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Book Details
Abstract
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.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Pediatric Critical Care | iii | ||
| Copyright | iv | ||
| Contributors | v | ||
| Preface | xxiii | ||
| Contents | xxv | ||
| Section 1 - Pediatric Critical Care: The Discipline | 1 | ||
| Chapter 1 - History of Pediatric Critical Care | 3 | ||
| Definitions | 4 | ||
| History of Critical Care | 4 | ||
| History of Pediatric Critical Care | 6 | ||
| Pediatric Critical Care | 10 | ||
| Acknowledgments | 18 | ||
| Chapter 2 - The Intensivist in the New Hospital Environment: Patient Care and Stewardship of Hospital Resources | 20 | ||
| Organization and Quality Issues | 20 | ||
| Manpower Issues | 21 | ||
| Summary | 22 | ||
| Chapter 3 - The Nurse in Pediatric Critical Care | 23 | ||
| Describing What Nurses Do: The Synergy Model | 23 | ||
| Leadership | 27 | ||
| Summary | 29 | ||
| Chapter 4 - Research in Pediatric Critical Care | 31 | ||
| Research Areas | 31 | ||
| Wellsprings of Research | 32 | ||
| Doing Research | 34 | ||
| Medical Research | 37 | ||
| Statistics: A Word | 40 | ||
| Neoempiricism, Data Mining, and Knowledge Discovery in Databases | 42 | ||
| Research Funding | 43 | ||
| Research Ethics | 51 | ||
| Acknowledgment | 53 | ||
| Chapter 5 - Proving the Point: Evidence-Based Medicine in Pediatric Critical Care | 54 | ||
| The Evidence-Based Medicine Process | 54 | ||
| Challenges to Evidence-Based Medicine | 57 | ||
| Conclusion | 58 | ||
| Chapter 6 - Outcomes in Pediatric Critical Care Medicine: Implications for Health Services Research and Patient Care | 59 | ||
| What Is Health Services Research? | 59 | ||
| A System of Care | 59 | ||
| Organizing Health Systems | 60 | ||
| The Macrosystem: Pediatric Critical Care | 61 | ||
| The Microsystem: Pediatric Intensive Care Unit | 65 | ||
| Conclusion | 66 | ||
| Chapter 7 - Safety and Quality Assessment in the Pediatric Intensive Care Unit | 67 | ||
| A Brief Consideration of the Relationship Between Safety and Quality | 67 | ||
| State of Safety and Quality in Pediatric Intensive Care Units | 67 | ||
| Fundamentals of Quality Improvement and Patient Safety: Systems Thinking | 68 | ||
| Fundamentals of Patient Safety | 71 | ||
| Patient Safety in the Pediatric Intensive Care Unit: Past, Present, and Future | 73 | ||
| Conclusions | 74 | ||
| Chapter 8 - Information Technology in Critical Care | 75 | ||
| The Electronic Health Record | 75 | ||
| Clinical Tools | 83 | ||
| Medical Knowledge Bases | 83 | ||
| Research Databases | 85 | ||
| Security | 86 | ||
| User Privacy | 88 | ||
| Conclusion | 91 | ||
| Chapter 9 - Family-Centered Care in the Pediatric Intensive Care Unit | 92 | ||
| Caring and Compassion | 92 | ||
| Humanitarianism and Defining the Family | 92 | ||
| Family-Centered Care Core Concepts | 93 | ||
| Chapter 10 - Ethics in Pediatric Intensive Care | 102 | ||
| Health Care Decision Making: Consent | 104 | ||
| Surrogate Decision Making: Parental Rights and Obligations | 106 | ||
| Conscientious Objection to Participation in Proposed Interventions | 108 | ||
| Pediatric Intensive Care and “Experimentation” | 108 | ||
| Chapter 11 - Ethical Issues in Death and Dying | 110 | ||
| Withholding and Withdrawing Life Support | 110 | ||
| Definition of Death and Organ Retrieval | 114 | ||
| Chapter 12 - Palliative Care | 115 | ||
| What Is Pediatric Palliative Care? | 115 | ||
| Issues of Concern in Palliative Care | 115 | ||
| Practical Aspects of Care at the End of Life | 118 | ||
| Chapter 13 - The Process of Organ Donation and Pediatric Donor Management | 122 | ||
| Role of the Pediatric Intensivist and Critical Care Team in the Process of Organ Donation | 123 | ||
| Determination of Brain Death | 123 | ||
| Brain Death Physiology | 125 | ||
| Treatment of Hemodynamic Instability | 127 | ||
| Hormonal Replacement Therapy | 127 | ||
| Management of Pulmonary Issues for the Potential Pediatric Organ Donor | 128 | ||
| Fluid and Electrolyte Disturbances | 129 | ||
| Diabetes Insipidus | 129 | ||
| Oliguria | 130 | ||
| Glucose, Potassium, and Calcium Derangements | 130 | ||
| Coagulation Abnormalities and Thermoregulatory Instability | 130 | ||
| Medical Examiner/Coroner Issues and Organ Donation for Children | 130 | ||
| Donation After Circulatory Determination of Death | 131 | ||
| Summary | 131 | ||
| Chapter 14 - Pediatric Transport: Shifting the Paradigm to Improve Patient Outcome | 132 | ||
| The Problem: An Adult-Oriented Retrieval System Focused on Rapid Movement | 133 | ||
| The Solution: A Retrieval System Focused on Improving Outcome | 135 | ||
| Summary | 138 | ||
| Chapter 15 - Pediatric Vascular Access and Centeses | 139 | ||
| Intraosseous Infusion | 139 | ||
| Arterial Catheter Placement | 142 | ||
| Pericardiocentesis | 145 | ||
| Umbilical Arterial Catheter and Umbilical Venous Catheter Placement | 148 | ||
| Central Venous Line Placement | 150 | ||
| Peripherally Inserted Central Venous Catheters | 155 | ||
| Thoracentesis and Tube Thoracostomy | 158 | ||
| Paracentesis | 161 | ||
| Chapter 16 - Pediatric Intensive Care in Developing Countries | 164 | ||
| Why Lower Child Mortality Rates? | 164 | ||
| Expenditure on Health | 164 | ||
| Child Mortality, Infections, and Intensive Care | 165 | ||
| Role of Intensive Care | 165 | ||
| Ethical Dilemma | 165 | ||
| Causes of Death | 165 | ||
| Pneumonia | 166 | ||
| Gastroenteritis | 167 | ||
| Low Birth Weight | 168 | ||
| Neonatal Asphyxia | 169 | ||
| Malaria | 169 | ||
| Measles | 170 | ||
| Human Immunodeficiency Virus | 170 | ||
| Pertussis | 171 | ||
| Tetanus | 171 | ||
| Tuberculosis | 172 | ||
| Diphtheria | 174 | ||
| Dengue | 176 | ||
| Malnutrition | 177 | ||
| Conclusion | 177 | ||
| Self-Assessment Question 1 | 178 | ||
| Self-Assessment Question 2 | 178 | ||
| Chapter 17 - Educating the Intensivist | 179 | ||
| Requirements | 179 | ||
