Fuhrman and Zimmerman's Pediatric Critical Care

6th Edition - February 5, 2021
Authors: Jerry J. Zimmerman, Alexandre T. Rotta
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 6 7 2 6 9 - 6
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 6 7 2 7 0 - 2

In the highly specialized field of caring for children in the PICU, Fuhrman and Zimmerman's Pediatric Critical Care is the definitive reference for all members of the pediatric… Read more

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In the highly specialized field of caring for children in the PICU, Fuhrman and Zimmerman's Pediatric Critical Care is the definitive reference for all members of the pediatric intensive care team. Drs. Jerry J. Zimmerman and Alexandre T. Rotta, along with an expert team of editors and contributors from around the world, have carefully updated the 6th Edition of this highly regarded text to bring you the most authoritative and useful information on today’s pediatric critical care—everything from basic science to clinical applications

Cover image
Title page
Disclaimer
Table of Contents
Copyright
Contributors
Preface
List of Tables
List of Illustrations
Section I: Pediatric Critical Care: The Discipline
1. History of pediatric critical care medicine
Evolution of modern medicine
Anatomy and physiology
Resuscitation and ventilatory support
Contributions of specific disciplines
Early use of mechanical ventilation in neonates and children
Poliomyelitis and creation of the first intensive care units
Definitions
First pediatric intensive care units
Central role of critical care nursing
Role of pediatric anesthesiologists and pediatricians in founding pediatric critical care medicine
Growth of pediatric critical care medicine
Cost of success in pediatric critical care medicine
Around the world
High-mortality countries
Summary
Key references
References
2. High-reliability pediatric intensive care unit: Role of intensivist and team in obtaining optimal outcomes
Pediatric intensive care unit as a system
Models of critical care delivery
Summary
References
3. Critical communications in the pediatric intensive care unit
Intensive care unit design
Medical record
Huddles
Checklists
Rounds
Closed-loop communication
Transitions of care
Medical training
Debriefing
Team training
Conclusion
Key references
References
4. Professionalism in pediatric critical care
Profession
The virtuous doctor
Stakes
Great paradox of the medical profession
Professionalism, the physician charter
Pediatric intensive care unit as a site for medical education and lifelong learning
References
5. Leading and managing change in the pediatric intensive care unit
National change day: A case study in leading change
History and development of change management
Change management in healthcare
Models and tools to facilitate change leadership and management
Conclusion
Key references
References
6. Evolution of critical care nursing
Early pediatric critical care nursing
Describing what nurses do: The synergy model
Leadership
Evolution of advanced practice registered nurses into pediatric critical care
Nursing research
Summary
Key references
References
7. Fostering a learning healthcare environment in the pediatric intensive care unit
Learning healthcare system
Foundation predicated on professionalism
Pillars of a learning healthcare environment
Benefits of a learning healthcare environment
Key references
References
8. Challenges of pediatric critical care in resource-poor settings
Child mortality rates
Cost considerations in critical care delivery
Ethics of intensive care in resource-poor settings
Strengthening critical care infrastructure
Critical illness during public health emergencies
Key references
References
9. Public health emergencies and emergency mass critical care
How many pediatric patients could be affected in a public health emergency?
What are the most likely public health emergencies?
Who will make decisions during an emergency?
What is the expected timeline of a public health emergency?
What is a surge and what can be done to meet surge needs?
How can the intensive care unit support the emergency department during a public health emergency?
How can all intensive care units work together?
What steps can be taken to maximize intensive care unit treatment in a disaster?
How will the intensive care unit evacuate if needed?
How should pediatric patients be tracked?
How will limited services be ethically rationed?
What are the mental health considerations relevant to emergency mass critical care?
What is the role of medical learners in public health emergencies?
Conclusion
Key references
References
10. Lifelong learning in pediatric critical care
Adult learning theory in medical education
Graduate medical education
Accreditation council for graduate medical education core competencies, milestones, and entrustable professional activities
Beyond graduate medical education
New methods of assessment and future challenges
Key references
References
Section II: Pediatric Critical Care: Tools and Procedures
11. Essential concepts in clinical trial design and statistical analysis
Purpose of a clinical trial
Clinical trial design
Phases of clinical trials for new drug approval
Statistical analysis and reporting
Hypothesis testing and determining the study result
Conclusions
Key references
References
12. Prediction of short-term outcomes during critical illness in children
Historical perspective
Methods
Current prediction tools for assessment of mortality risk
Next generation: Morbidity and mortality prediction—trichotomous outcome
Future directions: Predictive analytics and tools for decision support
Key references
References
13. Pediatric critical care transport
Pediatric transport systems
Components of a specialized interfacility transport team
Referring hospital responsibilities
Summary
Key references
References
14. Pediatric vascular access and centeses
Intraosseous infusion
Arterial catheter placement
Central venous line placement
Peripherally inserted central venous catheters
Umbilical arterial catheter and umbilical venous catheter placement
Thoracentesis
Tube thoracostomy
Pericardiocentesis
Abdominal paracentesis
Key references
References
15. Ultrasonography in the pediatric intensive care unit
Ultrasound physics and basics of image optimization
Procedural guidance
Drainage procedures
Lumbar puncture
Diagnostic modalities
Translation to practice
Conclusion
Key references
References
Section III: Pediatric Critical Care: Psychosocial and Societal
16. Patient- and family-centered care in the pediatric intensive care unit
Definition of “family”
Historical evolution of patient- and family-centered care
Fundamental needs of patients and families in the intensive care unit
Core principles of patient- and family-centered care1,12
Patient- and family-centered care improves outcomes for all stakeholders
Overcoming barriers and challenges to patient- and family-centered care in the intensive care unit
Summary
Key references
References
17. Pediatric critical care ethics
Defining bioethics
Approach to bioethics dilemmas in the pediatric intensive care unit
Ethics of patient and surrogate decision-making
Other ethical issues in the pediatric intensive care unit
Goals for the ethical practice of the intensivist
Key references
References
18. Ethical issues around death and dying
Decision-making at the end of life
Requests for potentially inappropriate treatments in the intensive care unit
Withholding and withdrawing of life-sustaining treatments
Administration of analgesics and sedatives in end-of-life care
Is there a role for neuromuscular blockade in end-of-life care?
Artificial hydration and nutrition
Key references
References
19. Palliative care in the pediatric intensive care unit
Palliative care consults in the pediatric intensive care unit
Communication
Limitation of interventions
Pain and symptom management
Care of family and staff after a child’s death
Key references
References
20. Organ donation process and management of the organ donor
Process of organ donation
Determination of neurologic death
Brain death physiology
Pediatric donor management
Treatment of hemodynamic instability
Hormonal replacement therapy
Management of pulmonary issues for the potential pediatric organ donor
Fluid and electrolyte disturbances
Diabetes insipidus
Oliguria
Medical examiner and coroner issues and organ donation for children
Donation after circulatory death
Contraindications to organ donation
Evolving areas of transplantation
Summary
Key references
References
21. Long-term outcomes following critical illness in children
Post–intensive care syndrome
Health-related quality of life
Assessing change from baseline
Summary of outcomes in general pediatric intensive care unit populations
Outcomes for common pediatric intensive care unit illness categories
Examples of postdischarge outcomes in pediatric interventional trials
Strategies to assess long-term outcomes
Potential targets for interventions
Conclusion
Key references
References
22. Burnout and resiliency
Burnout and compassion fatigue in pediatric critical care providers
Critical care societies work to address burnout
Strategies for building resilience
Promoting a healthy work environment
Summary
Key references
References
Section IV: Pediatric Critical Care: Cardiovascular
23. Structure and function of the heart
Anatomic development and structure
Physiologic development and function
Key references
References
24. Regional peripheral circulation
General features
Regional circulations
Conflicting needs of regional circulations
Key references
References
25. Endothelium and endotheliopathy
Normal endothelial function
Endothelial cell dysfunction
Biomarkers of endothelial activation
Conclusions
Key references
References
26. Principles of invasive cardiovascular monitoring
Role of invasive hemodynamic monitoring
Indications for invasive hemodynamic measurements
Principles of measurement
Invasive techniques
Monitoring techniques with the pulmonary artery catheter
Catheter placement
Measurement of cardiac output
Calculation of oxygen delivery and consumption
Novel monitoring strategies
Conclusions
Key references
References
27. Assessment of cardiovascular function
Cardiovascular function
Quantity of therapy
Variables that determine tissue oxygenation
Monitoring tissue oxygenation
Assessing variables that affect the quantity of therapy
Physiology of the patient with a single ventricle
Key references
References
28. Cardiac failure and ventricular assist devices
Pediatric heart failure
Mechanical circulatory support in pediatric patients
Extracorporeal life support
Ventricular assist devices
Indications and management
Basic management of ventricular assist device patients
Ventricular assist device—congenital heart disease and single-ventricle physiology
Outcomes
Current perspective and future directions
Conclusions
Key references
References
29. Echocardiographic imaging
Components of the examination
Modalities
Structural congenital heart disease and intracardiac shunting
Valve anatomy and function
Ventricular function
Pulmonary hypertension
Pericardial effusion
Intracardiac vegetations and thrombi
Kawasaki disease and coronary artery anomalies
Intravascular catheters
Balloon atrial septostomy
Extracorporeal membrane oxygenation and ventricular assist devices
Key references
References
30. Diagnostic and therapeutic cardiac catheterization
Catheterization laboratory environment
Diagnostic cardiac catheterization
Therapeutic cardiac catheterization
Risks and complications
Cardiac catheterization and extracorporeal membrane oxygenation
Conclusion
Key references
References
31. Pharmacology of the cardiovascular system
Mechanisms of response
Sympathomimetic amines
Bipyridines
Digitalis glycosides
Conclusion
Key references
References
32. Cardiopulmonary interactions
Effects of ventilation on circulation
Effects of cardiovascular function on respiration
Key references
References
33. Disorders of cardiac rhythm
Classification of arrhythmias
Approach to diagnosis
Treatment of rhythm disturbances
Approach to therapy
Specific arrhythmias
Key references
References
34. Shock states
Definition and physiology
Functional classification and common underlying etiologies
Multisystem effects of shock
Monitoring
Treatment
Specific shock state therapy considerations
Other therapies
Summary
Key references
References
35. Pediatric cardiopulmonary bypass
Background
Equipment and preparation for cardiopulmonary bypass
Cardiopulmonary bypass
Key references
References
36. Critical care after surgery for congenital cardiac disease
Neonatal considerations
Preoperative care
Postoperative care
Critical care management of selected specific lesions
Summary
Key references
References
37. Cardiac transplantation
Background
Indications for transplant
Transplant evaluation
Transplant listing
Management of the potential heart transplant recipient
Critical care management of the orthotopic heart transplant recipient
Complications of immunosuppression in heart transplant recipients that occur in the pediatric intensive care unit
Future management strategies for critical care of infants and children with cardiopulmonary failure
Key references
References
38. Physiologic foundations of cardiopulmonary resuscitation
Mechanisms of blood flow
Rate and duty cycle
Newer cardiopulmonary resuscitation techniques
Pharmacology
Management of ventricular fibrillation
Future directions
Key references
References
39. Performance of cardiopulmonary resuscitation in infants and children
Four phases of cardiac arrest
Epidemiology of pediatric cardiac arrest
Optimizing blood flow during cardiopulmonary resuscitation
Pediatric cardiopulmonary resuscitation targets
Airway and breathing management during cardiopulmonary resuscitation
Physiologic targets
Medications used to treat cardiac arrest
Postarrest interventions
Other considerations
