potential Heart Donor Critical Care Management of the Orthotopic Heart Transplant Recipient Intraoperative Considerations Early Perioperative Management Management of Early Heart Allograft Dysfunction Heart Allograft Rejection and Immune Suppression Complications of Immune Suppression in Heart Transplant Recipients Occurring in the Pediatric Intensive Care Unit Infection Renal Function Diabetes Mellitus Future Management Strategies for Critical Care of Infants and Children with Cardiopulmonary Failure Chapter 33 - Physiologic Foundations of Cardiopulmonary Resuscitation Mechanisms of Blood Flow Cardiac Versus Thoracic Pump Mechanism Rate and Duty Cycle Chest Geometry Effects of Cardiopulmonary Resuscitation on Intracranial Pressure Simultaneous Compression Ventilation Cardiopulmonary Resuscitation Interposed Abdominal Compression Cardiopulmonary Resuscitation Active Compression-Decompression Cardiopulmonary Resuscitation and Impedance Threshold Valve Interposition Vest Cardiopulmonary Resuscitation Abdominal Binding Open-Chest Cardiopulmonary Resuscitation Cardiopulmonary Bypass Transcutaneous Cardiac Pacing Pharmacology Adrenergic Agonists Vasopressin High-Dose Epinephrine Atropine Sodium Bicarbonate Other Alkalinizing Agents Calcium Glucose Management of Ventricular Fibrillation Defibrillation Amiodarone Postresuscitation Care Future Directions Chapter 34 - Performance of Cardiopulmonary Resuscitation in Infants and Children Four Phases of Cardiac Arrest Prearrest No Flow/Low Flow Postresuscitation Epidemiology of Pediatric Cardiac Arrest Interventions During the Low-Flow Phase: Cardiopulmonary Resuscitation Airway and Breathing Circulation Optimizing Blood Flow During Low-Flow Cardiopulmonary Resuscitation: Push Hard, Push Fast Chest Compression Depth Compression/Ventilation Ratios Duty Cycle Circumferential Versus Focal Sternal Compressions Open-Chest Cardiopulmonary Resuscitation Medications Used to Treat Cardiac Arrest Vasopressors Calcium Buffer Solutions Postresuscitation Interventions Temperature Management Glucose Control Blood Pressure Management Postresuscitation Myocardial Dysfunction Other Considerations Quality of CPR Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation Ventricular Fibrillation and Ventricular Tachycardia in Children Antiarrhythmic Medications: Lidocaine and Amiodarone Pediatric Automated External Defibrillators Summary Section III: Respiratory System Chapter 35 - Structure and Development of the Upper Respiratory System in Infants and Children Developmental Anatomy of the Upper Airway Anatomy and Physiology of the Upper Airway Nasal Passages Mouth and Pharynx Larynx Trachea and Bronchi Chapter 36 - Structure of the Respiratory System: Lower Respiratory Tract Lower Respiratory System Lungs Airways and Bronchus-Associated Lymphoid Tissue Definitions of Special Lung Unit and Alveolar Formation Alveolar-Capillary Unit Lung Circulation Pulmonary Vascular System Bronchial Vascular System Pulmonary Lymphatics Diaphragm Summary Chapter 37 - Physiology of the Respiratory System Physiology of the Respiratory System Physiology of the Respiratory System Conducting Airways Model of the Respiratory System Elastic Properties of the Respiratory System Compliance and Elastance Elastic Recoil of the Respiratory System Flow Resistance of the Respiratory System Dynamic Change in Airway Caliber During Respiration Applied Forces Interactions Between Lungs and Chest Wall Time Constant of Emptying Physiology of Positive Pressure Mechanical Ventilation Gas Exchange Ventilation Perfusion Relationships Alveolar Ventilation Diffusion of Oxygen and Carbon Dioxide Chapter 38 - Control of Breathing and Acute Respiratory Failure Normal Regulation of Breathing Failure of Respiratory Controls Acute Disorders of Respiratory Controls Acute Life-Threatening Events Chronic Disorders of Respiratory Controls Structural Brain Disorders Nonstructural Congenital Disorders Nonstructural Acquired Chronic Disorders Recognition and Treatment The Deteriorating Patient Evaluation During Recovery Measuring Respiratory Drive Therapy Related to Respiratory Controls Chapter 39 - Assessment and Monitoring of Respiratory Function Physical Examination of the Respiratory System Radiography Evaluation of Gas Exchange Noninvasive Respiratory Monitoring Transcutaneous Oxygen and Carbon Dioxide Monitoring Pulse Oximetry Capnography Arterial Blood Gas Monitoring Respiratory Mechanics Endoscopy Summary Chapter 40 - Overview of Breathing Failure Physiology of Breathing Diaphragm (Structure and Function) Intercostal Muscles Accessory Muscles of Respiration Integrated Control of Breathing Neural Automatic Control of Breathing Chemoregulation in the Physiology of Breathing Breathing Failure Final Common Pathways to Breathing Failure Failure of Neural Control Failure of Muscles of Breathing Failure of Mechanics of Breathing Breathing Failure from Lung Disease 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 Thoracic Dysfunction Altered Nutritional States: Malnutrition and Obesity Conclusion Chapter 41 - Ventilation/Perfusion Inequality Distribution of Ventilation Distribution of Perfusion Fractal Model of Pulmonary Blood Flow and Ventilation Fractal Model of the Pulmonary Ventilation VA/Q Abnormalities in Pulmonary Disease Hypoxemia Acute Respiratory Distress Syndrome Pneumonia Asthma Pulmonary Embolism Primary Pulmonary Hypertension Therapeutic Considerations Positive End-Expiratory Pressure Prone Positioning Nitric Oxide Chapter 42 - Mechanical Dysfunction of the Respiratory System Work, Power, and Energy Expenditure in the Respiratory System Determinants of Respiratory Work Volume-Pressure Relationships Nature of the Mechanical Forces Acting on the Respiratory Pump Nondissipative Phenomena: Elastic Behavior of the Respiratory System Lungs/Chest Wall Interactions Dissipative Forces Dynamic Volume-Pressure Relationships Effect of Flow Rate and Pattern on the Dynamics of the Gas Stream Airway Dynamics Airway Muscle and Compliance of the Airways Airway Obstruction A Specific Case Study in Airway Mechanics: Mechanical Ventilation Determinants of Regional Gas Flow Distribution in the Lungs Restrictive and Obstructive Respiratory Disease Determinants of Respiratory Efficiency Power of Breathing and Breathing Frequency Alterations in Chest Wall Configuration Diaphragmatic Configuration Rib Cage Distortion Alterations in Contractile State of the Respiratory Muscles Conclusion Chapter 43 - Noninvasive Monitoring in Children Vital Signs Electrocardiographic Monitoring Blood Pressure Measurement Temperature Monitoring and Routine Temperature Management Temperature Monitoring Sites Pulse Oximetry Principles of Pulse Oximetry Validation Sources of Error Probe Placement Cerebral Oximetry Somatic Regional Oximetry Muscle Oximetry Capnometry and Capnography Physiologic Basis Operating Principles of Capnometry Clinical and Technical Issues Gas Sampling Issues Dead-Space Ventilation Differential Diagnosis of Abnormal Capnograms Gradually Decreasing End-Tidal CO2 Concentration Sustained Low End-Tidal CO2 Concentrations Without Plateaus Sustained Low End-Tidal CO2 Concentration with Good Plateaus Exponential Decrease in End-Tidal CO2 Gradual Increase in both Baseline and End-Tidal CO2 Transcutaneous Monitoring Oxygen Monitoring Carbon Dioxide Monitoring Cerebral Function Monitoring Bispectral Index Monitoring Historical Perspective and Development of the Electroencephalogram Age-Related Maturation of the Electroencephalogram Validation Studies Utility Studies Summary of Bispectral Index–Related Studies in Critical Care Conclusion Chapter 44 - Specific Diseases of the Respiratory System: Upper Airway Initial Management Congenital Malformations Choanal Atresia Laryngomalacia Laryngeal Webs, Stenosis, and Tumors Vascular Impingement on the Trachea Bronchomalacia and Intrathoracic Tracheomalacia Infectious Processes Laryngotracheobronchitis Epiglottitis Peritonsillar Abscess Retropharyngeal Abscess Bacterial Tracheitis Laryngeal Papillomatosis Vocal Cord Paralysis Intrathoracic Mass Lesions Causing Respiratory Obstruction Trauma Postextubation Stridor Laryngotracheal (Subglottic) Stenosis Foreign Body Aspiration Traumatic Injury to the Airway Burn Injury to the Upper Airway Angioedema Tracheostomy Postoperative Nursing Care Complications Decannulation Chapter 45 - Asthma 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 (Salbutamol) Terbutaline Anticholinergic Agents Magnesium Sulfate Methylxanthine Agents Helium-Oxygen Mixtures Ketamine Mechanical Ventilation Indications