| Adult Learning | 181 | ||
| Methods of Teaching | 181 | ||
| Evaluation and Assessment of Competency | 186 | ||
| Education in Research, Scholarship, and Leadership | 187 | ||
| Mentorship | 188 | ||
| Establishing and Maintaining Competency | 188 | ||
| Chapter 18 - Critical Care in Public Health Emergencies | 190 | ||
| Basic Concepts | 190 | ||
| Pediatric Critical Care Needs and Resources in a Public Health Emergency | 191 | ||
| When the PICU Is Notified of a Sudden-Impact Public Health Emergency | 192 | ||
| Emergency Department Phase | 192 | ||
| Intensive Care Unit Phase | 193 | ||
| Critical Care in Specific Types of Public Health Emergencies | 194 | ||
| Rationing | 195 | ||
| Section II - Cardiovascular System | 197 | ||
| Chapter 19 - Structure and Function of the Heart | 199 | ||
| Anatomic Development and Structure | 199 | ||
| Physiologic Development and Function | 202 | ||
| Chapter 20 - Regional Circulation | 217 | ||
| General Features | 217 | ||
| Regional Circulations | 223 | ||
| Conflicting Needs of Regional Circulations | 233 | ||
| Chapter 21 - Principles of Invasive Monitoring | 234 | ||
| Role of Invasive Hemodynamic Monitoring | 234 | ||
| Indications for Invasive Hemodynamic Measurements | 234 | ||
| Principles of Measurement | 235 | ||
| Invasive Techniques | 237 | ||
| Measurement of Cardiac Output | 241 | ||
| Calculation of Oxygen Delivery and Consumption | 243 | ||
| Conclusions | 245 | ||
| Chapter 22 - Assessment of Cardiovascular Function | 246 | ||
| Cardiovascular Function | 246 | ||
| Quantity of Therapy | 246 | ||
| Variables that Determine Tissue Oxygenation | 247 | ||
| Monitoring Tissue Oxygenation | 247 | ||
| Assessing Variables that Affect the Quantity of Therapy | 250 | ||
| Physiology of the Patient with a Single Ventricle | 253 | ||
| Chapter 23 - Echocardiography and Noninvasive Diagnosis | 255 | ||
| Diagnosis of Congenital Heart Disease | 255 | ||
| Ventricular Function Assessment and Hemodynamics | 262 | ||
| Contrast Echocardiography | 262 | ||
| Transesophageal Echocardiography | 262 | ||
| Special Considerations after Chest Trauma | 264 | ||
| Safety of Ultrasound | 264 | ||
| Costs and Benefits | 265 | ||
| Trends | 265 | ||
| Chapter 24 - Diagnostic and Therapeutic Cardiac Catheterization | 266 | ||
| Catheterization Laboratory Environment | 266 | ||
| Hemodynamic and Oxygen Saturation Data | 267 | ||
| Assessment of Critical Illness | 267 | ||
| Transcatheter Radiofrequency Ablation | 268 | ||
| Congenital Heart Disease | 269 | ||
| Balloon Dilation of Pulmonary Arteries | 272 | ||
| Occlusion Device Insertion | 274 | ||
| Cardiac Catheterization and Extracorporeal Membrane Oxygenation | 276 | ||
| Chapter 25 - Pharmacology of the Cardiovascular System | 277 | ||
| Mechanisms of Response | 277 | ||
| Sympathomimetic Amines | 285 | ||
| Bipyridines | 300 | ||
| Digitalis Glycosides | 304 | ||
| Conclusion | 305 | ||
| Chapter 26 - Cardiopulmonary Interactions | 306 | ||
| Effects of Ventilation on Circulation | 306 | ||
| Effects of Cardiovascular Function on Respiration | 315 | ||
| Effect of Initiating Mechanical Ventilation | 318 | ||
| Chapter 27 - Myocardial Dysfunction, Ventricular Assist Devices, and Extracorporeal Life Support | 319 | ||
| Myocardial Dysfunction | 319 | ||
| Low Cardiac Output Syndrome | 319 | ||
| Mechanical Circulatory Support | 322 | ||
| Mechanical Support Devices | 322 | ||
| Long-Term Mechanical Support Devices | 333 | ||
| Ethics | 337 | ||
| Future Directions | 337 | ||
| Conclusion | 337 | ||
| Chapter 28 - Disorders of Cardiac Rhythm | 338 | ||
| Classification of Arrhythmias | 338 | ||
| Approach to Diagnosis | 343 | ||
| Treatment of Rhythm Disturbances | 347 | ||
| Approach to Therapy | 356 | ||
| Specific Arrhythmias | 357 | ||
| Chapter 29 - Shock States | 364 | ||
| Definition and Physiology | 364 | ||
| Recognition and Assessment of the Shock State | 365 | ||
| Treatment of Shock | 365 | ||
| Multisystem Effects of Shock | 366 | ||
| Functional Classification and Common Underlying Etiologies | 367 | ||
| Hypovolemic Shock | 368 | ||
| Cardiogenic Shock or Congestive Heart Failure | 369 | ||
| Obstructive Shock | 372 | ||
| Distributive Shock | 373 | ||
| Septic Shock | 373 | ||
| Summary | 378 | ||
| Chapter 30 - Cardiac Bypass for Repair of Congenital Heart Disease in Infants and Children | 379 | ||
| Cardiopulmonary Bypass in Infants Versus Adults | 380 | ||
| Physiology of Cardiopulmonary Bypass | 381 | ||
| Neurologic Injury and Protection | 385 | ||
| Myocardial Protection | 387 | ||
| Pulmonary Effects of Cardiopulmonary Bypass | 388 | ||
| Renal Function and Protection on Cardiopulmonary Bypass | 389 | ||
| Endocrine Response to Cardiopulmonary Bypass | 390 | ||
| Systemic Inflammation | 391 | ||
| Management of Cardiopulmonary Bypass | 392 | ||
| Initiation of Cardiopulmonary Bypass | 394 | ||
| Termination of Cardiopulmonary Bypass | 396 | ||
| Conclusions | 400 | ||
| Chapter 31 - Critical Care After Surgery for Congenital Cardiac Disease | 401 | ||
| Newborn Considerations | 401 | ||
| Preoperative Care | 402 | ||
| Postoperative Care | 405 | ||
| Critical Care Management of Specific Lesions | 421 | ||
| Summary | 439 | ||
| Chapter 32 - Cardiac Transplantation | 441 | ||
| Critical Care of the Pediatric Patient Waiting for Heart Transplantation | 442 | ||
| Management of the Potential Heart Donor | 443 | ||
| Critical Care Management of the Orthotopic Heart Transplant Recipient | 444 | ||
| Complications of Immune Suppression in Heart Transplant Recipients Occurring in the Pediatric Intensive Care Unit | 447 | ||
| Future Management Strategies for Critical Care of Infants and Children with Cardiopulmonary Failure | 448 | ||
| Chapter 33 - Physiologic Foundations of Cardiopulmonary Resuscitation | 449 | ||
| Mechanisms of Blood Flow | 450 | ||
| Newer Cardiopulmonary Resuscitation Techniques | 454 | ||
| Pharmacology | 458 | ||