Controversies in pediatric cardiac arrest management
Summary
Key references
References
Section V: Pediatric Critical Care: Pulmonary
40. Structure and development of the upper respiratory system
Developmental anatomy of the upper airway
Anatomy and physiology of the upper airway
Key references
41. Structure and development of the lower respiratory system
Lower respiratory system
Lung circulation
Summary
Key references
References
42. Physiology of the respiratory system
Physiology of the respiratory system
Gas exchange
Key references
References
43. Noninvasive respiratory monitoring and assessment of gas exchange
Pulse oximetry
Principles of pulse oximetry
Validation
Sources of error
Probe placement
Tissue oximetry
Near-infrared spectroscopy
Capnometry and capnography
Operating principles of capnometry
Physiologic basis
Differential diagnosis of abnormal capnograms
Clinical applications
Transcutaneous monitoring
Oxygen monitoring
Carbon dioxide monitoring
Conclusion
Key references
References
44. Overview of breathing failure
Physiology of breathing
Controls of breathing
Breathing failure
Conclusion
Key references
References
45. Ventilation/perfusion inequality
Distribution of ventilation
Distribution of perfusion
Fractal model of pulmonary blood flow and ventilation
VA/Q abnormalities in pulmonary disease
Therapeutic considerations
Key references
References
46. Mechanical dysfunction of the respiratory system
Pump dysfunction and failure
Therapeutic maneuvers to improve mechanical dysfunction of the respiratory system
Key references
References
47. Diseases of the upper respiratory tract
Anatomy and physiology
Diagnosis and management
Congenital malformations of the upper airway
Neoplasms of upper airway disease
Croup
Epiglottitis
Bacterial tracheitis
Peritonsillar abscess
Retropharyngeal abscess
Iatrogenic and acquired disorders of the upper airway
Pediatric tracheostomy
Foreign body aspiration
Burn injury to the upper airway
Airway trauma
Key references
References
48. Pediatric acute respiratory distress syndrome and ventilator-associated lung injury
Clinical features: Pathophysiology
Definition
Epidemiology
Pathobiology
Ventilator management
Ventilator-associated lung injury
Extracorporeal life support
Key references
References
49. Acute viral bronchiolitis
Microbiology
Epidemiology and risk factors
Pathophysiology
Clinical features and diagnosis
Prevention
Treatment
Complications
Key references
References
50. Asthma
Epidemiology and risk factors
Pathophysiology
Clinical assessment
Laboratory data
Electrocardiography
Spirometry
Treatment
Management in the intensive care unit
Mechanical ventilation
Antibiotics
Bronchoscopy
Extracorporeal life support
Prognosis
Key references
References
51. Neonatal pulmonary disease
Acute respiratory disorders
Immature respiratory control
Pulmonary malformations
Nonpulmonary causes of respiratory distress
Neonatal chronic lung disease of prematurity: Bronchopulmonary dysplasia
Key references
References
52. Pneumonitis and interstitial disease
Pathogenesis
Pathophysiology
Diagnosis
Bacterial pneumonitis
Viral pneumonitis
Fungal pneumonitis
Primary pulmonary fungi
Opportunistic pulmonary mycoses
Pneumocystis jirovecii pneumonia
Chemical pneumonitis
Idiopathic interstitial lung disease
Pediatric pulmonary hemorrhage
Summary
Key references
References
53. Diseases of the pulmonary circulation
Definition and classification
Pathology of pulmonary hypertension
Diagnostic evaluation of pulmonary hypertension/pulmonary vascular disease
Pharmacotherapy
Pulmonary hypertension in the context of specific diseases
Acute pulmonary hypertension crisis/right ventricular failure
Right ventricular dysfunction in pulmonary hypertension
Recent advances in molecular mechanisms and novel therapeutic targets in pulmonary hypertension
Long-term outcomes of patients with pulmonary vascular disease
Future directions and perspectives
Key references
References
54. Mechanical ventilation and respiratory care
Applied respiratory physiology
Indications for mechanical ventilation
Design and functional characteristics of ventilators
Ventilation for selected underlying pathophysiology
Patient-ventilator asynchrony
High-frequency ventilation
Adverse effects of mechanical ventilation
Specialty gases
Respiratory care during mechanical ventilation
Weaning from mechanical ventilation and extubation
Key references
References
55. Noninvasive ventilation in the pediatric intensive care unit
Epidemiology
Physiology and application of noninvasive ventilation
Patient selection
Patient monitoring and complications
Sedation during noninvasive ventilation
Failure of noninvasive ventilation
Long-term use of noninvasive ventilation
Key references
References
56. Extracorporeal life support
A trip around the extracorporeal membrane oxygenation circuit
Patient populations treated with extracorporeal life support
Patient selection criteria
Physiology of extracorporeal life support: Gas exchange and oxygen delivery
Patient management on extracorporeal membrane oxygenation
Weaning from extracorporeal membrane oxygenation
Complications from extracorporeal membrane oxygenation
Outcomes from extracorporeal life support
Future of extracorporeal membrane oxygenation
Key references
References
57. Pediatric lung transplantation
Indications
Contraindications
Survival and outcomes
Evaluation of the donor
Surgical approach
Presurgical management in the intensive care unit
Postsurgical management
Immunosuppression
Immunobiology
Rejection
Chronic lung allograft dysfunction
Summary
Key references
References
Section VI: Pediatric Critical Care: Neurologic
58. Structure, function, and development of the nervous system
Major cell types
Intercellular communication in the nervous system
Neurotransmitter systems
Major anatomic organization of the nervous system
Blood-brain barrier
Ventricles and cerebrospinal fluid
Vasculature in the central nervous system
Emerging characterization of the “lymphatic” circulation in the central nervous system
Developmental processes relevant to pediatric critical care medicine
New insights in neurodevelopment relevant to pediatric critical care
Conclusion
Key references
References
59. Critical care considerations for common neurosurgical conditions
Hydrocephalus
Arachnoid cysts
Chiari malformations
Dandy-walker complex
Encephalocele and meningocele
Conclusions
Key references
References
60. Neurologic assessment and monitoring
Nursing role in the recognition of neurologic complications of critical illness
Anticipatory planning for new neurologic deficits
History and assessment of risk factors
Iatrogenic complications of pharmacotherapy
Vital signs
General physical exam
Importance of observation in the neurologic exam
Assessment of level of consciousness and mental status
Fundoscopic examination
Cranial nerve examination
Approach to the motor exam
Reflexes
Cerebellar function and gait evaluation
Sensory examination
Abnormal movements or altered sensorium in the child with static encephalopathy
Distinguishing functional deficits from nonorganic pathology in the pediatric intensive care unit
Goals of the neurologic examination in the pediatric intensive care unit
Neuroimaging
Integrating neurologic monitoring data
Key references
References
61. Neuroimaging
Imaging modality overview
Hypoxic ischemic injury and germinal matrix hemorrhage in the neonate
Imaging of neurovascular disorders
Intracranial hemorrhage and vascular malformations
Central nervous system infection
Demyelinating disease
Trauma
Hydrocephalus
Tumor
Seizures
Conclusion
Key references
References
62. Coma and depressed sensorium
Definitions
Epidemiology
Relevance
Physiology/pathophysiology
Etiology
Initial treatment of the comatose child
History
Physical examination
Herniation syndromes
Diagnostic evaluation
Treatment goals: Initial and ongoing
Prognosis and outcomes
Key references
References
63. Intracranial hypertension and monitoring
Clinical background
Physiology of the intracranial vault
Measurement of intracranial pressure
Clinical analysis of intracranial pressure
Supplementing intracranial pressure monitoring with other monitoring modalities
Mechanism of brain injury in intracranial hypertension
Intracranial pressure monitoring and the postinsult natural history of injury
Key references
References
64. Status epilepticus
Definition of status epilepticus
Outcome of status epilepticus
Status epilepticus classification
Seizure types and classification
Seizures in the pediatric intensive care unit
Posttraumatic epilepsy
First- and second-line pharmacotherapy
Management of refractory status epilepticus and other forms of treatment-resistant status epilepticus
Surgical options
Changing goals of therapy in prolonged SRSE/FIRES
Key references
References
65. Hypoxic-ischemic encephalopathy
Epidemiology
Mechanisms of hypoxic-ischemic brain injury
Clinical pathophysiology
Clinical outcome and prognostication after pediatric cardiac arrest
Response of the immature brain to cardiac arrest
Treatment after cardiac arrest
Current and novel therapies and interventions
Futuristic approaches
Summary
Key references
References
66. Pediatric stroke and intracerebral hemorrhage
Significance
Arterial ischemic stroke
Etiologies and risk factors
Pathophysiology
Presentation
Neuroimaging
Laboratory evaluation
Treatment
Cerebral sinus venous thrombosis
Spontaneous intracranial hemorrhage
General care of the child with intracerebral hemorrhage
Conclusion
Key references
References
67. Central nervous system infections and related conditions
Bacterial meningitis
Subdural empyema
Brain abscess
Viral meningoencephalitis
Acute disseminated encephalomyelitis
Key references
References
68. Acute neuromuscular disease and disorders
Guillain-Barré syndrome
Myasthenia gravis
Congenital and transient neonatal myasthenia gravis
Tick paralysis
Periodic paralyses
Hypokalemic periodic paralysis
Hyperkalemic periodic paralysis
Botulism
Diphtheria
Acute intermittent porphyria
Spinal muscular atrophy
Poliomyelitis
Polio-like syndromes
Organophosphate and carbamate poisoning
Key references
References
69. Acute rehabilitation and early mobility in the pediatric intensive care unit
Rehabilitation team members in the pediatric intensive care unit
Important considerations for mobility in the pediatric intensive care unit
Acute rehabilitation across the intensive care unit continuum
Implementation of acute rehabilitation in the pediatric intensive care unit: Evidence and strategies
Summary
Key references
References
Section VII: Pediatric Critical Care: Renal
70. Renal structure and function
Renal anatomy
Renal development
Renal vasculature
The nephron
Tubular anatomy
Summary
Key references
References
71. Fluid and electrolyte issues in pediatric critical illness
Sodium
Hyponatremia
Hypernatremia
Potassium
Hyperkalemia
Magnesium
Hypomagnesemia
Hypermagnesemia
Calcium
Hypocalcemia
Hypercalcemia
Hypophosphatemia
Hyperphosphatemia
Key references
References
72. Acid-base disorders
Overview of acid-base physiology
Tools for interpreting acid-base disorders
Clinical approach to disorders of acid-base balance
Metabolic acidosis
Metabolic alkalosis
Respiratory acid-base derangements
Mixed acid-base derangements
Summary
Key references
References
73. Tests of kidney function in children
Assessment of glomerular function and injury
Renal clearance techniques
Plasma disappearance techniques
Renal inulin clearance compared with other glomerular filtration rate measurement techniques
Estimating equations
Neonatal renal function
Biomarkers of acute kidney injury and the next generation
Tubular function
Integration of kidney function assessment in critical care
Key references
References
74. Glomerulotubular dysfunction and acute kidney injury
Physiology of glomerular filtration
Glomerulotubular dysfunction
Treatment of acute kidney injury
Acute kidney injury: Clinical impact
Specific kidney diseases that may lead to acute kidney injury
Conclusions
Key references
References
75. Pediatric renal replacement therapy in the intensive care unit
Basic physiology of dialysis and ultrafiltration
Peritoneal dialysis
Intermittent hemodialysis
Continuous renal replacement therapy
Outcomes of renal replacement in critically ill children
Advances in pediatric renal replacement therapies
Summary
Key references
References
76. Pediatric renal transplantation
Donor source: Living donor versus deceased donor
Timing of transplantation
Histocompatibility
Surgical procedure
Posttransplantation monitoring