Intubation Ventilator Settings Ventilatory Monitoring Analgesia, Sedation, and Muscle Relaxation Inhalational Anesthetic Agents Antibiotics Bronchoscopy Extracorporeal Life Support Prognosis Chapter 46 - Neonatal Respiratory Disease Acute or Early-Onset Respiratory Disorders Delayed Clearance of Fetal Lung Liquid Pulmonary Air Leak Syndromes Pulmonary Hemorrhage Pneumonia Meconium Aspiration Syndrome Surfactant-Deficient Respiratory Distress Syndrome Surfactant Protein B Deficiency Congenital Malformations of the Lung Pulmonary Hypoplasia Congenital Diaphragmatic Hernia Cystic Adenomatoid Malformation Bronchogenic Cysts Pulmonary Parenchymal Cysts Pulmonary Sequestrations Congenital Lobar Emphysema Pulmonary Agenesis and Aplasia Special Treatment Considerations for Acute Respiratory Failure Surfactant Replacement High-Frequency Ventilation Extracorporeal Membrane Oxygenation Nitric Oxide Inhalation Liquid Ventilation Chronic Pulmonary Disease Chronic Lung Disease (Bronchopulmonary Dysplasia) Congenital Defects of the Lymphatics Nonpulmonary Conditions that Result in Respiratory Disease Apnea of Prematurity Choanal Atresia/Stenosis Laryngomalacia Vocal Cord Paralysis Subglottic Hemangioma 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 and/or Renal Bicarbonate Wasting Chapter 47 - Pneumonitis and Interstitial Disease 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 Miscellaneous Etiologic Agents 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 Carinii 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 Chapter 48 - Diseases of Pulmonary Circulation Etiology and Treatment of Pulmonary Hypertension Embryology Vascular Smooth Muscle Hemodynamic Features of Fetal Circulation Regulation of Pulmonary Vascular Tone in Utero Transitional Circulation Factors Responsible for Decrease in Pulmonary Vascular Resistance at Birth Persistent Pulmonary Hypertension of the Newborn Pathophysiology Clinical Presentation Treatment General Measures Hyperventilation and Alkali Infusion Oxygen Lung Recruitment Strategies High-Frequency Ventilation. Nitric Oxide. Phosphodiesterase Inhibitors Extracorporeal Membrane Oxygenation Pulmonary Arterial Hypertension in Children Pathophysiology Pulmonary Vascular Histopathology Congenital Heart Disease Clinical Presentation Diagnostic Approach Acute Vasodilator Testing Treatment General Measures Pulmonary Vasodilators Prostanoids. Epoprostenol. Treprostinil. Iloprost. Beraprost. Endothelin Receptor Antagonists. Bosentan. Selective ETA Receptor Antagonists. Nitric Oxide. Phosphodiesterase Inhibitors Combination Therapy Pulmonary Thromboendarterectomy Atrial Septostomy Lung and Combined Heart/Lung Transplantation Prognosis and Survival in Pulmonary Arterial Hypertension Chapter 49 - Mechanical Ventilation and Respiratory Care Applied Respiratory Physiology Lung Volumes and Capacities Physiology of Inflation and Deflation Work of Breathing Determinants of Gas Exchange Indications for Mechanical Ventilation Respiratory Failure Cardiovascular Dysfunction Neurologic and Neuromuscular Disorders Design and Functional Characteristics of Mechanical Positive-Pressure Ventilators Ventilator as a Machine Modes of Ventilation Mandatory Mechanical Ventilation Volume-Regulated Mandatory Breaths Pressure-Regulated Mandatory Breaths Continuous Flow Versus Demand Flow Intermittent Mandatory Ventilation Continuous Positive Airway Pressure/Positive End-Expiratory Pressure Selection of Parameters for Mandatory Breaths Assisted Mechanical Ventilation Pressure-Support Ventilation Other Modes of Ventilation Airway Pressure Release Ventilation Mandatory Minute Volume Ventilation Dual Control Modes Mandatory Dual-Control Breath-to-Breath Modes. Assisted Dual-Control Breath-to-Breath Mode. AutoMode Automatic Tube Compensation Proportional Assist Ventilation High-Frequency Ventilation Definitions Mechanism of Gas Flow in High-Frequency Ventilation in the Normal Lung Parameters to Be Selected High-Frequency Jet Ventilation High-Frequency Oscillatory Ventilation High-Frequency Percussive Ventilation Clinical Uses of High-Frequency Ventilation Approach to Mechanical Ventilation Based on Underlying Pathophysiology Primary Respiratory Muscle Failure (“Respiratory Pump Failure”) Disorders with Airway Obstruction Parenchymal Lung Disease Alveolar Recruitment and Derecruitment Prone Positioning Unilateral Lung Disease or Severely Differential Lung Disease Heart Failure Postoperative Management After Repair of Congenital Heart Disease Diseases with Abdominal Distention Neurologic and Neuromuscular Diseases Patient-Ventilator Asynchrony Use of Neuromuscular Blockade Special Techniques of Respiratory Support Altering Inspired Oxygen and Carbon Dioxide Concentration Helium-Oxygen Mixture Inhaled Nitric Oxide Adverse Effects of Mechanical Ventilation Yin-Yang of Mechanical Ventilation Airway Injury from Mechanical Ventilation Effects on the Lung Effects on the Circulatory System Respiratory Care During Mechanical Ventilation Pulmonary Hygiene Humidification Systems Aerosol Therapy Weaning from Mechanical Ventilation Traditional Method of Weaning “Modern” Method of Weaning Readiness to Extubate Trial Extubation Weaning Problems Tracheostomy and Weaning Home Respiratory Care Indications for Home Respiratory Care Logistics of Home Care Chapter 50 - Noninvasive Ventilation: Concepts and Practice Historical Perspective Indications Short-Term Noninvasive Ventilation Adult Studies on the Short-Term Use of Noninvasive Ventilation Pediatric and Neonatal Studies Interfaces Oral-Nasal Masks Nasal Masks Total Face Mask Adam’s Circuit Head Hood Equipment Optimizing Patient‑Ventilator Interaction Ventilator Settings Complications and Concerns During Short-Term Noninvasive Ventilation Circuit and Carbon Dioxide Rebreathing Long-Term Noninvasive Ventilation Physiologic Effects and Outcomes of Long-Term Noninvasive Ventilation Ventilator Settings Monitoring of Patients with Long-Term Noninvasive Ventilation Negative-Pressure Ventilation Design and Modes of Negative-Pressure Ventilators Clinical Applications Respiratory Dysfunction and Failure Cardiovascular Disorders Summary Chapter 51 - Ventilator-Induced Lung Injury Evidence for Ventilator-Induced Lung Injury Ventilation of Intact Lungs High Lung Volume Ventilator-Induced Lung Injury Low Lung Volume Ventilator-Induced Lung Injury Ventilation of Damaged Lungs High-Volume Lung Injury Low-Volume Lung Injury Roles of Tidal Volume, Positive End-Expiratory Pressure, and Overall Lung Distention Effects of Positive End-Expiratory Pressure When Tidal Volume Is Kept Constant Effects of Positive End-Expiratory Pressure when Tidal Volume Is Reduced Importance of Overall Lung Distention Possible Mechanisms of Ventilator-Induced Lung Injury Mechanisms of Increased Vascular Transmural Pressure Mechanisms of Altered Permeability Effects of Surfactant Inactivation Participation of Inflammatory Cells and Mediators Role of Inflammatory Mediators. The role of inflammatory cytokines in the course of VILI has been the subject of recent studies ... New Insights in Ventilator-Induced Lung Injury Cellular Response to Mechanical Strain Influence of Carbon Dioxide Tension on Ventilator-Induced Lung Injury Strategies to Reduce Ventilator-Induced Lung Injury: Use of the Pressure-Volume Curve Imaging Ventilator-Induced Lung Injury Conclusion and Clinical Applications Chapter 52 - Acute Respiratory Distress Syndrome in Children Pathogenesis Endothelial and Epithelial Injury Role of Cytokines Role of Ventilator-Induced Lung Injury Resolution of Lung Injury Fibrosing Lung Injury Clinical Features Incidence and Etiology Clinical Course Oxygenation and Ventilator Strategy Permissive Hypercapnia Adjunct Therapies Noninvasive Ventilation Conclusion Chapter 53 - Extracorporeal Life Support Materials and Methods Cannulation Techniques Venoarterial Extracorporeal Membrane Oxygenation Arterial Access. Venovenous Extracorporeal Membrane Oxygenation Percutaneous Cannulation Decannulation Venous Reservoir and Venous Saturation Monitor Types of Pumps and Oxygenators Roller-Head Pumps Centrifugal Pumps Membrane Oxygenator Hollow-Fiber Oxygenator Other Points Patient Populations Treated with Extracorporeal Life Support Neonatal Cardiopulmonary Failure Pediatric and Adult Patients Extracorporeal Membrane Oxygenation in Adults Extracorporeal Membrane Oxygenation for Myocardial Dysfunction Extracorporeal Membrane Oxygenation for Resuscitation Trauma Patients Patient Selection Criteria Gas Exchange and Oxygen Delivery Oxygenation Carbon Dioxide Exchange Oxygen