| Management of Ventricular Fibrillation | 467 | ||
| Future Directions | 473 | ||
| Chapter 34 - Performance of Cardiopulmonary Resuscitation in Infants and Children | 474 | ||
| Four Phases of Cardiac Arrest | 474 | ||
| Epidemiology of Pediatric Cardiac Arrest | 475 | ||
| Interventions During the Low-Flow Phase: Cardiopulmonary Resuscitation | 476 | ||
| Medications Used to Treat Cardiac Arrest | 479 | ||
| Postresuscitation Myocardial Dysfunction | 480 | ||
| Other Considerations | 480 | ||
| Ventricular Fibrillation and Ventricular Tachycardia in Children | 481 | ||
| Summary | 482 | ||
| Section III - Respiratory System | 483 | ||
| Chapter 35 - Structure and Development of the Upper Respiratory System in Infants and Children | 485 | ||
| Developmental Anatomy of the Upper Airway | 485 | ||
| Anatomy and Physiology of the Upper Airway | 486 | ||
| Chapter 36 - Structure of the Respiratory System: Lower Respiratory Tract | 490 | ||
| Lower Respiratory System | 490 | ||
| Lung Circulation | 496 | ||
| Pulmonary Lymphatics | 497 | ||
| Diaphragm | 497 | ||
| Summary | 498 | ||
| Chapter 37 - Physiology of the Respiratory System | 499 | ||
| Physiology of the Respiratory System | 499 | ||
| Flow Resistance of the Respiratory System | 502 | ||
| Dynamic Change in Airway Caliber During Respiration | 503 | ||
| Applied Forces | 504 | ||
| Interactions Between Lungs and Chest Wall | 505 | ||
| Time Constant of Emptying | 505 | ||
| Physiology of Positive Pressure Mechanical Ventilation | 505 | ||
| Gas Exchange | 506 | ||
| Alveolar Ventilation | 508 | ||
| Chapter 38 - Control of Breathing and Acute Respiratory Failure | 509 | ||
| Normal Regulation of Breathing | 509 | ||
| Failure of Respiratory Controls | 510 | ||
| Chronic Disorders of Respiratory Controls | 512 | ||
| Nonstructural Acquired Chronic Disorders | 513 | ||
| Recognition and Treatment | 513 | ||
| Chapter 39 - Assessment and Monitoring of Respiratory Function | 515 | ||
| Physical Examination of the Respiratory System | 515 | ||
| Radiography | 516 | ||
| Evaluation of Gas Exchange | 516 | ||
| Noninvasive Respiratory Monitoring | 516 | ||
| Respiratory Mechanics | 518 | ||
| Endoscopy | 519 | ||
| Summary | 519 | ||
| Chapter 40 - Overview of Breathing Failure | 520 | ||
| Physiology of Breathing | 520 | ||
| Breathing Failure from Lung Disease | 524 | ||
| Conclusion | 527 | ||
| Chapter 41 - Ventilation/Perfusion Inequality | 528 | ||
| Distribution of Ventilation | 529 | ||
| Distribution of Perfusion | 529 | ||
| Fractal Model of Pulmonary Blood Flow and Ventilation | 530 | ||
| Fractal Model of the Pulmonary Ventilation | 530 | ||
| VA/Q Abnormalities in Pulmonary Disease | 531 | ||
| Therapeutic Considerations | 533 | ||
| Chapter 42 - Mechanical Dysfunction of the Respiratory System | 534 | ||
| Work, Power, and Energy Expenditure in the Respiratory System | 534 | ||
| Determinants of Respiratory Work | 535 | ||
| Volume-Pressure Relationships | 535 | ||
| Nature of the Mechanical Forces Acting on the Respiratory Pump | 536 | ||
| Nondissipative Phenomena: Elastic Behavior of the Respiratory System | 537 | ||
| Lungs/Chest Wall Interactions | 538 | ||
| Dissipative Forces | 540 | ||
| Determinants of Regional Gas Flow Distribution in the Lungs | 545 | ||
| Restrictive and Obstructive Respiratory Disease | 545 | ||
| Power of Breathing and Breathing Frequency | 547 | ||
| Alterations in Chest Wall Configuration | 548 | ||
| Conclusion | 549 | ||
| Chapter 43 - Noninvasive Monitoring in Children | 550 | ||
| Vital Signs | 550 | ||
| Pulse Oximetry | 552 | ||
| Capnometry and Capnography | 554 | ||
| Transcutaneous Monitoring | 558 | ||
| Cerebral Function Monitoring | 559 | ||
| Conclusion | 560 | ||
| Chapter 44 - Specific Diseases of the Respiratory System: Upper Airway | 561 | ||
| Initial Management | 561 | ||
| Congenital Malformations | 562 | ||
| Infectious Processes | 565 | ||
| Vocal Cord Paralysis | 569 | ||
| Intrathoracic Mass Lesions Causing Respiratory Obstruction | 569 | ||
| Trauma | 570 | ||
| Angioedema | 573 | ||
| Tracheostomy | 573 | ||
| Chapter 45 - Asthma | 575 | ||
| Epidemiology and Risk Factors | 575 | ||
| Pathophysiology | 576 | ||
| Clinical Assessment | 577 | ||
| Laboratory Data | 579 | ||
| Electrocardiography | 580 | ||
| Spirometry | 580 | ||
| Treatment | 580 | ||
| Management in the Intensive Care Unit | 581 | ||
| Mechanical Ventilation | 585 | ||
| Antibiotics | 588 | ||
| Bronchoscopy | 588 | ||
| Extracorporeal Life Support | 588 | ||
| Prognosis | 589 | ||
| Chapter 46 - Neonatal Respiratory Disease | 590 | ||
| Acute or Early-Onset Respiratory Disorders | 590 | ||
| Congenital Malformations of the Lung | 596 | ||
| Special Treatment Considerations for Acute Respiratory Failure | 600 | ||
| Chronic Pulmonary Disease | 602 | ||
| Nonpulmonary Conditions that Result in Respiratory Disease | 604 | ||
| Metabolic Disorders | 608 | ||
| Chapter 47 - Pneumonitis and Interstitial Disease | 609 | ||
| Pathogenesis | 609 | ||
| Pathophysiology | 609 | ||
| Diagnosis | 610 | ||
| Bacterial Pneumonitis | 610 | ||
| Viral Pneumonitis | 614 | ||
| Fungal Pneumonitis | 619 | ||
| Primary Pulmonary Fungi | 620 | ||
| Opportunistic Pulmonary Mycoses | 622 | ||
| Pneumocystis Carinii Pneumonia | 623 | ||
| Chemical Pneumonitis | 625 | ||
| Idiopathic Interstitial Lung Disease | 627 | ||
| Pediatric Pulmonary Hemorrhage | 628 | ||
| Summary | 631 | ||
| Chapter 48 - Diseases of Pulmonary Circulation | 632 | ||
| Etiology and Treatment of Pulmonary Hypertension | 632 | ||
| Developmental Pulmonary Vascular Anatomy | 632 | ||
| Developmental Pulmonary Vascular Physiology | 633 | ||
| Transitional Circulation | 636 | ||
| Persistent Pulmonary Hypertension of the Newborn | 638 | ||
| Pulmonary Arterial Hypertension in Children | 645 | ||
| Prognosis and Survival in Pulmonary Arterial Hypertension | 655 | ||
| Chapter 49 - Mechanical Ventilation and Respiratory Care | 657 | ||
| Applied Respiratory Physiology | 657 | ||
| Indications for Mechanical Ventilation | 659 | ||
| Design and Functional Characteristics of Mechanical Positive-Pressure Ventilators | 660 | ||
| High-Frequency Ventilation | 672 | ||
| Approach to Mechanical Ventilation Based on Underlying Pathophysiology | 675 | ||
| Patient-Ventilator Asynchrony | 679 | ||
| Use of Neuromuscular Blockade | 679 | ||
| Special Techniques of Respiratory Support | 679 | ||
| Adverse Effects of Mechanical Ventilation | 680 | ||
| Respiratory Care During Mechanical Ventilation | 682 | ||
| Weaning from Mechanical Ventilation | 683 | ||
| Home Respiratory Care | 687 | ||
| Chapter 50 - Noninvasive Ventilation: Concepts and Practice | 689 | ||
| Historical Perspective | 689 | ||
| Indications | 689 | ||
| Short-Term Noninvasive Ventilation | 689 | ||
| Adult Studies on the Short-Term Use of Noninvasive Ventilation | 690 | ||
| Pediatric and Neonatal Studies | 692 | ||
| Interfaces | 692 | ||
| Equipment | 693 | ||
| Optimizing Patient‑Ventilator Interaction | 693 | ||
| Ventilator Settings | 693 | ||
| Complications and Concerns During Short-Term Noninvasive Ventilation | 694 | ||
| Long-Term Noninvasive Ventilation | 694 | ||
| Negative-Pressure Ventilation | 694 | ||
| Summary | 696 | ||
| Chapter 51 - Ventilator-Induced Lung Injury | 697 | ||
| Evidence for Ventilator-Induced Lung Injury | 697 | ||
| Roles of Tidal Volume, Positive End-Expiratory Pressure, and Overall Lung Distention | 700 | ||
| Possible Mechanisms of Ventilator-Induced Lung Injury | 701 | ||
| New Insights in Ventilator-Induced Lung Injury | 704 | ||
| Strategies to Reduce Ventilator-Induced Lung Injury: Use of the Pressure-Volume Curve | 704 | ||
| Imaging Ventilator-Induced Lung Injury | 705 | ||
| Conclusion and Clinical Applications | 705 | ||
| Chapter 52 - Acute Respiratory Distress Syndrome in Children | 706 | ||
| Pathogenesis | 707 | ||
| Clinical Features | 709 | ||
| Noninvasive Ventilation | 714 | ||
| Conclusion | 716 | ||
| Chapter 53 - Extracorporeal Life Support | 717 | ||
| Materials and Methods | 718 | ||
| Patient Populations Treated with Extracorporeal Life Support | 724 | ||
| Patient Selection Criteria | 730 | ||
| Gas Exchange and Oxygen Delivery | 730 | ||
| Patient Management | 731 | ||
| Weaning from Extracorporeal Membrane Oxygenation | 734 | ||
| Complications | 735 | ||
| Long-Term Outcome | 736 | ||
| The Future | 737 | ||
| Section IV - Central Nervous System | 739 | ||
| Chapter 54 - Pediatric Neurocritical Care | 741 | ||
| Historical Context | 741 | ||
| Rationales for Development of Pediatric Neurocritical Care | 742 | ||
| Future of Pediatric Neurocritical Care | 744 | ||
| Chapter 55 - Pediatric Neurologic Assessment and Monitoring | 746 | ||
| Overview and Basic Principles of Pediatric Intensive Care Unit Neurology | 746 | ||
| Approach to the Physical Exam | 748 | ||
| Goals of the Neurologic Examination in the Pediatric Intensive Care Unit | 753 | ||
| Neuromonitoring | 754 | ||
| Integrating Neurologic Monitoring Data | 758 | ||
| Chapter 56 - Neuroimaging | 759 | ||
| Imaging Modality Overview | 759 | ||
| Preterm and Term Neonate Imaging | 765 | ||
| Stroke in the Older Infant/Child | 769 | ||
| Vascular Malformations | 772 | ||
| Central Nervous System Infection | 772 | ||
| Demyelinating Disease | 777 | ||
| Trauma | 777 | ||
| Hydrocephalus | 778 | ||
| Tumor | 781 | ||
| Seizures | 782 | ||
| Conclusion | 782 | ||
| Chapter 57 - Structure, Function, and Development of the Nervous System | 783 | ||
| Major Cell Types | 783 | ||
| Intercellular Communication in the Nervous System | 784 | ||
| Neurotransmitter Systems | 785 | ||
| Major Anatomic Organization of the Nervous System | 790 | ||
| Blood-Brain Barrier | 796 | ||
| Ventricles and Cerebrospinal Fluid | 798 | ||
| Vasculature in the Central Nervous System | 799 | ||
| Developmental Processes Relevant to Pediatric Critical Care Medicine | 801 | ||
| Conclusion | 804 | ||
| Chapter 58 - Coma and Depressed Sensorium | 805 | ||
| Pathophysiology | 805 | ||
| Anatomy of Arousal and Ascending Reticular Activating System | 805 | ||
| States of Impaired Sensorium | 806 | ||
| Identification of Cause | 807 | ||
| Initial Assessment and Immediate Resuscitation | 808 | ||
| Focused Neurologic Examination | 808 | ||
| Respiratory Pattern | 809 | ||
| Eye Examination | 809 | ||
| Motor Examination | 812 | ||
| Focal Neurologic Lesions Could Be Supratentorial or Subtentorial | 812 | ||
| Presentation of Nonfocal Neurologic Lesions | 814 | ||
| Herniation Syndromes | 815 | ||
| Diagnostic Evaluation | 817 | ||
| Therapeutic Intervention | 819 | ||
| Outcome | 820 | ||
| Ethical Considerations | 821 | ||
| Chapter 59 - Intracranial Hypertension and Brain Monitoring | 822 | ||
| Clinical Background | 822 | ||
| Physiology of the Intracranial Vault | 823 | ||
| Measurement of Intracranial Pressure | 825 | ||
| Analysis of Intracranial Pressure | 827 | ||
| Clinical Utility of Intracranial Pressure Monitoring with Other Monitoring Modalities | 830 | ||
| Monitoring and the Postinsult Natural History | 832 | ||
| Newer Modalities: Supplementary Monitoring of Intracranial Pressure | 832 | ||
| Chapter 60 - Status Epilepticus | 837 | ||
| Definition | 837 | ||
| Classification of Status Epilepticus | 837 | ||
| Epidemiology of Status Epilepticus | 838 | ||
| Outcome | 839 | ||
| Pathophysiology | 839 | ||
| Diagnosis | 839 | ||
| Refractory Status Epilepticus | 841 | ||
| Treatment of Status Epilepticus | 841 | ||
| Treatment of Refractory Status Epilepticus | 843 | ||
| Surgical Treatment | 847 | ||
| Investigations | 847 | ||
| Acknowledgment | 847 | ||
| Chapter 61-Severe Traumatic Brain Injury in Infants and Children | 849 | ||
| Epidemiology | 849 | ||
| Pathophysiology | 850 | ||
| History | 854 | ||
| Signs and Symptoms | 854 | ||
| Initial Resuscitation | 855 | ||
| Miscellaneous | 869 | ||
| Outcomes | 870 | ||
| Conclusion | 870 | ||
| Chapter 62 - Hypoxic-Ischemic Encephalopathy: Pathobiology and Therapy of the Post-Resuscitation Syndrome in Children | 871 | ||
| Epidemiology | 872 | ||
| Cellular and Molecular Pathobiology | 872 | ||
| Clinical Pathophysiology | 877 | ||
| Treatment of Cardiopulmonary Arrest | 884 | ||
| Current and Novel Therapies | 887 | ||
| Futuristic Approaches | 890 | ||
| Summary | 892 | ||
| Acknowledgment | 892 | ||
| Chapter 63 - Stroke and Intracerebral Hemorrhage | 893 | ||
| Arterial Ischemic Stroke | 893 | ||
| Cerebral Venous Sinus Thrombosis | 901 | ||
| Spontaneous Intracranial Hemorrhage | 904 | ||
| Chapter 64 - Acute Neuromuscular Diseases and Disorders | 907 | ||
| Guillain-Barré Syndrome | 908 | ||
| Myasthenia Gravis | 908 | ||
| Congenital and Transient Neonatal Myasthenia Gravis | 910 | ||
| Tick Paralysis | 910 | ||
| Periodic Paralyses | 911 | ||
| Botulism | 912 | ||
| Diphtheria | 913 | ||
| Acute Intermittent Porphyria | 913 | ||
| Spinal Muscular Atrophy | 914 | ||
| Poliomyelitis | 915 | ||
| Polio-like Syndromes | 915 | ||
| Organophosphate and Carbamate Poisoning | 915 | ||
| Rhabdomyolysis | 916 | ||
| Malignant Hyperthermia | 917 | ||
| Neuroleptic Malignant Syndrome | 917 | ||
| Inflammatory Myopathies | 917 | ||
| Chapter 65 - Central Nervous System Infections Presenting to the Pediatric Intensive Care Unit | 918 | ||
| Bacterial Meningitis | 918 | ||
| Subdural Empyema | 922 | ||
| Meningoencephalitis | 923 | ||
| Acute Disseminated Encephalomyelitis | 928 | ||
| Brain Abscesses | 930 | ||
| Primary and Granulomatous Amoebic Central Nervous System Infections | 931 | ||
| Conclusions | 932 | ||
| Section V-Respiratory SystemRenal, Endocrine, and Gastrointestinal Systems | 933 | ||
| Chapter 66 - Renal Structure and Function | 935 | ||
| Renal Development | 935 | ||
| Renal Anatomy | 935 | ||
| Renal Vasculature | 935 | ||
| The Nephron Unit | 936 | ||
| Tubular Anatomy | 939 | ||
| Summary | 943 | ||
| Chapter 67 - Fluid and Electrolyte Issues in Pediatric Critical Illness | 944 | ||
| Fluids Update | 944 | ||
| Potassium | 950 | ||
| Magnesium | 954 | ||
| Phosphorus | 956 | ||
| Disorders of Calcium Homeostasis | 959 | ||
| Chapter 68 - Acid-Base Balance and Disorders | 963 | ||
| Understanding Acid-Base Physiology: Traditional and Newer Approaches | 964 | ||
| Merging Traditional and Newer Approaches: Is an Integrated Approach Ready for the Bedside? | 974 | ||
| New Insights for Old Problems | 976 | ||
| Metabolic Acidosis | 978 | ||
| Metabolic Alkalosis | 988 | ||
| Respiratory Acid-Base Derangements | 991 | ||
| Respiratory Acidosis | 991 | ||
| Respiratory Alkalosis | 995 | ||
| Mixed Acid-Base Derangements | 996 | ||
| Acid-Base Balance in Special Situations | 996 | ||
| Summary | 997 | ||
| Chapter 69 - Tests of Kidney Function in Children | 998 | ||
| Assessment of Glomerular Function and Injury | 998 | ||
| Renal Clearance Techniques | 999 | ||
| Plasma Disappearance Techniques | 1000 | ||
| Plasma Markers | 1001 | ||
| Estimating Equations | 1004 | ||
| Other Novel Biomarkers of Acute Kidney Injury Under Investigation | 1005 | ||
| Tubular Function | 1006 | ||
| Chapter 70 - Renal Pharmacology | 1009 | ||
| Kidney Function and Drug Disposition | 1009 | ||
| Drug Dosing in Kidney Disease | 1011 | ||
| The Kidney as a Therapeutic Target: Diuretics | 1012 | ||
| Prevention/Reversal of Acute Renal Failure | 1015 | ||
| Chapter 71 - Glomerulotubular Dysfunction and Acute Kidney Injury | 1016 | ||
| Acute Kidney Injury Pathophysiology | 1016 | ||
| Classification of Acute Glomerulotubular Dysfunction | 1020 | ||
| Treatment of Acute Kidney Injury | 1021 | ||
| Acute Kidney Injury: Clinical Impact | 1023 | ||
| Specific Kidney Diseases that May Lead to Acute Kidney Injury | 1024 | ||
| Chapter 72 - Pediatric Renal Replacement Therapy in the Intensive Care Unit | 1036 | ||
| Renal Failure and Other Indications for Renal Support | 1036 | ||
| Conservative Management | 1037 | ||
| Basic Physiology of Dialysis and Ultrafiltration | 1037 | ||
| Peritoneal Dialysis | 1037 | ||
| Intermittent Hemodialysis | 1039 | ||
| Continuous Renal Replacement Therapy | 1040 | ||
| Outcomes of Renal Replacement in Critically Ill Children | 1042 | ||
| Summary | 1042 | ||
| Chapter 73 - Hypertension in the Pediatric Intensive Care Unit | 1043 | ||
| Definition of Terms | 1043 | ||
| Etiology and Evaluation | 1044 | ||
| Pathophysiology | 1049 | ||
| Endothelial Homeostasis | 1049 | ||
| Hemodynamics of the Kidney | 1049 | ||
| The Autonomic System: Sympathetic Activation | 1049 | ||
| Renin-Angiotensin System | 1050 | ||
| Nitric Oxide | 1050 | ||
| Hypervolemia | 1050 | ||
| Clinical Symptoms | 1050 | ||
| Management Strategy | 1052 | ||
| Summary | 1057 | ||
| Chapter 74 - Cellular Respiration | 1058 | ||
| Metabolism of Respiration | 1058 | ||
| Monitoring of Tissue Oxygenation | 1063 | ||
| Continuous Central Venous Oxygen Saturation Monitoring | 1064 | ||
| Carbomyl Phosphate Synthase—A Marker of Mitochondrial Damage | 1067 | ||
| Clinical Correlations in Altered Cellular Respiration | 1067 | ||
| Substrate Deficiency (Hypoglycemia) | 1067 | ||
| The Four Dysoxias | 1068 | ||
| Anemic Dysoxia | 1069 | ||
| Hypoxemic Dysoxia | 1069 | ||
| Ischemic Dysoxia | 1070 | ||
| Cytopathic Dysoxia | 1070 | ||
| Sepsis and Dysoxia | 1071 | ||
| Chapter 75 - Nutrient Metabolism and Nutrition Therapy During Critical Illness | 1073 | ||
| Malnutrition in the Critically Ill Pediatric Patient | 1074 | ||
| Assessment of Nutritional Status | 1074 | ||
| Nutritional Requirements During Critical Illness | 1075 | ||
| Enteral Nutrition in Critically Ill Children | 1081 | ||
| Parenteral Nutrition | 1086 | ||
| Nutritional Support of Obese Critically Ill Children | 1086 | ||
| Guidelines for Pediatric Critical Care Nutrition | 1087 | ||
| Conclusions | 1087 | ||
| Chapter 76 - Inborn Errors of Metabolism | 1089 | ||
| Pathophysiology of Inborn Errors of Metabolism | 1089 | ||
| Inheritance of Inborn Errors of Metabolism | 1090 | ||
| Signs and Symptoms of Inborn Errors of Metabolism | 1090 | ||
| Laboratory Evaluation of Suspected Inborn Errors of Metabolism | 1091 | ||
| Postmortem Evaluation of a Child with Suspected Inborn Errors of Metabolism | 1093 | ||
| Emergency Treatment of Children with Suspected Inborn Errors of Metabolism | 1094 | ||
| Classification of Inborn Errors of Metabolism by Clinical Presentation | 1094 | ||
| Metabolic Acidosis | 1100 | ||
| Hypoglycemia | 1100 | ||
| Cardiomyopathy and Inborn Errors of Metabolism | 1102 | ||
| Metabolic Myopathies and Rhabdomyolysis | 1103 | ||
| Neonatal Screening for Inborn Errors of Metabolism | 1104 | ||
| Conclusion | 1104 | ||
| Chapter 77 - Common Endocrinopathies in the Pediatric Intensive Care Unit | 1105 | ||
| Functional Elements of the Stress Response | 1105 | ||
| Hypothalamic-Pituitary-Adrenal Axis | 1105 | ||
| Cortisol Biochemistry | 1106 | ||
| Actions of Cortisol | 1106 | ||
| Assessing Adequacy of the Cortisol Stress Response | 1108 | ||
| Adrenal Insufficiency in the Intensive Care Unit | 1109 | ||
| Cortisol Replacement Studies | 1110 | ||
| Current Guidelines for Corticosteroid Prescription in the Pediatric Intensive Care Unit | 1111 | ||
| Corticosteroid Adverse Effects | 1111 | ||
| Alterations of Glucose Homeostasis | 1112 | ||
| Alterations of Thyroid Hormone in Critical Illness | 1120 | ||
| Chapter 78 - Diabetic Ketoacidosis | 1124 | ||
| Etiology, Definition, and Presentation | 1124 | ||
| Chapter 79 - Structure and Function of Hematopoietic Organs | 1131 | ||
| Structure and Function of the Bone Marrow | 1131 | ||
| Hematopoiesis | 1132 | ||
| Lymphopoiesis | 1138 | ||
| Chapter 80 - Thrombosis in Pediatric Intensive Care | 1140 | ||
| Developmental Hemostasis | 1140 | ||
| Etiology and Epidemiology | 1141 | ||
| Clinical Features | 1146 | ||
| Diagnosis | 1146 | ||
| Management | 1148 | ||
| Conclusions | 1150 | ||
| Chapter 81 - Hematology and Oncology Problems in the Intensive Care Unit | 1151 | ||
| Hematologic Emergencies | 1151 | ||
| Oncologic Emergencies | 1156 | ||
| Acute Airway Compromise in Anterior Mediastinal Tumors | 1159 | ||
| Chapter 82 - Transfusion Medicine | 1162 | ||
| Red Blood Cells | 1162 | ||
| Plasma | 1169 | ||
| Platelets | 1170 | ||
| Cryoprecipitate | 1172 | ||
| Transfusion Reactions and Complications | 1172 | ||
| Conclusion | 1176 | ||
| Chapter 83 - Critical Illness Involving Children Undergoing Hematopoietic Progenitor Cell Transplantation | 1177 | ||
| Sources of Hematopoietic Progenitor Cells and Identification of Donors | 1177 | ||
| Indications and Outcomes | 1178 | ||
| Transplant Procedure | 1179 | ||
| Nutritional Support in the Critically Ill Hematopoietic Progenitor Cell Transplantation Patient | 1190 | ||
| Chapter 84 - Hemoglobinopathies | 1191 | ||
| Perspective | 1191 | ||
| The Globin Gene Loci | 1191 | ||
| Sickle Cell Disease | 1192 | ||
| Thalassemia | 1202 | ||
| Acknowledgment | 1206 | ||
| Chapter 85 - Gastrointestinal Structure and Function | 1207 | ||
| Intestinal Structure, Digestion, and Absorption of Nutrients, Water, and Electrolytes | 1207 | ||
| Digestion of Proteins | 1209 | ||
| Digestion of Lipids | 1210 | ||
| Digestion of Fat | 1211 | ||
| Intestinal Lymphatics | 1211 | ||
| Regulation of Electrolyte and Water Movement | 1211 | ||
| Electrolyte Transport | 1212 | ||
| Zinc | 1213 | ||
| Hydrogen Ions | 1213 | ||
| Pancreas | 1213 | ||
| Hepatobiliary System | 1214 | ||
| Host-Defense Mechanisms of the Gut: Immunology and Microbiology | 1217 | ||
| Gastrointestinal and Hepatobiliary Testing in the Intensive Care Unit | 1218 | ||
| Chapter 86 - Disorders and Diseases of the Gastrointestinal Tract and Liver | 1221 | ||
| Gastrointestinal Evaluation of the Critically Ill Child | 1221 | ||
| Life-Threatening Complications of Gastrointestinal Disorders | 1225 | ||
| Chapter 87 - Gastrointestinal Pharmacology | 1234 | ||
| Nausea and Vomiting | 1234 | ||
| Diarrhea | 1237 | ||
| Constipation | 1238 | ||
| Gastroesophageal Reflux Disease | 1238 | ||
| Gastrointestinal Hemorrhage | 1240 | ||
| Drug-Induced Liver Injury | 1241 | ||
| Dose Adjustments for Hepatic Dysfunction | 1246 | ||
| Rectal Administration of Medication | 1246 | ||
| Chapter 88 - Acute Liver Failure, Liver Transplantation, and Extracorporeal Liver Support | 1248 | ||
| Definition | 1248 | ||
| Epidemiology | 1248 | ||
| Clinical Presentation by Etiology | 1249 | ||
| Family Support | 1249 | ||
| Management | 1249 | ||
| Chapter 89 - Acute Abdomen | 1259 | ||
| Anatomic and Physiologic Considerations | 1259 | ||
| Physical Exam of the Abdomen | 1260 | ||
| Laboratory Tests | 1260 | ||
| Imaging Options | 1261 | ||
| Abdominal Conditions Requiring Intensive Care Unit Care | 1262 | ||
| Other Specific Conditions | 1263 | ||
| The Intestine as a Source of Sepsis | 1264 | ||
| Surgical Intervention | 1264 | ||
| Section VI-Immunity and Infection | 1265 | ||
| Chapter 90 - The Innate Immune System | 1267 | ||
| Components of the Innate Immune System | 1267 | ||
| Circulating Pattern Recognition Receptors: Complement, Lectins, and Defensins | 1268 | ||
| Neutrophils | 1268 | ||
| Cellular Pattern Recognition Receptors | 1268 | ||
| Signaling | 1270 | ||
| Crosstalk | 1270 | ||
| Complex System | 1271 | ||
| Predisposition to an (in)Appropriate Response | 1271 | ||
| Cytokines | 1272 | ||
| Therapeutic Interventions | 1273 | ||
| Chapter 91 - Infection and Host Response | 1274 | ||
| Historical Perspectives | 1274 | ||
| Innate Immune Versus Adaptive Immune Response | 1274 | ||
| Pattern Recognition Receptors | 1275 | ||
| Soluble Components of Immunity | 1276 | ||
| Cellular Components of Immunity | 1283 | ||
| Leukocyte Localization | 1287 | ||
| Host Response to Infection: A Summary | 1289 | ||
| Chapter 92 - Congenital Immunodeficiencies | 1292 | ||
| The Immune System and the Classification of the Primary Immunodeficiency Diseases | 1292 | ||
| Laboratory Diagnosis of Congenital Immunodeficiencies | 1293 | ||
| Clinical Presentations of Congenital Immunodeficiency Syndromes | 1295 | ||
| Summary | 1301 | ||
| Chapter 93 - Acquired Immune Dysfunction | 1302 | ||
| Immune Function and Critical Illness | 1302 | ||
| Malnutrition and Immune Deficiency | 1304 | ||
| Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome | 1305 | ||
| Epidemiology | 1305 | ||
| Pulmonary Complications and Respiratory Failure | 1306 | ||
| Cardiovascular Complications | 1309 | ||
| Renal Failure | 1310 | ||
| Abdominal Complications | 1312 | ||
| Malignancies | 1312 | ||
| Neurologic Complications | 1312 | ||
| Ethical Issues | 1313 | ||
| Summary | 1314 | ||
| Chapter 94 - Bacterial Infection, Antimicrobial Use, and Antibiotic-Resistant Organisms in the Pediatric Intensive Care Unit | 1315 | ||
| Antibiotic Classes | 1315 | ||
| Antibiotic Resistance | 1320 | ||
| Antimicrobial Stewardship | 1322 | ||
| Summary | 1323 | ||
| Chapter 95 - Life-Threatening Viral Diseases and Their Treatment | 1324 | ||
| Myocarditis | 1324 | ||
| Acute Liver Failure | 1326 | ||
| Viral Pneumonia/Pneumonitis | 1327 | ||
| Central Nervous System Infections | 1328 | ||
| Exotic Viral Diseases | 1330 | ||
| Diagnosing Viral Disease | 1330 | ||
| Treatment for Viral Infections | 1333 | ||
| Chapter 96 - Infectious Syndromes in the Pediatric Intensive Care Unit | 1336 | ||
| Meningococcus | 1336 | ||
| Staphylococcus Toxic Shock Syndrome | 1338 | ||
| Invasive Group A β-Hemolytic Streptococcus | 1340 | ||
| Invasive Pneumococcus | 1342 | ||
| Lyme Disease | 1343 | ||
| Rocky Mountain Spotted Fever | 1345 | ||
| Hantavirus | 1347 | ||
| Chapter 97 - Health Care–Associated Infection in the Pediatric Intensive Care Unit: Epidemiology and Control—Keeping Patients Safe | 1349 | ||
| Burden of Illness and Scope of the Problem | 1349 | ||
| Epidemiologic Principles of Infection Prevention and Control | 1349 | ||
| Infection Prevention and Control Measures | 1350 | ||
| Specific Infection Syndromes in the Pediatric Intensive Care Unit | 1356 | ||
| Chapter 98 - Autoimmune Diseases: Diagnosis, Treatment, and Life-Threatening Complications | 1364 | ||
| Rheumatologic Diseases: Clinical Presentation, Diagnosis, and Treatment | 1365 | ||
| Critical Rheumatic Disease– Related Events in the Intensive Care Unit | 1372 | ||
| Complications of the Treatment of Rheumatologic Diseases | 1376 | ||
| Summary | 1376 | ||
| Chapter 99 - Genomic and Proteomic Medicine in Critical Care | 1377 | ||
| Genomics | 1377 | ||
| Proteomics | 1380 | ||
| Metabolomics | 1381 | ||
| Systems Biology | 1381 | ||
| Clinical Applications | 1382 | ||
| Ethical Issues | 1386 | ||
| Chapter 100 - Molecular Foundations of Cellular Injury: Necrosis, Apoptosis, and Autophagy | 1387 | ||
| Cell Death | 1387 | ||
| Pathways of Apoptosis and Autophagy | 1388 | ||
| Human Studies | 1388 | ||
| Animal Studies | 1390 | ||
| Chapter 101 - Endotheliopathy | 1394 | ||
| Normal Endothelial Function | 1394 | ||
| Endothelial Cell Dysfunction | 1400 | ||
| Conclusions | 1402 | ||
| Chapter 102 - Neuroendocrine–Immune Mediator Coordination and Disarray in Critical Illness | 1403 | ||
| Organization of the Stress Response | 1403 | ||
| Neuroendocrine–Immune Dysfunction Causing Critical Illness | 1405 | ||
| Intensive Care Unit Therapies That Interfere with the Neuroendocrine–Immune System | 1408 | ||
| Other Neuroendocrine–Immune Mediators | 1411 | ||
| Clinical Relevance | 1412 | ||
| Chapter 103 - Sepsis | 1413 | ||
| Epidemiology | 1413 | ||
| Definitions | 1414 | ||
| Clinical Presentation | 1415 | ||
| Pathogenesis | 1415 | ||
| Genomic Medicine and Sepsis | 1420 | ||
| Treatment Strategies | 1422 | ||
| The Case for More Effective Stratification in Pediatric Septic Shock | 1428 | ||
| Concluding Perspectives | 1429 | ||
| Chapter 104 - Inflammation and Immunity: Systemic Inflammatory Response Syndrome, Sepsis, Acute Lung Injury, and Multiple Organ Failure | 1430 | ||
| The Inflammation/Coagulation/Immune Dysfunction/Dysregulated Metabolism Hypothesis | 1430 | ||
| Definitions and Scoring | 1432 | ||
| Outcomes | 1433 | ||
| Multiple Organ Failure/Dysfunction Phenotypes, Respective Biomarkers, and Therapies | 1433 | ||
| Therapeutic Approaches to Systemic Inflammatory Response Syndrome, Sepsis, Acute Lung Injury, and Multiple Organ Failue | 1435 | ||
| Time Course of Systemic Inflammatory Response Syndrome, Sepsis, and Multiple Organ Dysfunction | 1438 | ||
| Summary | 1438 | ||
| Section VII -Environmental Hazards, Trauma, Pharmacology, and Anesthesia | 1439 | ||
| Chapter 105 - Principles of Toxin Assessment and Screening | 1441 | ||
| Common Agents Involved | 1441 | ||
| Resources for the Clinician | 1441 | ||
| General Assessment of the Poisoned Patient | 1442 | ||
| Additional Readings | 1450 | ||
| Chapter 106 - Toxidromes and Their Treatment | 1451 | ||
| Opiates | 1451 | ||
| Sympathomimetic Agents | 1452 | ||
| Anticholinergic Agents | 1453 | ||
| Cholinergic Agents | 1453 | ||
| Methemoglobinemia | 1454 | ||
| Hyperthermia | 1455 | ||
| Metabolic Acidosis with Increased Anion Gap | 1456 | ||
| Bradycardia, Hypotension, and Cardiac Conduction Abnormality | 1459 | ||
| Acetaminophen (Paracetamol) | 1461 | ||
| Tricyclic Antidepressants | 1461 | ||
| Chapter 107 - Bites and Stings | 1463 | ||
| Snakebites | 1463 | ||
| Widow Spider Bites | 1468 | ||
| Hymenoptera Stings (Bees, Wasps, and Ants) | 1470 | ||
| Chapter 108 - Heat Injury | 1472 | ||
| Definitions | 1472 | ||
| Epidemiology | 1473 | ||
| Pathophysiology and Pathogenesis of Heat-Related Illnesses | 1473 | ||
| Systemic Clinical Features | 1474 | ||
| Treatment | 1475 | ||
| Chapter 109 - Accidental Hypothermia | 1477 | ||
| Pathophysiology | 1477 | ||
| Treatment | 1478 | ||
| Outcome | 1479 | ||
| Chapter 110 - Drowning | 1480 | ||
| Definitions | 1480 | ||
| Epidemiology | 1480 | ||
| Pathophysiologic Considerations | 1481 | ||
| Mammalian Diving Reflex | 1484 | ||
| Preexisting Associated Conditions | 1484 | ||
| Management | 1484 | ||
| Chapter 111 - Burn and Inhalation Injuries | 1489 | ||
| Types of Burn Injuries | 1489 | ||
| Depth and Extent of the Burn Injury | 1490 | ||
| Early Management of Burn Injuries | 1491 | ||
| Inhalational Injury | 1494 | ||
| Nutritional Support in Burn Patients | 1496 | ||
| Wound Care | 1498 | ||
| Chapter 112 - Evaluation, Stabilization, and Initial Management After Multiple Trauma | 1500 | ||
| Prehospital Care and Trauma Team Activation | 1501 | ||
| Trauma Resuscitation | 1501 | ||
| The Primary Survey | 1501 | ||
| The Secondary Survey | 1508 | ||
| Diagnostic Assessment | 1509 | ||
| Emergency Department Thoracotomy | 1510 | ||
| Stabilization and Definitive Care | 1511 | ||
| Chapter 113 - Child Abuse and Neglect | 1512 | ||
| Recognition of Child Abuse | 1513 | ||
| Skeletal Survey | 1514 | ||
| Abusive Head Trauma | 1515 | ||
| Shaken Baby Syndrome | 1516 | ||
| Inflicted Abdominal and Thoracic Trauma | 1516 | ||
| Sexual Abuse | 1517 | ||
| Protocol for the Medical Investigation of Child Abuse | 1517 | ||
| Fatal Child Abuse | 1517 | ||
| Documentation and Testifying in Court | 1518 | ||
| Chapter 114 - Thoracic Injuries in Children | 1520 | ||
| Epidemiology | 1520 | ||
| Anatomic and Physiologic Considerations with Chest Injuries | 1521 | ||
| Diagnosis and Immediate Management of Chest Injuries | 1521 | ||
| Rib Fractures | 1522 | ||
| Clavicle, Sternal, and Scapular Fractures | 1522 | ||
| Pulmonary Contusion | 1522 | ||
| Traumatic Asphyxia | 1523 | ||
| Pneumothorax/Hemothorax | 1523 | ||
| Tracheobronchial Injuries | 1524 | ||
| Cardiac Injuries | 1525 | ||
| Commotio Cordis | 1525 | ||
| Aortic and Great Vessel Injuries | 1525 | ||
| Other Miscellaneous Injuries | 1526 | ||
| Penetrating Trauma | 1526 | ||
| Functional Outcome | 1527 | ||
| Summary | 1527 | ||
| Chapter 115 - Abdominal Trauma in Pediatric Critical Care | 1528 | ||
| Mechanisms and Patterns of Injury | 1528 | ||
| Evaluation and Resuscitation | 1529 | ||
| Management of Specific Abdominal Injuries | 1530 | ||
| Chapter 116 - Principles of Drug Disposition in the Critically Ill Child | 1538 | ||
| Drug Disposition in Infants and Children | 1538 | ||
| Determinants of Effective Therapy | 1538 | ||
| Pharmacokinetic Principles | 1548 | ||
| Critical Care Therapeutics | 1551 | ||
| Chapter 117 - Molecular Mechanisms of Drug Actions: From Receptors to Effectors | 1553 | ||
| Targets For Drug Action | 1553 | ||
| Receptor Type and Regulation | 1556 | ||
| Signal Transduction Mechanisms: Intracellular Messengers and Effectors | 1562 | ||
| Multiple Drug Targets Within an Organ System: The Myocardium | 1565 | ||
| Drug Response and Genetic Polymorphisms | 1566 | ||
| Drug Response and Development | 1568 | ||
| Drug Response and Disease | 1568 | ||
| Conclusion | 1568 | ||
| Chapter 118 - Adverse Drug Reactions and Drug-drug Interactions | 1569 | ||
| Defining Adverse Drug Reactions | 1569 | ||
| Adverse Drug Reactions by Organ System | 1570 | ||
| Drug-drug Interactions | 1578 | ||
| Chapter 119 - Airway Management | 1590 | ||
| Anatomic Considerations | 1590 | ||
| Basic Airway Management | 1591 | ||
| Establishing a Functional Airway | 1593 | ||
| Endotracheal Intubation | 1594 | ||
| Special Circumstances | 1605 | ||
| Alternative Approaches to the Airway | 1609 | ||
| Chapter 120 - Organ System Considerations that Affect Anesthetic Management | 1614 | ||
| Cardiovascular Performance | 1614 | ||
| Anemia and Transfusion | 1616 | ||
| Respiratory Failure | 1617 | ||
| Neurologic Injury | 1617 | ||
| Effects of Anesthetics on Cerebral Blood Flow | 1618 | ||
| Hepatic Dysfunction | 1619 | ||
| Intravenous Alimentation | 1624 | ||
| Chapter 121 - Anesthesia Principles and Operating Room Anesthesia Regimens | 1625 | ||
| Preoperative Evaluation | 1626 | ||
| NPO Guidelines | 1627 | ||
| Preoperative Medication | 1627 | ||
| Monitoring | 1628 | ||
| The Pharmacology of Anesthetic Agents | 1629 | ||
| Intraoperative Anesthetic Care | 1635 | ||
| Postoperative Care | 1636 | ||
| Conclusions | 1637 | ||
| Chapter 122 - Neuromuscular Blocking Agents | 1638 | ||
| The Neuromuscular Junction | 1638 | ||
| Neuromuscular Blocking Agents: Depolarizing Agents | 1639 | ||
| Neuromuscular Blocking Agents: Nondepolarizing Agents | 1642 | ||
| Reversal of Neuromuscular Blockade | 1648 | ||
| Monitoring Neuromuscular Blockade | 1649 | ||
| Adverse Effects of Neuromuscular Blockade | 1650 | ||
| Summary: Neuromuscular Blocking Agents in the PICU | 1652 | ||
| Chapter 123 - Sedation and Analgesia | 1654 | ||
| Opioids and Analgesia in the Pediatric Intensive Care Unit | 1656 | ||
| Specific Opioid Agonists | 1656 | ||
| Opiate Antagonists | 1660 | ||
| Opiate Tolerance | 1661 | ||
| Benzodiazepines | 1663 | ||
| Specific Benzodiazepines | 1663 | ||
| Flumazenil | 1664 | ||
| Chloral Hydrate | 1665 | ||
| Other Agents for Sedation in the PICU Patient | 1666 | ||
| Neuroleptic Malignant Syndrome | 1666 | ||
| Baclofen | 1667 | ||
| Dexmedetomidine | 1668 | ||
| Propofol | 1669 | ||
| Sedation and Analgesia for Procedures | 1672 | ||
| Specific Drugs for Sedation | 1677 | ||
| Apoptosis | 1681 | ||
| Pharmacoeconomics | 1681 | ||
| Chapter 124 - Malignant Hyperthermia | 1682 | ||
| Pathophysiology | 1682 | ||
| Genetics | 1682 | ||
| Clinical Recognition of a Malignant Hyperthermia Episode in Humans | 1683 | ||
| Treatment of an Episode of Malignant Hyperthermia | 1685 | ||
| The Course of a Clinical Episode of Malignant Hyperthermia | 1688 | ||
| Evaluation of Patients at Risk | 1689 | ||
| The “Safe” Anesthesia | 1690 | ||
| Testing for Malignant Hyperthermia Susceptibility | 1690 | ||
| Neuroleptic Malignant Syndrome and Serotonin Syndrome | 1691 | ||
| The Malignant Hyperthermia Assocation | 1692 | ||
| Index | 1693 |