Recovery of renal function
Immunosuppression
Infection surveillance and prevention
Posttransplantation complications
References
77. Renal pharmacology
Kidney function and drug disposition
Drug dosing in kidney disease
Drug dosing in dialysis
Kidney as a therapeutic target: Diuretics and agents regulating renal excretion
Medications for the prevention/reversal of acute kidney injury
Key references
References
78. Acute severe hypertension
Terminology
Etiology
Pathophysiology
Endothelial homeostasis
Sympathetic nervous system activation
Renin-angiotensin-aldosterone system
Nitric oxide
Volume overload
Clinical presentation
Pharmacologic therapy
Special situations
Summary
Key references
References
Section VIII: Pediatric Critical Care: Metabolic and Endocrine
79. Cellular respiration
Pathways of cellular respiration
Impaired cellular respiration in critical illness
Clinical assessment of oxygen utilization
Lactate
Venous oxygen saturation
Microdialysis
Near-infrared spectroscopy
Optical spectroscopy
Tissue oxygen tension
Magnetic resonance spectroscopy
Blood mitochondrial DNA
Mitochondrial- and bioenergetic-targeted therapy in critical illness
Antioxidants
Glycemic control
Substrate provision
Mitochondrial biogenesis and mitophagy
Membrane stabilizers
Hibernation
Mitochondrial transplantation
Conclusions
Key references
References
80. Biology of the stress response
Definitions and background
Stress system primary elements
Stress response
Stress response in critical illness
Recommendations and conclusions
Key references
References
81. 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
Metabolic acidosis
Hypoglycemia
Cardiomyopathy and inborn errors of metabolism
Metabolic myopathies and rhabdomyolysis
Neonatal screening
Conclusions
Key references
References
82. Progress towards precision medicine in critical illness
Genetic variation and critical illness
Transcriptomics and critical illness
Plasma biomarkers and critical illness
Summary
Key references
References
83. Molecular foundations of cellular injury
Caspase-dependent forms of regulated cell death
Caspase-independent forms of regulated cell death
Cell death as a therapeutic target
Key references
References
84. Endocrine emergencies
Hypothalamic-pituitary-adrenal axis
Cortisol biochemistry and biology
Actions of cortisol
Assessing the cortisol stress response
Adrenal insufficiency in the intensive care unit
Corticosteroid side effects
Alterations of glucose homeostasis
Hyperglycemia
Glucose measurement
Hypoglycemia
Alterations of thyroid hormone in critical illness
Key references
References
85. Diabetic ketoacidosis
Etiology, definition, and presentation
Epidemiology
Management guidelines (fig. 85.1)
Diabetic ketoacidosis–associated complications
Healthcare costs associated with diabetic ketoacidosis
Key references
References
Section IX: Pediatric Critical Care: Hematology and Oncology
86. Structure and function of the hematopoietic organs
Normal peripheral blood values
Structure of the bone marrow
Function of the bone marrow: Hematopoiesis
Lymphopoiesis
Key references
References
87. The erythron
Oxygen transport
Carbon dioxide transport
Biophysical factors influencing gas transport
Regulation of blood flow distribution by red blood cells
Summary
Key references
References
88. Hemoglobinopathies
Globin gene loci
Sickle cell disease
Thalassemia
Key references
References
89. Coagulation and coagulopathy
Overview of hemostasis
Approach to the patient with an identified or suspected coagulation disorder
Abnormal hemostasis in critical illness
Iatrogenic coagulopathy
New oral anticoagulants
Platelet disorders
Summary
Key references
References
90. Thrombosis in pediatric critical care
Developmental hemostasis
Etiology and epidemiology
Clinical features
Diagnosis
Management
Conclusions
Key references
References
91. Transfusion medicine
Red blood cells
Red blood cell transfusion: Why and why not
Transfusion of red blood cells: Indications (when)
Types of red blood cell units
Transfusion of red blood cells: How
Plasma
Platelets
Whole blood
Cryoprecipitate
Transfusions reactions and complications
Conclusion
Key references
References
92. Hematology and oncology problems
Hematologic emergencies
Oncologic emergencies
Key references
References
93. Critical illness in children undergoing hematopoietic progenitor cell transplantation
Sources of hematopoietic progenitor cells and identification of donors
Indications and outcomes
Transplant procedure
Key references
References
Section X: Pediatric Critical Care: Gastroenterology and Nutrition
94. Gastrointestinal structure and function
Intestinal structure, digestion, absorption of nutrients, water, and electrolytes
Water and solute transport across intestinal epithelium
Pancreas
Hepatobiliary system
Key references
References
95. Disorders and diseases of the gastrointestinal system
Gastrointestinal evaluation of the critically ill child
Life-threatening complications of gastrointestinal disorders
Key references
References
96. Acute liver failure
Acute liver failure
Pediatric intensive care unit complications and management
Key references
References
97. Hepatic transplantation
Current state of pediatric liver transplantation
Indications for liver transplant
Liver transplant evaluation
Pretransplant considerations
Transplant considerations
Liver transplant procedure
Complications of liver transplantation
Posttransplant management in the intensive care unit
Immunosuppression
Liver transplant outcomes
Retransplantation
Key references
References
98. Acute abdomen
Anatomic and physiologic considerations
Physical examination of the abdomen
Laboratory tests
Imaging options
Abdominal conditions requiring treatment in the intensive care unit
Other specific conditions
Abdominal compartment syndrome
Intraabdominal abscess
Intestine as a source of sepsis
Key references
References
99. Nutrition of the critically ill child
Malnutrition in the pediatric critically ill patient
Assessment of nutritional status
Body composition
Biochemical assessment
Underfeeding and overfeeding in the pediatric intensive care unit
Lipid requirements
Micronutrient requirements
Refeeding syndrome
Enteral nutrition in critically ill children
Parenteral nutrition
Obese critically ill children
Revised guidelines for pediatric critical care nutrition
Conclusions
Key references
References
Section XI: Pediatric Critical Care: Immunity and Infection
100. Innate immunity
Components of innate immune system
Regulation of the innate immune response
Clinical manifestations of the innate immune response in the intensive care unit
Therapeutic targets of the innate immune system
Therapeutic questions arising from the innate immune system
Conclusion
Key references
References
101. Adaptive immunity
Lymphocytes develop to recognize specific antigens
B-cell activation leads to antibody secretion: The humoral immune response
Effector T cells direct cell-mediated immunity
Additional T-cell subtypes
Adaptive immunity in the intensive care unit
Summary
Key references
References
102. Critical illness and the microbiome
General concepts in the field of microbiome science
Studying the microbiome
Development of the microbiome in children
Development of intensive care unit dysbiosis in children
Known and potential clinical consequences of intensive care unit dysbiosis
Microbiome-based therapeutics in the intensive care unit
Monitoring the intensive care unit microbiome
Future of microbiome science
Key references
References
103. Congenital immunodeficiency
Basic framework for understanding the immune system
Specific disorders likely to be encountered in the pediatric intensive care unit
Radiation-sensitive disorders: Ataxia telangiectasia and nijmegen breakage syndrome
Laboratory evaluation of the immune system
Treatment of immune system disorders
Key references
References
104. Acquired immune dysfunction
Immune dysfunction during sepsis, malnutrition, HIV/AIDS, and other critical illness states
Malnutrition and immune dysfunction
HIV infection and AIDS
Pulmonary complications and respiratory failure
Upper airway obstruction
Cardiovascular complications
Abdominal complications
Hematologic and malignancy complications
Central nervous system complications
Occupational human immunodeficiency virus exposure
Other selected causes of secondary immune dysfunction
Neonatal period
Key references
References
105. Immune balance in critical illness
Innate and adaptive immunity
Proinflammatory and antiinflammatory responses
CARS and clinical outcomes
Immunomodulation in the pediatric intensive care unit
Immune monitoring in the intensive care unit
Conclusion
Key references
References
106. Pediatric rheumatologic disease
Rheumatologic diseases: Overview
Rheumatologic diseases: Clinical presentation, diagnosis, and treatment
Autoinflammatory syndromes
Rheumatologic diseases: Conditions and complications in the intensive care unit
Treatment-related complications of rheumatologic diseases
Summary
Key references
References
107. Bacterial and fungal infections
Bacterial infections in the intensive care unit
General considerations for antibiotic therapy
Antibiotic classes
Antibiotic resistance and treatment of multidrug-resistant pathogens
Fungal infections and antifungal agents
Antimicrobial stewardship
Summary
Key references
References
108. Life-threatening viral diseases and their treatment
Myocarditis
Acute liver failure
Viral pneumonia/pneumonitis
Central nervous system infections
Emerging viral diseases
Key references
References
109. Healthcare-associated infections
Epidemiology
Risk factors
Pathogen transmission and isolation practices
Infection prevention strategies
Specific healthcare-associated infections in the pediatric intensive care unit
Key references
References
110. Pediatric sepsis
Epidemiology
Definitions
Clinical presentation
Pathogenesis
Genomic medicine and sepsis
Treatment strategies
The case for more effective stratification in pediatric septic shock
Conclusion
Key references
References
111. Multiple-organ dysfunction syndrome
Pathophysiology and targeted therapies
Mitochondrial dysfunction
Innate and adaptive immune response
Microcirculatory dysfunction, ischemia-reperfusion injury
Epithelial dysfunction
Neurohumoral response
Multiple-organ dysfunction syndrome phenotypes
Multiple-organ dysfunction syndrome definitions
Multiple-organ dysfunction syndrome scoring
Epidemiology
Time course and outcomes
Conclusions and research perspectives
Key references
References
Section XII: Pediatric Critical Care: Environmental Injury and Trauma
112. Bites and stings
Snakebites
Spider bites
Scorpion stings
Hymenoptera stings (bees, wasps, and ants)
Key references
References
113. Hyperthermic injury
Definitions
Epidemiology
Pathophysiology of heat-related illnesses
Clinical features of heat stroke
Key references
References
114. Accidental hypothermia
Physiology
Central nervous system
Cardiovascular
Respiratory
Renal
Coagulation
Treatment
Outcome
Key references
References
115. Drowning
Definitions
Epidemiology
Pathophysiologic considerations
Management
Prognosis
Key references
References
116. Burn and inhalation injury
Types of burns
Normal skin anatomy
Depth and size of burn
Prehospital and early management
Transfer to burn centers
Pain management
Resuscitation
Treatment of burn wounds
Inhalation injury
Nutrition
Rehabilitation
Reconstructions
Prevention
Key references
References
117. Evaluation, stabilization, and initial management after trauma
Prehospital care and trauma team activation
Trauma resuscitation
Primary survey
Secondary survey
Diagnostic assessment
Emergency department thoracotomy
Stabilization and definitive care
Conclusions
Key references
References
118. Traumatic brain injury
Epidemiology
Pathophysiology
History
Signs and symptoms
Initial resuscitation
Diagnostic studies and monitoring modalities
Treatment in the pediatric intensive care unit
Miscellaneous
Linking rehabilitation and acute care
Outcomes
Conclusion
Key references
References
119. Pediatric thoracic trauma
Epidemiology and prevention
Anatomic and physiologic considerations
Initial resuscitation and diagnosis
Chest wall injury
Lung and airway injury
Traumatic asphyxia
Cardiac injuries
Esophageal injury
Chylothorax
Diaphragmatic injury
Conclusions
Key references
References
120. Pediatric abdominal trauma
Mechanisms and patterns of injury
Evaluation and resuscitation
Management of specific abdominal injuries
Key references
References
121. Child abuse
Case example
Abuse vs. accident?
Epidemiology
Medical vs. forensic assessment
Abusive head trauma
Abdominal trauma
Alternative explanations of injuries
Mandated reporting
Approach to parents
Coroner cases
Conclusions
Key references
References
Section XIII: Pediatric Critical Care: Pharmacology and Toxicology
122. Principles of drug disposition
Clinical pharmacokinetics
Clinical pharmacodynamics
Determinants of effective therapy
Pharmacokinetic processes
Pharmacodynamics changes
Critical care therapeutics
Conclusion
Key references
References
123. Molecular mechanisms of drug actions
Targets for drug action
Receptor type and regulation
Signal transduction mechanisms: Intracellular messengers and effectors
Multiple drug targets within an organ system: The myocardium
Drug response and genetic polymorphisms
Drug response and development
Drug response and disease
Conclusion
Key references
References
124. Adverse drug reactions and drug-drug interactions
Adverse drug reactions by organ system
Drug-drug interactions
Key references
References
125. Principles of toxin assessment and screening
Common agents involved in serious pediatric poisonings
Resources for the clinician
General assessment of the poisoned patient
Additional investigations
Summary
Key references
References
126. Toxidromes and their treatment
Opioids
Sedative hypnotics
Sympathomimetic agents
Anticholinergic agents
Cholinergic agents
Methemoglobinemia
Xenobiotic-induced hyperthermia
Metabolic acidosis with increased anion gap
Acetaminophen (paracetamol)
Key references
References
Section XIV: Pediatric Critical Care: Anesthesia Principles in the Pediatric Intensive Care Unit
127. Airway management
Anatomic considerations
Basic airway management
Establishing a functional airway
Endotracheal intubation
Adjunctive airway approaches
Extubation
Complications of endotracheal intubation
Special circumstances
Key references
References
128. Anesthesia effects on organ systems
Anesthetic agents and regional anesthesia methods
Neurologic effects
Cardiovascular effects
Respiratory, gastrointestinal, and renal effects
Key references
References
129. Anesthesia principles and operating room anesthesia regimens
Preoperative evaluation
Nothing-by-mouth guidelines
Preoperative medication
Monitoring
Pharmacology of anesthetic agents
Intraoperative anesthetic care
Postoperative care
Conclusions
Key references
References
130. Malignant hyperthermia
Pathophysiology
Genetics
Clinical recognition of malignant hyperthermia
Management of an episode of malignant hyperthermia
Testing for malignant hyperthermia susceptibility
Disorders associated with malignant hyperthermia
Malignant Hyperthermia Association and Registry
Key references
References
131. Neuromuscular blocking agents
Neuromuscular junction
Neuromuscular blocking agents: Depolarizing agents
Summary: Neuromuscular blocking agents in the PICU
Key references
References
132. Sedation and analgesia
Posttraumatic stress disorder
Sedation scoring and assessment
Opioids and analgesia in the pediatric intensive care unit
Specific opioid agonists
Opiate antagonists
Incidental pain syndromes in the pediatric intensive care unit
Opiate tolerance
Benzodiazepines
Specific benzodiazepines
Flumazenil
Other agents for sedation in the pediatric intensive care unit
Neuroleptic malignant syndrome
Baclofen
Cannabis
Dexmedetomidine
Propofol
Ketamine
Etomidate
Inhalational anesthetic agents
Inhalation agent withdrawal syndrome
Sedation for children with preexisting cognitive impairment
Apoptosis and neurocognitive effects of anesthetic agents
Sedation-related complications
Pharmacoeconomics of analgesia and sedation in the pediatric intensive care unit
Key references
References
133. Tolerance, dependency, and withdrawal
History of tolerance and withdrawal in medical practice
Clinical signs and symptoms of withdrawal
Limitation of the development of tolerance and physical dependency
Incidence of tolerance and physical dependency
Weaning from sedative and analgesic agents
Summary
Key references
References
134. Pediatric delirium
Background
Etiology
Epidemiology
Risk factors
Outcomes
Clinical presentation
Diagnosis
Treatment
Underlying illness
Iatrogenic factors
Environment
Pharmacotherapy
Prevention
Conclusion
Key references
References
135. Procedural sedation for the pediatric intensivist
Differences between outpatient and inpatient sedation
Outpatient procedural sedation training during pediatric critical care fellowship
Sedation team structure
Classification of sedation
Equipment, monitoring, and rescue drugs
Sedation prescreening
Considerations in choosing commonly used medications
Nonpharmacologic approach to outpatient sedation
Sedation adverse events
Key references
References
Section XV: Pediatric Critical Care: Board Review Questions
136. Board review questions
Chapter 1: History of pediatric critical care medicine
Chapter 2: High-reliability pediatric intensive care unit: role of intensivist and team in obtaining optimal outcomes
Chapter 3: Critical communication in the pediatric intensive care unit
Chapter 4: Professionalism in pediatric critical care
Chapter 5: Leading and managing change in the pediatric intensive care unit
Chapter 7: Fostering a learning healthcare environment in the pediatric intensive care unit
Chapter 8: Challenges of pediatric critical care in resource-poor settings
Chapter 9: Public health emergencies and emergency mass critical care
Chapter 10: Lifelong learning in pediatric critical care
Chapter 11: Essential concepts in clinical trial design and statistical analysis
Chapter 12: Prediction tools for short-term outcomes following critical illness in children
Chapter 13: Pediatric critical care transport
Chapter 14: Pediatric vascular access and centeses
Chapter 15: Ultrasonography in the pediatric intensive care unit
Chapter 16: Patient- and family-centered care in the pediatric intensive care unit
Chapter 17: Pediatric critical care ethics
Chapter 18: Ethical issues around death and dying
Chapter 19: Palliative care in the pediatric intensive care unit
Chapter 20: Organ donation process and management of the organ donor
Chapter 21: Long-term outcomes following critical illness in children
Chapter 22: Burnout and resiliency
Chapter 23: Structure and function of the heart
Chapter 24: Regional and peripheral circulation
Chapter 25: Endothelium and endotheliopathy
Chapter 26: Principles of invasive cardiovascular monitoring
Chapter 27: Assessment of cardiovascular function
Chapter 28: Cardiac failure and ventricular assist devices
Chapter 29: Echocardiographic imaging
Chapter 30: Diagnostic and therapeutic cardiac catheterization
Chapter 31: Pharmacology of the cardiovascular system
Chapter 32: Cardiopulmonary interaction
Chapter 33: Disorders of cardiac rhythm
Chapter 34: Shock states
Chapter 35: Pediatric cardiopulmonary bypass
Chapter 36: Critical care after surgery for congenital cardiac disease
Chapter 37: Cardiac transplantation
Chapter 38: Physiologic foundations of cardiopulmonary resuscitation
Chapter 39: Performance of cardiopulmonary resuscitation in infants and children
Chapter 40: Structure and development of the upper respiratory system
Chapter 41: Structure and development of the lower respiratory system
Chapter 42: Physiology of the respiratory system
Chapter 43: Noninvasive respiratory monitoring and assessment of gas exchange
Chapter 44: Overview of breathing failure
Chapter 45: Ventilation/perfusion inequality
Chapter 46: Mechanical dysfunction of the respiratory system
Chapter 47: Diseases of the upper respiratory tract
Chapter 48: Pediatric acute respiratory distress syndrome and ventilator-associated lung injury
Chapter 49: Acute viral bronchiolitis
Chapter 50: Asthma
Chapter 51: Neonatal pulmonary disease
Chapter 52: Pneumonitis and interstitial disease
Chapter 53: Diseases of the pulmonary circulation
Chapter 54: Mechanical ventilation and respiratory care
Chapter 55: Noninvasive ventilation in the pediatric intensive care unit
Chapter 56: Extracorporeal life support
Chapter 57: Pediatric lung transplantation
Chapter 58: Structure, function, and development of the nervous system
Chapter 59: Critical care considerations for common neurosurgical conditions
Chapter 60: Neurologic assessment and monitoring
Chapter 61: Neuroimaging
Chapter 62: Coma and depressed sensorium
Chapter 63: Intracranial hypertension and monitoring
Chapter 64: Status epilepticus
Chapter 65: Anoxic ischemic encephalopathy
Chapter 66: Pediatric stroke and intracerebral hemorrhage
Chapter 67: Central nervous system infections and related conditions
Chapter 68: Acute neuromuscular disease and disorders
Chapter 70: Renal structure and function
Chapter 71: Fluid and electrolyte issues in pediatric critical illness
Chapter 72: Acid-base balance in critical illness
Chapter 73: Tests of kidney function in children
Chapter 74: Glomerulotubular dysfunction and acute kidney injury
Chapter 75: Pediatric renal replacement therapy in the intensive care unit
Chapter 76: Pediatric renal transplantation
Chapter 77: Renal pharmacology
Chapter 78: Hypertensive urgencies and emergencies
Chapter 79: Cellular respiration
Chapter 80: Biology of the stress response
Chapter 81: Inborn errors of metabolism
Chapter 82: Genetic variation in health and disease
Chapter 83: Molecular foundations of cellular injury
Chapter 84: Endocrine emergencies
Chapter 85: Diabetic ketoacidosis
Chapter 86: Structure and function of the hematopoietic organs
Chapter 87: The erythron
Chapter 88: Hemoglobinopathies
Chapter 89: Coagulation and coagulopathy
Chapter 90: Thrombosis in pediatric critical care
Chapter 91: Transfusion medicine
Chapter 92: Hematology and oncology problems
Chapter 93: Critical illness in children undergoing hematopoietic progenitor cell transplantation
Chapter 94: Gastrointestinal structure and function
Chapter 95: Disorders of the gastrointestinal system
Chapter 96: Acute liver failure
Chapter 97: Hepatic transplantation
Chapter 98: Acute abdomen
Chapter 99: Nutrition of the critically ill child
Chapter 100: Innate immunity
Chapter 101: Adaptive immunity
Chapter 102: Critical illness and the microbiome
Chapter 103: Congenital immunodeficiencies
Chapter 104: Acquired immune dysfunction
Chapter 105: Immune balance in critical illness
Chapter 106: Pediatric rheumatologic disease
Chapter 107: Bacterial and fungal infections
Chapter 108: Life-threatening viral diseases and their treatment
Chapter 109: Healthcare-associated infections
Chapter 110: Pediatric sepsis
Chapter 111: Multiple organ dysfunction syndrome
Chapter 112: Bites and stings
Chapter 113: Hyperthermic injury
Chapter 114: Hypothermic injury
Chapter 115: Drowning
Chapter 116: Burn and inhalation injuries in children
Chapter 117: Evaluation, stabilization, and initial management after trauma
Chapter 118: Traumatic brain injury
Chapter 119: Pediatric thoracic trauma
Chapter 120: Pediatric abdominal trauma
Chapter 121: Child abuse
Chapter 122: Principles of drug disposition
Chapter 123: Molecular mechanisms of drug action
Chapter 124: Adverse drug reactions and drug-drug interactions
Chapter 125: Principles of toxin assessment and screening
Chapter 126: Toxidromes and their treatment
Chapter 127: Airway management
Chapter 128: Anesthesia effects on organ systems
Chapter 129: Anesthesia principles and operating room anesthesia regimens
Chapter 130: Malignant hyperthermia
Chapter 131: Neuromuscular blocking agents
Chapter 132: Sedation and analgesia
Chapter 133: Tolerance, dependency, and withdrawal
Chapter 134: Pediatric delirium
Chapter 135: Procedural sedation for the pediatric intensivist
Index

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Fuhrman and Zimmerman's Pediatric Critical Care

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Jerry J. Zimmerman

Alexandre T. Rotta