Delivery Patient Management Screening Cannulation and Initiation of Extracorporeal Life Support Priming Patient Management During Extracorporeal Life Support Weaning from Extracorporeal Membrane Oxygenation Complications Bleeding Infection Long-Term Outcome The Future Section IV: Central Nervous System Chapter 54 - Pediatric Neurocritical Care Historical Context Rationales for Development of Pediatric Neurocritical Care Rationale 1 Rationale 2 Rationale 3 Future of Pediatric Neurocritical Care Chapter 55 - Pediatric Neurologic Assessment and Monitoring Overview and Basic Principles of Pediatric Intensive Care Unit Neurology Recognition of Neurologic Complications in the PICU Patient Establishing a Baseline Neurologic Examination and Anticipatory Planningfor New Deficits History and Assessment of Risk Factors Iatrogenic Complications of Pharmacotherapy Approach to the Physical Exam Vital Signs General Physical Exam Importance of Observation in the Neurologic Exam Nonorganic Pathology in the Pediatric Intensive Care Unit 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 Goals of the Neurologic Examination in the Pediatric Intensive Care Unit Neuromonitoring Neuroimaging Intracranial Pressure Monitoring Brain Tissue Oxygen Monitoring Cerebral Microdialysis Near-Infrared Spectroscopy Electroencephalographic Monitoring Integrating Neurologic Monitoring Data Chapter 56 - Neuroimaging Imaging Modality Overview Ultrasound Computerized Tomography Magnetic Resonance Imaging Advanced Magnetic Resonance Imaging Techniques Magnetic Resonance Angiography Catheter Angiograms Myelography Nuclear Medicine Preterm and Term Neonate Imaging Stroke in the Older Infant/Child Posterior Reversible Encephalopathy Syndrome Venous Infarct Vasculopathy/Vasculitis Vascular Malformations Central Nervous System Infection Demyelinating Disease Trauma Hydrocephalus Tumor Seizures Conclusion Chapter 57 - Structure, Function, and Development of the Nervous System 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 Developmental Processes Relevant to Pediatric Critical Care Medicine Cell Origin and Differentiation Synaptogenesis and Synaptic Pruning Neurotransmitter System Maturation Myelination Development of the Cerebrovasculature and Blood-Brain Barrier Developmental Aspects of Cerebral Blood Flow, Autoregulation, and Cerebral Metabolism Conclusion Chapter 58 - Coma and Depressed Sensorium Pathophysiology Anatomy of Arousal and Ascending Reticular Activating System States of Impaired Sensorium Identification of Cause Initial Assessment and Immediate Resuscitation Focused Neurologic Examination Respiratory Pattern Eye Examination Motor Examination Focal Neurologic Lesions Could Be Supratentorial or Subtentorial Presentation of Nonfocal Neurologic Lesions Herniation Syndromes Diagnostic Evaluation Therapeutic Intervention Immediately Treatable Forms of Coma Rapidly Progressive Reversible Lesions States Amenable to Prolonged Therapy Outcome Ethical Considerations Chapter 59 - Intracranial Hypertension and Brain Monitoring Clinical Background Physiology of the Intracranial Vault Intracranial Pressure Hydrodynamic Model of Intracranial Pressure Cerebral Vasodilation and Cerebrospinal Fluid Pressure Cerebral Perfusion Pressure and Autoregulation Measurement of Intracranial Pressure Monitoring Devices Noninvasive Inference of Intracranial Pressure Pressure Compartments Analysis of Intracranial Pressure Normal Values in Intracranial Pressure Monitoring Normal Trends in Intracranial Pressure and Waveform Analysis Assessment of Pressure-Volume Compensatory Reserve and Cerebrovascular Pressure Reactivity Monitoring Optimal Cerebral Perfusion Pressure Derived from Intracranial Pressure Parameters Quantifying the Cumulative Intracranial Pressure/Cerebral Perfusion Pressure Insult to the Brain Clinical Utility of Intracranial Pressure Monitoring with Other Monitoring Modalities Mechanism of Brain Injury Where Intracranial Hypertension Occurs Monitoring and the Postinsult Natural History Newer Modalities: Supplementary Monitoring of Intracranial Pressure Neurochemical Protein Markers of Injury Brain Oxygenation Microdialysis and Brain Tissue Biochemistry Transcranial Doppler Ultrasonography and Assessment of Autoregulation Clinical Neurophysiology Chapter 60 - Status Epilepticus Definition Classification of Status Epilepticus Epidemiology of Status Epilepticus Incidence Cause Outcome Mortality Subsequent Development of Epilepsy Pathophysiology Diagnosis Refractory Status Epilepticus Treatment of Status Epilepticus General Supportive Measures Initial Management Benzodiazepines Barbiturates Phenytoin Fosphenytoin Paraldehyde Treatment of Refractory Status Epilepticus Goals of Therapy High-Dose Barbiturates High-Dose Benzodiazepines Propofol Valproic Acid Inhalational Anesthetics Ketamine and Lidocaine Pyridoxine Surgical Treatment Investigations Acknowledgment Chapter 61 - Severe Traumatic Brain Injury in Infants and Children Epidemiology Pathophysiology Posttraumatic Ischemia Excitotoxicity Apoptosis 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 Pressu... Diagnostic Studies and Monitoring Modalities Computed Tomography Magnetic Resonance Imaging Intracranial Pressure Monitoring Advanced Monitoring Techniques Monitoring Cerebral Metabolism Treatment in the Pediatric Intensive Care Unit Intracranial Pressure and Cerebral Perfusion Pressure Thresholds 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 Lumbar Cerebrospinal Fluid Drainage Controlled Arterial Hypertension Is Rigorous Intracranial Pressure Control the Common Denominator in Studies with Exceptionally Good Outcome? Miscellaneous Outcomes Conclusion Chapter 62 - Hypoxic-Ischemic Encephalopathy: Pathobiology and Therapy of the Post-Resuscitation Syndrome in Children Epidemiology Cellular and Molecular Pathobiology Mechanisms of Hypoxic-Ischemic Brain Injury Energy Failure Selective Vulnerability Cell Death Mechanisms Reperfusion Injury 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 After Pediatric Cardiopulmonary Arrest Response of the Immature Brain to Cardiopulmonary Arrest Treatment of Cardiopulmonary Arrest Field Interventions Supportive Care in the Intensive Care Unit Current and Novel Therapies Postresuscitative Hypothermia Inhibition of PostischemicExcitotoxicity Voltage-Operated Calcium Channel Antagonists Inhibitors of Oxygen Radical Mediated Injury Phospholipid-Derived Mediator Manipulation and Antiinflammatory Therapies Futuristic Approaches Anti–Cell Death Strategies Neuronal Regeneration and Replacement Extracorporeal Support Summary Acknowledgment Chapter 63 - Stroke and Intracerebral Hemorrhage Arterial Ischemic Stroke Pathophysiology Epidemiology Etiologies and Risk Factors Sickle Cell Disease Moyamoya Disease and Syndrome Arterial Dissection Congenital and Acquired Heart Disease Focal and “Transient” Cerebral Arteriopathy Vasculitis Hypercoagulable States Metabolic Disorders and Toxins Clinical Manifestations Imaging and Laboratory Evaluation Treatment Supportive Measures Thrombolytic Therapy Antithrombotic Therapy: General Principles Antiplatelet Therapy Anticoagulant Therapy Special Circumstances Moyamoya Syndrome. Rehabilitation Cerebral Venous Sinus Thrombosis Pathophysiology Epidemiology Clinical Manifestations Imaging and Laboratory Evaluation Treatment Prognosis Spontaneous Intracranial Hemorrhage Epidemiology Clinical Manifestations Evaluation Treatment Prognosis Chapter 64 - Acute Neuromuscular Diseases and Disorders Guillain-Barré Syndrome Myasthenia Gravis Congenital and Transient Neonatal Myasthenia Gravis Tick Paralysis Periodic Paralyses Hypokalemic Periodic Paralysis Hyperkalemic Periodic Paralysis Normokalemic Periodic Paralysis Botulism Diphtheria Acute Intermittent Porphyria Spinal Muscular Atrophy Poliomyelitis Polio-like Syndromes Organophosphate and Carbamate Poisoning Rhabdomyolysis Malignant Hyperthermia Neuroleptic Malignant Syndrome Inflammatory Myopathies Dermatomyositis and Polymyositis Benign Acute Childhood Myositis Chapter 65 - Central Nervous System Infections Presenting to the Pediatric Intensive Care Unit Bacterial Meningitis Epidemiology Pathogenesis Clinical Manifestations Diagnosis Treatment Supportive Care Adjunctive Therapy Prevention Outcomes Subdural Empyema Meningoencephalitis Epidemiology Pathophysiology/Pathogenesis of Viral Meningoencephalitis Clinical Evaluation Laboratory Manifestations Neuroimaging Clinical Presentation and Course Treatment Prognosis Acute Disseminated Encephalomyelitis Brain Abscesses Primary and Granulomatous Amoebic Central Nervous System Infections Conclusions Section V: Renal, Endocrine, and Gastrointestinal Systems Chapter 66 - Renal Structure and Function Renal Development Renal Anatomy Renal Vasculature Vascular Development Vascular Anatomy Vascular Function The Nephron Unit Nephron Development Glomerular Anatomy Glomerular Function Tubular Anatomy Proximal Tubule Loop of Henle Distal Nephron Tubular Function Proximal Tubule Loop of Henle Distal Tubule Collecting Duct The Interstitium Development Structure and Function Summary Chapter 67 - Fluid and Electrolyte Issues in Pediatric Critical Illness Fluids Update Albumin Starch Fluid Balance Diabetic Ketoacidosis/Cerebral Edema Sodium Hyponatremia Pathophysiology and Etiology Decreased Total Body Sodium. Increased Total Body Sodium. Congestive Heart Failure Cirrhosis Nephrotic Syndrome Renal Failure Normal Total Body Sodium Signs and Symptoms Treatment Hypernatremia Low Total Body Sodium Level Normal Total Body Sodium Level Increased Total Body Sodium Level Signs and Symptoms Treatment Potassium Hypokalemia Hypokalemia with Potassium Deficit. Renal Losses. Gastrointestinal Losses. Signs and Symptoms Treatment Hyperkalemia Causes of Hyperkalemia Artifactual. Redistribution. Increased Potassium Load. Decreased Excretion. Manifestations of Hyperkalemia Treatment Magnesium Hypomagnesemia Causes of Hypomagnesemia Signs and Symptoms Treatment Hypermagnesemia Causes of Hypermagnesemia Signs and Symptoms Treatment Phosphorus Hypophosphatemia Cause of Severe Hypophosphatemia Signs and Symptoms Treatment Hyperphosphatemia Causes of Hyperphosphatemia Signs and Symptoms Treatment Disorders of Calcium Homeostasis Regulation of Extracellular Calcium Hormonal Regulation of Calcium Hypocalcemia Clinical and Laboratory Diagnosis Treatment Hypercalcemia Clinical and Laboratory Diagnosis Treatment Chapter 68 - Acid-Base Balance and Disorders Understanding Acid-Base Physiology: Traditional and Newer Approaches Acids, Bases, Buffers: The Traditional Understanding Acid Production in the Body The Classic Paradigm: H+ Depends on CO2, H2CO3, and HCO3− Base Excess and Standard Base Excess Bicarbonate Rules Anion Gap and Corrected Anion Gap Water as the Main Source of Hydrogen Ions: The Stewart Approach CO2 and Bicarbonate in Stewart’s Approach The Strong Ion Difference Strong Ion Gap Nonvolatile Weak Acids (Albumin and Phosphate) Merging Traditional and Newer Approaches: Is an Integrated Approach Ready for the Bedside? Corrected Anion Gap New Insights for Old Problems The Clinical Problem: Does Abnormal pH Harm? Blood Gases: Arterial, Central Venous, or Capillary Samples? Metabolic Acidosis Elevated Anion Gap Acidoses Lactic Acidosis Ketoacidosis Toxic Compounds that Directly Provoke Acidosis Other Forms of Metabolic Acidosis Associated with an Increased Anion Gap Hyperchloremic Acidoses: The Non–Anion Gap Metabolic Acidoses Exogenous Chloride Load Postpyloric Gastrointestinal Fluid Losses Renal Tubular Acidoses and Drug-Mediated Tubulopathies Urinary Reconstruction Using Bowel Segments Treating Metabolic Acidosis Sodium Bicarbonate Carbicarb Tris(hydroxymethyl)aminomethane Dichloroacetate Dialysis Management of Metabolic Acidosis Metabolic Alkalosis Treating Metabolic Alkalosis Respiratory Acid-Base Derangements Respiratory Acidosis Treating Respiratory Acidosis Permissive Hypercapnia Respiratory Alkalosis Pseudorespiratory Alkalosis Mixed Acid-Base Derangements Acid-Base Balance in Special Situations Hypothermia Alpha-Stat and pH-Stat Summary Chapter 69 - Tests of Kidney Function in Children Assessment of Glomerular Function and Injury Renal Clearance Techniques Inulin Iothalamate Creatinine Clearance Plasma Disappearance Techniques Radioisotopes Iohexol Plasma Markers Creatinine Cystatin C Estimating Equations Other Novel Biomarkers of Acute Kidney Injury Under Investigation Tubular Function Urine Electrolytes (Sodium and Chloride) Urine Concentration Capacity Serum Blood Urea Nitrogen/Creatinine Ratio Urine Microscopy Proteinuria Renal Acidification Potassium Regulation Generalized Proximal Tubulopathy Chapter 70 - Renal Pharmacology Kidney Function and Drug Disposition Drug Dosing in Kidney Disease Dialysis The Kidney as a Therapeutic Target: Diuretics Diuretic Resistance Prevention/Reversal of Acute Renal Failure Chapter 71 - Glomerulotubular Dysfunction and Acute Kidney Injury Acute Kidney Injury Pathophysiology Physiology of Glomerular Filtration Morphologic Changes in Renal Injury Pathogenesis of Reduced Glomerular Filtration Rate in Acute Kidney Injury Mechanisms of Renal Cell Injury Alterations in Cell Membranes Cellular Calcium Homeostasis Production of Free Radicals Tubular Cell Energy Metabolism Classification of Acute Glomerulotubular Dysfunction Hemodynamically Mediated Acute Kidney Injury Treatment of Acute Kidney Injury Prevention/Attenuation of Acute Renal Failure Dopamine 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 Clinical Signs Complications Therapy Prognosis Acute Glomerulonephritis Acute Postinfectious (Streptococcal) Glomerulonephritis Clinical Signs. Laboratory Findings. Treatment. Prognosis. Systemic Lupus Erythematosus Clinical Signs. T Treatment. Prognosis. Other Glomerulonephritides Nephrotic Syndrome and Acute Kidney Failure Tubulointerstitial Disease Acute Tubulointerstitial Nephritis Cardiorenal Syndrome Basis for Deteriorating Renal Function 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 Sirolimus Nonsteroidal Antiinflammatory Drugs Contrast-Induced Nephropathy Role of Renal Replacement Therapy. Acute Renal Failure After Stem Cell Transplantation Urinary Tract Obstruction Chapter 72 - Pediatric Renal Replacement Therapy in the Intensive Care Unit Renal Failure and Other Indications for Renal Support Acute Kidney Injury Acute Intoxication and Metabolic Disorders Renal Support Conservative Management 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 Dialysis Fluid and Infused Fluids Clearance Disadvantages and Complications Intensive Care Unit Issues Extended Daily Dialysis Outcomes of Renal Replacement in Critically Ill Children Summary Chapter 73 - Hypertension in the Pediatric Intensive Care Unit Definition of Terms Etiology and Evaluation Pathophysiology Endothelial Homeostasis Hemodynamics of the Kidney The Autonomic System: Sympathetic Activation Renin-Angiotensin System Nitric Oxide Hypervolemia Clinical Symptoms Management Strategy Monitoring Pharmacotherapy Sodium Nitroprusside Nitroglycerin Nicardipine Esmolol Labetalol Hydralazine Clonidine Enalaprilat Fenoldopam Isradipine Summary Chapter 74 - Cellular Respiration Metabolism of Respiration Oxygen Chemistry Mitochondria Adenosine Triphosphate Respiration, Metabolic Pathways Glycolysis Krebs Cycle Electron Transport Chain Monitoring of Tissue Oxygenation Blood Lactate Monitoring in Critically Ill Patients Anaerobic Hyperlactatemia Aerobic Hyperlactatemia Continuous Central Venous Oxygen Saturation Monitoring Functional Magnetic Resonance Imaging Magnetic Resonance Spectroscopy Near-Infrared Spectroscopy Optical Spectroscopy Carbomyl Phosphate Synthase—A Marker of Mitochondrial Damage Clinical Correlations in Altered Cellular Respiration Substrate Deficiency (Hypoglycemia) The Four Dysoxias Anemic Dysoxia Hypoxemic Dysoxia Ischemic Dysoxia Cytopathic Dysoxia Drug Effects on Cellular Respiration Cyanide Aspirin 2,4-Dinitrophenol Propofol Sepsis and Dysoxia Hibernation Physiology in Sepsis Chapter 75 - Nutrient Metabolism and Nutrition Therapy During Critical Illness Malnutrition in the Critically Ill Pediatric Patient Assessment of Nutritional Status Body Composition Biochemical Assessment Nutritional Requirements During Critical Illness Metabolic Consequences of the Stress Response Underfeeding and Overfeeding in the Pediatric Intensive Care Unit Assessing Energy Expenditure in Critically Ill Patients Indirect Calorimetry Protein Requirements Lipid Requirements Micronutrient Requirements Enteral Nutrition in Critically Ill Children Immune-Enhancing Diets for the Critically Ill Child Parenteral Nutrition Carbohydrates Amino Acids Lipids Electrolytes/Minerals and Trace Elements Biochemical Monitoring Refeeding Syndrome Nutritional Support of Obese Critically Ill Children Guidelines for Pediatric Critical Care Nutrition Conclusions Chapter 76 - Inborn Errors of Metabolism 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 Group 3 Inborn Errors of Metabolism Summary Metabolic Acidosis Hypoglycemia Cardiomyopathy and Inborn Errors of Metabolism Metabolic Myopathies and Rhabdomyolysis Neonatal Screening for Inborn Errors of Metabolism Conclusion Chapter 77 - Common Endocrinopathies in the Pediatric Intensive Care Unit Functional Elements of the Stress Response Hypothalamic-Pituitary-Adrenal Axis Cortisol Biochemistry Actions of Cortisol Inflammation Hemodynamics Metabolism Assessing Adequacy of the Cortisol Stress Response Free Cortisol Adrenal Insufficiency in the Intensive Care Unit Primary Adrenal Insufficiency Secondary Adrenal Insufficiency Cortisol Replacement Studies Adult Investigations Pediatric Investigations Current Guidelines for Corticosteroid Prescription in the Pediatric Intensive Care Unit Septic Shock Bronchopulmonary Dysplasia Neonatal Hypotension Acute Lung Injury/Acute Respiratory Distress Syndrome Postextubation Stridor Corticosteroid Adverse Effects Alterations of Glucose Homeostasis Normal Glycemic Regulation Glucose Uptake and Metabolism Hyperglycemia Etiology of Critical Illness Hyperglycemia Hyperglycemia and Outcomes Hyperglycemia Pathogenesis Management of Critical Illness Hyperglycemia Clinical Trials The Ideal Glycemic Target Summary Hypoglycemia Definition Pathogenesis Clinical Manifestations Fasting Adaptation Diagnostic Approach Defects of Gluconeogenesis Defective Glycogen Storage and Mobilization Ketotic Hypoglycemia Hormonal Deficiencies Fatty Acid Oxidation Disorders Hyperinsulinism Hypoglycemia and Critical Illness Hypoglycemia Treatment Summary Alterations of Thyroid Hormone in Critical Illness Classic Thyroid Endocrinology Thyroid Hormone Biochemistry Thyroid Hormone Actions Hyperthyroidism Hypothyroidism Sick Euthyroid Syndrome in Critical Illness Thyroid Hormone Supplementation in the Pediatric Intensive Care Unit Chapter 78 - Diabetic Ketoacidosis 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 Fluids Insulin Electrolytes Correction of Acidosis Monitoring Diabetic Ketoacidosis–Associated Complications Cerebral Edema Neuropsychologic Sequelae Thrombotic Complications Other Complications Hyperglycemic Hyperosmolar Syndrome Health Care Costs Associated with Diabetic Ketoacidosis Chapter 79 - Structure and Function of Hematopoietic Organs Structure and Function of the Bone Marrow Hematopoiesis Erythropoiesis Granulopoiesis Megakaryocyte and Platelet Production Lymphopoiesis The Spleen Lymph Nodes Chapter 80 - Thrombosis in Pediatric Intensive Care 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 Conclusions Chapter 81 - Hematology and Oncology Problems in the Intensive Care Unit Hematologic Emergencies Anemia Hemorrhagic Anemia Anemia Secondary to Bone Marrow Failure Hemolytic Anemia Thrombocytopenia Immune Thrombocytopenia Nonimmune Thrombocytopenia Bleeding in Uremia Oncologic Emergencies Tumor Lysis Syndrome Pathophysiology Therapy Hyperleukocytosis Spinal Cord Compression Acute Airway Compromise in Anterior Mediastinal Tumors Superior Vena Cava Syndrome Septic Shock in Pediatric Oncologic Patients Hemophagocytic Lymphohistiocytosis Anthracycline-Induced Cardiogenic Shock Chapter 82 - Transfusion Medicine Red Blood Cells Red Blood Cell Transfusion: Why and Why Not Anemia and O2 Delivery Adaptive Mechanisms to Anemia O2 Kinetics in the Critically Ill Regulation by Red Blood Cells of DO2 to Tissue Transfusion of Red Blood Cells: Indications (When) Evidence-Based Medicine: Clinical Studies Red Blood Cell Transfusion: Current Recommendations Prevention of Red Blood Cell Transfusion Types of Packed Red Blood Cell Units Standard Packed RBC Units Other Types of Packed Red Blood Cell Units Leukocyte-Reduced Packed Red Blood Cell Units. Washed Packed Red Blood Cell Units. Irradiated Packed Red Blood Cell Units. Cytomegalovirus-Negative Packed Red Blood Cell Units. Directed Packed Red Blood Cell Units. Autologous Packed Red Blood Cell Units. RBC substitutes and other alternatives to RBC transfusion Transfusion of Packed Red Blood Cells: How Blood Types Volume and Number of Units Length of Storage Perfusion, Warming, and Filtration Monitoring and Reporting Adverse Events Plasma Transfusion of Plasma: Indication (When) Transfusion of Plasma: How Platelets Standard Platelet Concentrates Special Platelet Concentrates Leukocyte-Reduced Platelets Irradiated Platelets Cytomegalovirus-Negative Platelets Platelets Substitutes Transfusion of Platelets: Indication (When) Transfusion of Platelets: How Cryoprecipitate Transfusion Reactions and Complications Red Blood Cells, Plasma, and Platelets Immediate Transfusion Reactions Respiratory System Cardiovascular System Other Acute Transfusion Reactions Delayed Transfusion Reactions Complications Related to Massive Red Blood Cell Transfusion Transfusion Transmitted Infections Transfusion-Related Immunomodulation Complications Specific to Plasma Transfusion Complications Specific to Platelet Transfusion Treatment of Transfusion Reactions Conclusion Chapter 83 - Critical Illness Involving Children Undergoing Hematopoietic Progenitor Cell Transplantation 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 Engraftment Syndrome Diffuse Alveolar Hemorrhage Idiopathic Pneumonia Syndrome Etiology of Idiopathic Pneumonia Syndrome. Treatment of Idiopathic Pneumonia Syndrome. Late Pulmonary Complications Bronchiolitis Obliterans/Bronchiolitis Obliterans Organizing Pneumonia Pulmonary Veno-occlusive Disease Dilemmas in the Diagnosis of Pulmonary Complications Hepatic Complications Myelosuppression and Hematologic Complications Myelosuppression and Immune Dysregulation Infectious Complications Graft Rejection Hematologic Complications Iron Overload Graft-Versus-Host Disease Neurologic Complications Late Effects Nutritional Support in the Critically Ill Hematopoietic Progenitor Cell Transplantation Patient Chapter 84 - Hemoglobinopathies Perspective The Globin Gene Loci Sickle Cell Disease Molecular Description and Epidemiology Sickle Cell Trait Spectrum of Sickle Cell Disease Genotypes Natural History Laboratory and Diagnostics Pathophysiology Hemoglobin Polymerization Red Cells, Inflammation, and the Endothelium Hemolysis and Nitric Oxide Homeostasis Clinical Manifestations Pain Pathophysiology, Diagnosis, and Presentation. Management. Sepsis Pathophysiology and Etiology. Management Acute Chest Syndrome Presentation. Management Stroke Natural History. Diagnosis. S Management. Aplastic Crisis Splenic Sequestration Pulmonary Hypertension Pathophysiology and Etiology. Diagnosis. Management Multiorgan Failure Priapism Skin Ulcers Cholelithiasis Renal Conditions Ocular Conditions Avascular Necrosis Iron Overload Sleep Conditions Depression and Suicide Surgery and Anesthesia Therapies and Interventions Hydroxyurea Transfusion Choice of Product. Type and Goals of Transfusion. Indications Hematopoietic Stem Cell Transplantation Gene Therapy Nitric Oxide Induction of β-like Chains Antioxidants Endothelial Protectants Thalassemia Molecular Description and Epidemiology Laboratory and Diagnostics Pathophysiology Forms and Variations α-Thalassemia β-Thalassemia HbE/β0-Thalassemia Combined Mutations Natural History Assessment of Iron Overload Spectrum of Disease Anemia Transfusion-Related Complications Cardiac Failure Assessments Management Hepatic Dysfunction Endocrine Abnormalities Growth, Osteoporosis, Osteopenia, and Fractures Thrombosis and Pulmonary Emboli Pulmonary Hypertension Therapies and Interventions Hematopoietic Stem Cell Transplantation Gene Therapy Inducers of Other β-like Genes Acknowledgment Chapter 85 - Gastrointestinal Structure and Function Intestinal Structure, Digestion, and Absorption of Nutrients, Water, and Electrolytes Water and Solute Transport Across the Intestinal Epithelium Digestion of Carbohydrates Digestion of Proteins Digestion of Lipids Digestion of Fat Intestinal Lymphatics Regulation of Electrolyte and Water Movement Electrolyte Transport Zinc Hydrogen Ions Pancreas Pancreatic Exocrine Secretory Function Hepatobiliary System Examination Anatomy: Microanatomy, Structure, and Function Portal Circulation Hepatic Function Enterohepatic Circulation Host-Defense Mechanisms of the Gut: Immunology and Microbiology Gastrointestinal and Hepatobiliary Testing in the Intensive Care Unit Chapter 86 - Disorders and Diseases of the Gastrointestinal Tract and Liver 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 The Intensive Care Unit as a Satellite Laboratory Facility Breath Hydrogen Testing Life-Threatening Complications of Gastrointestinal Disorders 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 Hirschsprung Disease Acute Colonic Pseudo-obstruction Abdominal Compartment Syndrome Acute Pancreatitis Acute and Chronic Liver Failure Chapter 87 - Gastrointestinal Pharmacology Nausea and Vomiting Introduction and Definitions Pathophysiology Chemotherapy-Induced Nausea and Vomiting: Types of Emesis Treatment Guidelines Postoperative Nausea and Vomiting Diarrhea Introduction and Definition Treatment Constipation Introduction and Definition Treatment Gastroesophageal Reflux Disease Histamine-2 Receptor Antagonists Proton Pump Inhibitors Antacids Surface Agents Prokinetic Therapy Gastroesophageal Reflux Disease and Acute Life-Threatening Event Stress-Induced Mucosal Damage: Ulcer Prophylaxis Gastrointestinal Hemorrhage Proton Pump Inhibitors Octreotide and Somatostatin Vasopressin Helicobacter Pylori Infection Drug-Induced Liver Injury Cause Treatment Cerebral Edema and Hepatic Encephalopathy Ascites Coagulopathy and Hemorrhagic Complications Pruritus Cholangitis Miscellaneous Dose Adjustments for Hepatic Dysfunction Rectal Administration of Medication Chapter 88 - Acute Liver Failure, Liver Transplantation, and Extracorporeal Liver Support Definition Epidemiology Clinical Presentation by Etiology Family Support Management Initial Assessment and Care Fluid Balance Nonspecific Adjunctive Therapy Antibiotic Therapy Nutritional Support Central Nervous System Monitoring Prevention and Management of Complications Hypoglycemia Coagulopathy and Hemorrhage Prevention of Gastrointestinal Hemorrhage Encephalopathy Management of Hepatic Encephalopathy Cerebral Edema Renal Dysfunction Ascites Secondary Bacterial and Fungal Infections Hemofiltration for Hepatic Support Extracorporeal Hepatic Support Liver Transplantation Technical Aspects of Liver Transplantation Immune Suppression Postoperative Management Issues of Concern to the Intensivist Primary Nonfunction Bleeding Monitoring Vascular Anastomotic Patency Infection Biliary Complications Rejection Complications of Immune Suppressive Medications Chapter 89 - Acute Abdomen Anatomic and Physiologic Considerations The Peritoneum Visceral Blood Flow Physical Exam of the Abdomen Laboratory Tests Imaging Options Ultrasonography Abdominal Plain Radiographs Computed Tomography Magnetic Resonance Imaging Abdominal Conditions Requiring Intensive Care Unit Care Perforated Viscera Ischemia Neutropenic Enterocolitis Pancreatitis Hemorrhage Other Specific Conditions Cholecystitis Abdominal Compartment Syndrome The Intestine as a Source of Sepsis Surgical Intervention Section VI: Immunity and Infection Chapter 90 - The Innate Immune System Components of the Innate Immune System Circulating Pattern Recognition Receptors: Complement, Lectins, and Defensins Neutrophils Cellular Pattern Recognition Receptors Signaling Crosstalk Hypoxic-ischemic injury Complex System Predisposition to an (in)Appropriate Response Cytokines Therapeutic Interventions Chapter 91 - Infection and Host Response Historical Perspectives Innate Immune Versus Adaptive Immune Response Pattern Recognition Receptors Toll-Like Receptors Endogenous Antimicrobials Soluble Components of Immunity C-Reactive Protein Complement System Immunoglobulin Contact Activation System Lipid-Derived Mediators of Inflammation Cytokines Interleukin-1 and Tumor Necrosis Factor Interferons and Other Soluble Products Cellular Components of Immunity Platelets Leukocyte Localization Host Response to Infection: A Summary Chapter 92 - Congenital Immunodeficiencies The Immune System and the Classification of the Primary Immunodeficiency Diseases Laboratory Diagnosis of Congenital Immunodeficiencies Clinical Presentations of Congenital Immunodeficiency Syndromes Combined T- and B-Lymphocyte Defects Severe Combined Immunodeficiency Clinical Presentations and Laboratory Findings in SCID. Therapy for Patients with Clinical Suspicion or Diagnosis of SCID. Other Combined Immunodeficiency Disorders Hyper Immunoglobulin M Syndrome Clinical and Laboratory Presentation of X-Linked Hyper Immunoglobulin M. Antibody Deficiency Syndromes Clinical Presentations and Laboratory Findings in Antibody Defects. Congenital Defects of Phagocytes Chronic Granulomatous Disease Complement Deficiencies Other Well-Defined Immunodeficiency Syndromes Wiskott-Aldrich Syndrome Clinical and Laboratory Presentation of Wiskott-Aldrich Syndrome. DiGeorge Syndrome Clinical and Laboratory Presentation of DiGeorge Syndrome. DNA Repair Defects with Immunodeficiency Hyper Immunoglobulin E Syndrome Diseases of Immune Dysregulation Familial Hemophagocytic Lymphohistiocytosis. Summary Chapter 93 - Acquired Immune Dysfunction Immune Function and Critical Illness Malnutrition and Immune Deficiency Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome Epidemiology Antiretroviral Therapy Pulmonary Complications and Respiratory Failure Pneumocystis Jirovecii Pneumonia Cytomegalovirus Pneumonitis Other Viral Pathogens Mycobacterial Pathogens Fungal Infections Lymphoid Interstitial Pneumonitis Upper Airway Obstruction Cardiovascular Complications Septic Shock Vasculitis Myocardial Dysfunction Dysrhythmias Pericardial Disease Renal Failure Abdominal Complications The Acute Abdomen Pancreatitis Hepatobiliary Failure Hematologic Complications Malignancies Neurologic Complications Human Immunodeficiency Virus Encephalopathy Cerebrovascular Disease Central Nervous System Malignancy Infections of the Central Nervous System Ethical Issues Occupational Human Immunodeficiency Virus Exposure Summary Chapter 94 - Bacterial Infection, Antimicrobial Use, and Antibiotic-Resistant Organisms in the Pediatric Intensive Care Unit Antibiotic Classes β-Lactam Antibiotics Penicillins β-Lactam Antimicrobial plus β-Lactamase Inhibitor Combination Cephalosporins Carbapenems Monobactams Aminoglycosides Glycopeptides Macrolides Fluoroquinolones Miscellaneous Clindamycin Linezolid Metronidazole Colistin Tigecycline Daptomycin Antibiotic Resistance Antibiotic Resistance Mechanisms Antibiotic Resistance and Infections in the Pediatric Intensive Care Unit An Approach to Therapy in the Pediatric Intensive Care Unit General Considerations for Antibiotic Therapy Antibiotic Therapy for Specific Pathogens Antimicrobial Stewardship Summary Chapter 95 - Life-Threatening Viral Diseases and Their Treatment Myocarditis Background Pathogenesis Cause Clinical Presentation Acute Liver Failure Background Cause Clinical Presentation Viral Pneumonia/Pneumonitis Background Cause Clinical Presentation Central Nervous System Infections Background Cause Clinical Presentation Exotic Viral Diseases Diagnosing Viral Disease Myocarditis Acute Liver Failure Pneumonia/Pneumonitis Meningitis/Encephalitis Treatment for Viral Infections Myocarditis Acute Liver Failure Pneumonitis Encephalitis Chapter 96 - Infectious Syndromes in the Pediatric Intensive Care Unit Meningococcus Etiology and Epidemiology Clinical Presentation Diagnosis Management Conventional Therapy Novel Therapy Prevention and Vaccines Prognosis Staphylococcus Toxic Shock Syndrome Etiology and Epidemiology Clinical Presentation Diagnosis Management Prognosis Invasive Group A β-Hemolytic Streptococcus Etiology and Epidemiology Clinical Presentation Diagnosis Management Prognosis Invasive Pneumococcus Etiology and Epidemiology Clinical Presentation Diagnosis Management Prevention and Vaccination Prognosis Lyme Disease Etiology and Epidemiology Clinical Presentation Diagnosis Management Prognosis Rocky Mountain Spotted Fever Etiology and Epidemiology Clinical Presentation Diagnosis Management Prognosis Hantavirus Etiology and Epidemiology Clinical Presentation Diagnosis Management Prognosis Chapter 97 - Health Care–Associated Infection in the Pediatric Intensive Care Unit: Epidemiology and Control—Keeping Patients Safe Burden of Illness and Scope of the Problem Epidemiologic Principles of Infection Prevention and Control Chain of Infection Routes of Infectious Disease Transmission Infection Prevention and Control Measures The Infection Prevention and Control team Isolation Practices: Standard Precautions and Additional (Transmission-Based) Precautions Hand Hygiene Personal Protective Equipment Surveillance Screening Patient Screening Visitor Screening Occupational Health Selected Topics in Policy, Procedure, and Program Development to Prevent Health Care–Associated Infection Intervention Bundles Antibiotic Stewardship Antibiotic Prophylaxis Antibiotic Cycling Antibiotic Gastric Decontamination Specific Infection Syndromes in the Pediatric Intensive Care Unit Bloodstream Infections Epidemiology Prevention Management Respiratory Infections and Ventilator-Associated Pneumonia Respiratory Infections Epidemiology Prevention Ventilator-Associated Pneumonia. Management Ventilator-Associated Pneumonia. Sinusitis Epidemiology Prevention Management Urinary Tract Infections Epidemiology Prevention Management Skin and Surgical Site Infections Epidemiology Prevention Surgical Site Infection Bundle Management Ventriculostomy-Related Infections Hospital-Associated Diarrhea Chapter 98 - Autoimmune Diseases: Diagnosis, Treatment, and Life-Threatening Complications Rheumatologic Diseases: Clinical Presentation, Diagnosis, and Treatment Juvenile Idiopathic Arthritis Clinical Presentation Laboratory Studies Complications Management Systemic Lupus Erythematosus Clinical Presentation Central Nervous System Disease. Pulmonary Involvement. Gastrointestinal Involvement. Cardiovascular Disease. Renal Involvement. Hematologic Involvement. Musculoskeletal Manifestations. Endocrine Issues. Immune Dysfunction. Laboratory Studies. Management Neonatal Lupus Syndromes Juvenile Dermatomyositis Laboratory Studies. Management. Mixed Connective Tissue Disease (Overlap Syndrome) Antiphospholipid Antibody Syndrome Laboratory Studies Management Vasculitic Syndromes Small Vessel Vasculitis Syndromes Laboratory Studies. Management Wegener Granulomatosis Laboratory Studies Management. Microscopic Polyangiitis Laboratory Studies. Management. Medium Vessel Vasculitis Diagnosis. Management. Large Vessel Vasculitis Diagnosis. Management. Primary Vasculitis of the Central Nervous System Diagnosis. Management. Kawasaki Disease Clinical Presentation Laboratory Studies Management Scleroderma (Systemic Sclerosis) Clinical Presentation Critical Rheumatic Disease– Related Events in the Intensive Care Unit Infections Severe Infections Endocrine Involvement Adrenal Insufficiency Airway Compromise Pulmonary Involvement Pneumonitis Pleuritis and Pleural Effusions Pulmonary Hemorrhage Pulmonary Embolism Cardiovascular Events Pericarditis and Pericardial Tamponade Myocarditis Valvular Disease Arrhythmias Acute Coronary Syndromes Gastrointestinal Involvement Gastrointestinal Hemorrhage Acute Surgical Abdomen: Peritonitis and Intestinal Perforation Pancreatitis Renal Involvement Renal Failure and Malignant Hypertension Central Nervous System Involvement Hematologic and Immunologic Involvement Thrombotic Thrombocytopenic Purpura Macrophage Activation Syndrome Complications of the Treatment of Rheumatologic Diseases Summary Chapter 99 - Genomic and Proteomic Medicine in Critical Care Genomics From the Discovery of the Double Helix to the Human Genome Project Gene Expression and Microarrays Gene Expression Microarrays Quantifying Gene Expression Genes and Human Variation Single-Nucleotide Polymorphisms Copy-Number Variations Genotyping and Microarrays Proteomics Metabolomics Systems Biology Clinical Applications Cancer Pharmacology Drug Discovery Biomarkers Critical Care Gene Expression Microarrays Genetic Variation Ethical Issues Chapter 100 - Molecular Foundations of Cellular Injury: Necrosis, Apoptosis, and Autophagy Cell Death Pathways of Apoptosis and Autophagy Human Studies Sepsis Noninfectious Inflammation Animal Studies Sepsis Noninfectious Inflammation Chapter 101 - Endotheliopathy 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 Conclusions Chapter 102 - Neuroendocrine–Immune Mediator Coordination and Disarray in Critical Illness Organization of the Stress Response Central Stress Response Immune Response to Microscopic Threats Acute Versus Chronic Stress Neuroendocrine–Immune Dysfunction Causing Critical Illness Hypothalamic-Pituitary-Adrenal Axis Vasopressin Intensive Care Unit Therapies That Interfere with the Neuroendocrine–Immune System Catecholamines and Autonomic Control of Inflammation Growth and Lactogenic Hormone Family Prolactin Growth Hormone and Insulin-like Growth Factor Morphine and Other Opioids Somatostatin Other Neuroendocrine–Immune Mediators Macrophage Migration Inhibitory Factor Substance P, Neuropeptide Y, and Calcitonin Gene-Related Peptide Clinical Relevance Chapter 103 - Sepsis Epidemiology Definitions Clinical Presentation Pathogenesis Pathogen Recognition and Signal Transduction Cytokines as Principal Mediators of the Sepsis Response Tumor Necrosis Factor-α Interleukin-1β Interleukin-6 Interleukin-8 Macrophage Migration Inhibitory Factor Interleukin-18 Interleukin-10 High-Mobility Group Box 1 Adhesion Molecules Nitric Oxide The Coagulation Cascade The Peroxisome Proliferator-Activated Receptor-γ Pathway The 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 Immune Modulation The Case for More Effective Stratification in Pediatric Septic Shock Concluding Perspectives Chapter 104 - Inflammation and Immunity: Systemic Inflammatory Response Syndrome, Sepsis, Acute Lung Injury, and Multiple Organ Failure The Inflammation/Coagulation/Immune Dysfunction/Dysregulated Metabolism Hypothesis Definitions and Scoring Outcomes Multiple Organ Failure/Dysfunction Phenotypes, Respective Biomarkers, and Therapies Thrombocytopenia-Associated Multiple Organ Failure Immune Paralysis and Lymphoid Depletion Syndrome Viral/Lymphoproliferative Disease–Associated Sequential or Liver-Associated Multiple Organ Failure Syndrome Secondary Hemochromatosis-Associated Cardiac Hepatopancreatic Multiple Organ Failure Hyperleukocytosis-Associated Multiple Organ Failure Therapeutic Approaches to Systemic Inflammatory Response Syndrome, Sepsis, Acute Lung Injury, and Multiple Organ Failue Time Course of Systemic Inflammatory Response Syndrome, Sepsis, and Multiple Organ Dysfunction Summary Section VII: Environmental Hazards, Trauma, Pharmacology, and Anesthesia Chapter 105 - Principles of Toxin Assessment and Screening Common Agents Involved 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 Additional Readings Chapter 106 - Toxidromes and Their Treatment Opiates Sympathomimetic Agents Anticholinergic Agents Cholinergic Agents Methemoglobinemia Hyperthermia Malignant Hyperthermia Serotonin Syndrome Neuroleptic Malignant Syndrome Metabolic Acidosis with Increased Anion Gap Methanol and Ethylene Glycol Carbon Monoxide Cyanide Iron Isoniazid Salicylates Bradycardia, Hypotension, and Cardiac Conduction Abnormality Calcium Channel Antagonists β-Adrenergic Antagonists Digoxin Acetaminophen (Paracetamol) Tricyclic Antidepressants Chapter 107 - Bites and Stings Snakebites Epidemiology Pathophysiology Clinical Presentation Diagnostic Studies Pitfalls Prehospital Care Emergency and Critical Care Therapeutic Complications Resources Disposition Prognosis Future Directions Widow Spider Bites Epidemiology Pathophysiology Clinical Presentation Diagnostic Studies Pitfalls Emergency and Critical Care Therapeutic Complications Resources Disposition Prognosis Prevention Future Directions Hymenoptera Stings (Bees, Wasps, and Ants) Chapter 108 - Heat Injury Definitions Epidemiology Pathophysiology and Pathogenesis of Heat-Related Illnesses Acclimatization Acute Phase Response Systemic Clinical Features Central Nervous System Pulmonary Cardiovascular Renal Gastroenterologic Metabolic Hematologic Infectious Treatment Chapter 109 - Accidental Hypothermia Pathophysiology Central Nervous System Cardiovascular System Respiratory System Renal System Coagulation Treatment Outcome Chapter 110 - Drowning Definitions Epidemiology Pathophysiologic Considerations Type of Aspirated Fluid Pulmonary Effects Cardiovascular Effects Central Nervous System Effects Effects on Other Organ Systems Submersion Hypothermia Mammalian Diving Reflex Preexisting Associated Conditions Management Management at the Scene Emergency Department Evaluation and Stabilization Management in the Intensive Care Unit Prognosis Chapter 111 - Burn and Inhalation Injuries Types of Burn Injuries Scald Burns Thermal Burns Electrical Burns Chemical Burns Depth and Extent of the Burn Injury Normal Anatomy Superficial Burns Superficial Partial-Thickness Burns Deep Partial-Thickness Burns Full-Thickness Burns Zones of Injury Estimating the Extent of the Burn Early Management of Burn Injuries Transfer to Burn Centers Burn Resuscitation Colloid Resuscitation Complications of Resuscitation Inhalational Injury Pathophysiology of Inhalation Injury Diagnosis of Inhalation Injury Management of Inhalation Injury Nutritional Support in Burn Patients Calculating Nutritional Requirements Monitoring Nutritional Status Enteral Support Parenteral Support Vitamin and Anabolic Steroid Supplementation Wound Care Chapter 112 - Evaluation, Stabilization, and Initial Management After Multiple Trauma Prehospital Care and Trauma Team Activation Trauma Resuscitation The Primary Survey Overview Establish an Airway with Cervical Spine Stabilization (A) Breathing (B) Circulation (C) Disability (D) Exposure (E) The Secondary Survey Diagnostic Assessment Laboratory Studies Radiographic Imaging Emergency Department Thoracotomy Stabilization and Definitive Care Conclusions Chapter 113 - Child Abuse and Neglect Recognition of Child Abuse History of Injury Patterns of Injury Bruising Burns Fractures Skeletal Survey Abusive Head Trauma Characteristics of the Infant Brain and Cervical Spine Mechanisms of Head Injury Neuroimaging of Abusive Head Trauma Retinal Hemorrhages Shaken Baby Syndrome Inflicted Abdominal and Thoracic Trauma Abdominal Trauma Thoracic Trauma Sexual Abuse Protocol for the Medical Investigation of Child Abuse Fatal Child Abuse Osseous Injury in Fatal Child Abuse Scene Investigation in Fatal Child Abuse Autopsy Organ Procurement Organization and Fatal Child Abuse Documentation and Testifying in Court Chapter 114 - Thoracic Injuries in Children Epidemiology Anatomic and Physiologic Considerations with Chest Injuries Diagnosis and Immediate Management of Chest Injuries Rib Fractures Clavicle, Sternal, and Scapular Fractures Pulmonary Contusion Traumatic Asphyxia Pneumothorax/Hemothorax Tracheobronchial Injuries Cardiac Injuries Commotio Cordis Aortic and Great Vessel Injuries Other Miscellaneous Injuries Penetrating Trauma Functional Outcome Summary Chapter 115 - Abdominal Trauma in Pediatric Critical Care 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 Chapter 116 - Principles of Drug Disposition in the Critically Ill Child Drug Disposition in Infants and Children Determinants of Effective Therapy Pharmacokinetics Pharmacokinetics Drug Absorption Intramuscular Administration. Subcutaneous Absorption. Percutaneous Absorption. Rectal Absorption. Drug Distribution Developmental Aspects of Protein Binding. Developmental Aspects of Fluid Compartment Sizes. Developmental Aspects of Body Composition Critical Illness and Drug Distribution. Drug Clearance Biotransformation: Phase I Reactions CYP1A2 CYP2C9 CYP2D6 CYP3A4. Biotransformation (Phase II Reactions). Additional Factors Affecting Hepatic Biotransformation. Drug Elimination Renal Excretion Drug Delivery Systems Effect of Extracorporeal Therapies on Drug Disposition. Pharmacodynamics Effect of Disease on Drug Action Pharmacokinetic Principles Evaluation of the Plasma Concentration-Time Curve Applied Pharmacokinetics Bioavailability Half-Life Apparent Volume of Distribution Total Body Clearance Critical Care Therapeutics Target Concentration Strategy Target Effect Strategy Chapter 117 - Molecular Mechanisms of Drug Actions: From Receptors to Effectors Targets For Drug Action Receptors Ion Channels Enzymes Carrier Proteins Receptor Type and Regulation Classification of Receptors 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 and Drug Targets and Signaling Mechanisms Drug Response and Development Drug Response and Disease Conclusion Chapter 118 - Adverse Drug Reactions and Drug-drug Interactions Defining Adverse Drug Reactions Adverse Drug Reactions by Organ System Renal Hepatic Cardiovascular Central Nervous System Hematologic Respiratory Endocrine and Metabolic Dermatologic Drug-drug Interactions Pharmacokinetic Drug-drug Interactions Interactions Affecting Drug Absorption (Enteral Absorption) Interactions Affecting Drug Absorption (Alternative Sites of Absorption) Interactions Affecting Drug Distribution (Protein or Tissue Binding) Alterations in Total Body Water Interactions Affecting Drug Metabolism Interactions Affecting Drug Excretion Interactions Affecting P-Glycoprotein Receptors Pharmacodynamic Drug-drug Interactions Drug-drug Interactions in Intravenous Admixtures Drug-Drug Interactions by Therapeutic Class Cardiovascular Agents Anticonvulsant Medications Antiinfective and Antimicrobial Agents Anesthetic Agents and Sedatives Analgesic Agents Anticoagulants Immunosuppressive Agents Pulmonary and Respiratory Medications Antineoplastic Agents Chapter 119 - Airway Management Anatomic Considerations Basic Airway Management Nasopharyngeal Airway Oropharyngeal Airways Oxygen Delivery Devices Nasal Cannulas Oxygen Hoods Masks Noninvasive Positive Pressure Ventilation Establishing a Functional Airway Endotracheal Intubation Indications Respiratory Failure Hemodynamic Instability Neuromuscular Dysfunction Failure of Central Nervous System Regulation of Ventilatory Drive Other Indications Physiologic Effects of Intubation Recognition of a Difficult Airway Process of Intubation Pharmacologic Agents Facilitating Intubation Anticholinergic Agents Sedative and Analgesic Agents Neuromuscular Blocking Agents Orotracheal Intubation Nasotracheal Intubation Videolaryngoscopy Flexible Fiberoptic Bronchoscopy Extubation Complications of Endotracheal Intubation Prolonged Intubation Special Circumstances Full Stomach Increased Intracranial Pressure and Neurologic Dysfunction Cervical Spine Instability Upper Airway Obstruction Facial and Laryngotracheal Injury Open Globe Injury Alternative Approaches to the Airway Lighted Intubation Stylet (Light Wand)–Assisted Intubation Laryngeal Mask Airway Tracheostomy Cricothyrotomy and Retrograde Intubation Chapter 120 - Organ System Considerations that Affect Anesthetic Management Cardiovascular Performance Changes with Development Effects of Disease Effects of Anesthetic Agents Anemia and Transfusion Respiratory Failure Neurologic Injury Intracranial Pressure Regulation of Cerebral Blood Flow Effects of Anesthetics on Cerebral Blood Flow Hepatic Dysfunction Effects of Anesthetics on Hepatic Blood Flow Effects of Liver Disease on Pharmacokinetics The Role of the Liver in Coagulation Renal Failure Fluid and Electrolyte Disturbances Renal Drug Metabolism Intravenous Alimentation Chapter 121 - Anesthesia Principles and Operating Room Anesthesia Regimens Preoperative Evaluation NPO Guidelines Preoperative Medication Monitoring The Pharmacology of Anesthetic Agents Local Anesthetic Agents Intravenous Anesthetic Agents Opioids Inhalational Anesthetic Agents Neuromuscular Blocking Agents Intraoperative Anesthetic Care Maintenance Anesthesia Intraoperative Fluid Management Postoperative Care Postoperative Analgesia Conclusions Chapter 122 - Neuromuscular Blocking Agents The Neuromuscular Junction Neuromuscular Blocking Agents: Depolarizing Agents Neuromuscular Blocking Agents: Nondepolarizing Agents Pancuronium Vecuronium Rocuronium Pipecuronium Rapacuronium Mivacurium Atracurium Cis-atracurium Doxacurium Reversal of Neuromuscular Blockade Monitoring Neuromuscular Blockade Adverse Effects of Neuromuscular Blockade Summary: Neuromuscular Blocking Agents in the PICU Chapter 123 - Sedation and Analgesia Opioids and Analgesia in the Pediatric Intensive Care Unit Specific Opioid Agonists Morphine Meperidine Fentanyl Sufentanil Alfentanil Codeine Remifentanil 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 and Dependence to the Benzodiazepines Flumazenil Chloral Hydrate Other Agents for Sedation in the PICU Patient Butyrophenones and Phenothiazines Haloperidol Droperidol Chlorpromazine The Lytic Cocktail Neuroleptic Malignant Syndrome Baclofen Dexmedetomidine Propofol Special Issue Regarding Long-Term Infusion of Propofol Propofol Infusion Syndrome Sedation and Analgesia for Procedures Types of Procedures and Preprocedure Evaluation Monitoring During the Procedure Postprocedure Care and Monitoring Sedation for Magnetic Resonance Imaging Specific Drugs for Sedation Ketamine Etomidate Inhalational Anesthetic Agents Apoptosis Pharmacoeconomics Chapter 124 - Malignant Hyperthermia Pathophysiology Genetics Clinical Recognition of a Malignant Hyperthermia Episode in Humans Potential Systemic Complications Hyperthermia in the Pediatric Intensive Care Unit Postoperative Fever Abortive Malignant Hyperthermia Episodes and Isolated Masseter Spasm Rhabdomyolysis Treatment of an Episode of Malignant Hyperthermia Remove Trigger Agents Administer Dantrolene Symptomatic Treatment Urine and Blood Tests in Malignant Hyperthermia The Course of a Clinical Episode of Malignant Hyperthermia Recrudescence Factors that “Trigger” Malignant Hyperthermia Muscular Diseases Associated with Malignant Hyperthermia Evaluation of Patients at Risk Asymptomatic Elevation of Creatine Kinase Values The “Safe” Anesthesia Testing for Malignant Hyperthermia Susceptibility In Vitro Caffeine-Halothane Contracture Testing Less Invasive Tests of Malignant Hyperthermia Susceptibility Neuroleptic Malignant Syndrome and Serotonin Syndrome The Malignant Hyperthermia Assocation Index A B C D E F G H I J K L M N O P Q R S T U V W X Z
