Cardiovascular Pediatric Critical Illness And Injury

The development of pediatric cardiac surgical programs has had a profound effect on the s- cialty of pediatric critical care medicine, and as a result, the ? eld of pediatric cardiac intensive care is rapidly emerging as a separate subspecialty of pediatric critical care medicine. The ability to provide care for the critically ill child with congenital heart disease clearly separates pediatric intensivists from our adult colleagues. A thorough understanding and knowledge of the unique physiology of the child with congenital heart disease are therefore absolutely crucial for anyone working in the pediatric intensive care unit. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pe- atric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley v Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU).

The principal role of the respiratory system is to permit ef? cient exchange of respiratory gases (O and CO ) with the environment. The respiratory system is unique in that it is constantly 2 2 exposed to a barrage of foreign substances from both the internal environment (at any one point in time, approximately one-half of the cardiac output is received by the lungs) and the external environment (with each breath, the respiratory tract is exposed to pollens, viruses, bacteria, smoke, etc). According to the Centers for Disease Control and Prevention, diseases of the res- ratory system were the seventh and eighth leading causes of deaths in children aged 1 to 19 years in 2003 [1]. Dr. George A. Gregory, one of the founding fathers of pediatric critical care me- cine, once estimated that acute respiratory failure accounts for nearly 50% of all admissions to the pediatric intensive care unit (PICU) [2]. Just as important are the many diseases that affect the respiratory system that are not associated with acute respiratory failure, but nevertheless constitute a major portion of the practice of pediatric critical care medicine, some of which account for signi? cant morbidity and mortality [3]. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P.

The care of the critically ill or injured child begins with timely, prompt, and aggressive res- citation and stabilization. Ideally, stabilization should occur before the onset of organ failure in order to achieve the best possible outcomes. In the following pages, an international panel of experts provides an in-depth discussion of the early recognition, resuscitation, and stabilization of the critically ill or injured child. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley V Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU). The head of the pediatrics clerkship was kind enough to let me have a few days off around the time of the delivery—my wife, Cathy, was 2 weeks past her due date and had been scheduled for elective induction.

The topics in this issue represent the most current research areas of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). The CPCCRN is a national pediatric critical care research network that is charged with investigating the efficacy of treatment and management strategies to care for critically ill and injured children, as well as to better understand the pathophysiological basis of critical illness and injury in childhood. The proposed authors are past and present principal and co-investigators affiliated with the CPCCRN; the proposed topics represent the individual author’s area of clinical and research expertise. Each review article is an up-to-date review of the topic relevant to practicing clinicians and trainees in critical care medicine, with incorporation of the most recently published research findings pertinent to the topic, some of which may be the author’s own. The specific articles are devoted to the following topics: Cardiopulmonary resuscitation in pediatric and cardiac ICU; Approach to the critically ill pediatric trauma patient; Transfusion Decision Making in Pediatric Critical Illness; Pathophysiology and management of ARDS in children; Ventilator associate pneumonias in critically ill children; Mechanical ventilation and decision support in pediatric intensive care; Inflammation, pathobiology, phenotypes and sepsis: From meningococcemia to H1N1-MRSA, to Ebola; Immune paralysis in pediatric critical care; Molecular biology of critical illness; Sedation in pediatric critical illness; Delirium in pediatric critical illness; Challenges of drug development in pediatric intensive care; Potential of All Steroid Hormone Subclasses as Adjunctive Treatment for Sepsis; Morbidity: Changing the outcome paradigm; and End-of-Life and Bereavement Care in Pediatric Intensive Care Units.

This volume provides an overview of the most important current controversies in the field of pediatric intensive care. Organized into sections based on organ systems, the text focuses on controversies surrounding disease processes of the cardiac, respiratory, gastrointestinal, hematologic / immunologic, endocrine, and neurologic systems. Each chapter reviews the pros and cons of specific management approaches through case studies and the most up-to-date evidence-based resources, and concludes with bulleted take-home points for ease of use. Written by experts in the field, Pediatric Critical Care: Current Controversies is a valuable resource for intensivists, advanced practice providers, nurses, and other health care providers involved in the care of critically-ill children.

The principal role of the respiratory system is to permit ef? cient exchange of respiratory gases (O and CO ) with the environment. The respiratory system is unique in that it is constantly 2 2 exposed to a barrage of foreign substances from both the internal environment (at any one point in time, approximately one-half of the cardiac output is received by the lungs) and the external environment (with each breath, the respiratory tract is exposed to pollens, viruses, bacteria, smoke, etc). According to the Centers for Disease Control and Prevention, diseases of the res- ratory system were the seventh and eighth leading causes of deaths in children aged 1 to 19 years in 2003 [1]. Dr. George A. Gregory, one of the founding fathers of pediatric critical care me- cine, once estimated that acute respiratory failure accounts for nearly 50% of all admissions to the pediatric intensive care unit (PICU) [2]. Just as important are the many diseases that affect the respiratory system that are not associated with acute respiratory failure, but nevertheless constitute a major portion of the practice of pediatric critical care medicine, some of which account for signi? cant morbidity and mortality [3]. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P.

The second edition of Pediatric Critical Care Medicine spans three volumes, with major sections dedicated to specific organ systems. Each major section consists of separate chapters dedicated to reviewing the specific disease processes affecting each organ system. Each chapter concludes with a comprehensive list of references, with brief, concise remarks denoting references of ‘special interest’ and ‘of interest’. Consequently, the books are unique in their comprehensive coverage of pediatric critical care and their ease of use and will be of value to those studying towards pediatric critical care examinations and those who are already qualified.

Neurologic emergencies are a common reason for admission to the pediatric intensive care unit (PICU). A thorough understanding of the diseases and disorders affecting the pediatric central nervous system is vital for any physician or healthcare provider working in the PICU. In the following pages, an international panel of experts provides an in-depth discussion on the res- citation, stabilization, and ongoing care of the critically ill or injured child with central nervous system dysfunction. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley v Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU).