Pediatric critical care medicine

✍ Scribed by Derek S. Wheeler (editor); Thomas P. Shanley (editor); Hector R. Wong (editor)

• Publisher: Springer
• Year: 2014
• Tongue: English
• Leaves: 735
• Edition: 2
• Category: Library

✦ Table of Contents

Foreword to the First Edition
Preface to the Second Edition
Preface to the First Edition
Acknowledgements
Contents
Contributors
Part I: The Respiratory System in Critical Illness and Injury
1: Applied Respiratory Physiology
Introduction
Developmental Anatomy
Developmental Mechanics of Breathing
Elastic Properties of the Lung and Chest Wall
Compliance of the Lung and Chest Wall
Airway Resistance
Lung Volumes
Physiologic Effects of Mechanical Ventilation
Maintenance of Oxygenation
Maintenance of Alveolar Ventilation
Mechanics of Ventilation
Work of Breathing
Developmental Anatomy and Physiology of the Pulmonary Circulation
Pulmonary Vascular Pressures
Distribution of Blood Flow
Pulmonary Vascular Resistance
Ventilation-Perfusion Relationships
References
2: Life-Threatening Diseases of the Upper Respiratory Tract
Introduction
Developmental Anatomy
Acute Airway Obstruction
Physiology of Airway Obstruction
Clinical Manifestations of Airway Obstruction
Infectious Disorders of the Pediatric Airway
Viral Laryngotracheobronchitis (“Croup”)
Supraglottis (“Epiglottitis”)
Bacterial Tracheitis
Retropharyngeal Abscess
Peritonsillar Abscess (“Quinsy” Tonsillitis)
Recurrent Respiratory Papillomatosis
Infectious Mononucleosis
Non-infectious Disorders of the Pediatric Airway
Obesity
Angioedema
Adenotonsillar Hypertrophy
Acquired Subglottic Stenosis
Laryngeal Neoplasms and Mediastinal Masses
Airway Trauma
Post-extubation Stridor
Foreign Body Aspiration
Inhalational Injury
Direct Trauma
References
3: Congenital Airway Anomalies
The Pediatric Airway in the PICU Setting: General Considerations
Prevention of Complications
Difficult Intubation
The Child with a Tracheotomy
Single-Stage Airway Reconstruction
Congenital Anomalies of the Airway
Retrognathia/Glossoptosis
Laryngomalacia
Vocal Cord Paralysis
Subglottic Stenosis
Posterior Laryngeal Clefts
Vascular Compression
Complete Tracheal Rings
References
4: Status Asthmaticus
Introduction
Epidemiology
Pathophysiology
Clinical Manifestations
Management
Oxygen
Systemic Corticosteroids
Inhaled Corticosteroids
Beta-Adrenergic Agonists (Table  4.4)
Epinephrine
Albuterol (Salbutamol)
Terbutaline
Isoproterenol
Ipratropium Bromide
Magnesium
Theophylline (Table  4.5)
Helium-Oxygen
Ketamine
Leukotriene Modifying Agents
Mechanical Ventilation
Volatile Anesthetics
Conclusion
References
5: Bronchiolitis
Introduction
Pathogens, Pathogenesis and Pathophysiology
Immune Response to RSV Infection
Epidemiology
Mortality
Clinical Diagnosis
Laboratory Confirmation of Bronchiolitis
Clinical Phenotype
Severity of Disease and Risk Factors
Extrapulmonary Manifestations/Effects
Therapeutic Options in PICU
Oxygen
Bronchodilators
Adrenergics: Epinephrine (Adrenaline)
Corticosteroids
Methylxanthines
Chest Physiotherapy, Nebulised Hypertonic Saline
Ribavirin
Antibiotics
Exogenous Surfactant
Helium – Oxygen (Heliox) Mixture
Inhaled Nitric Oxide (iNO)
Recombinant Human DNAse (rhDNAse)
Respiratory Support
Preventive Therapies and Treatments
RSV Immunotherapy
Vaccination
New Anti-RSV Agents
Conclusion
References
6: Pneumonia
Introduction
Definition of Pneumonia and Guidelines for Admission to the Pediatric Intensive Care Unit
Pathogenesis
Etiologies
Community-Acquired Pneumonia
Immunocompromised Pneumonia
Aspiration Pneumonia
Diagnostic Approach
Imaging
Non-invasive Pathogen Identification
Invasive Pathogen Identification
General Treatment Principles
Antimicrobial Therapy
Anti-inflammatory Therapy
Complications
Empyema and Effusion
Lung Abscess
Prevention
References
7: Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS)
Introduction
Epidemiology
Etiology
Risk Factors and Outcomes
Clinical Course and Histopathology
Pathophysiologic Mechanisms in ARDS
Development of Pulmonary Edema
Cytokines
Leukocyte Chemotaxis Related to Acute and Transitional Inflammation
Role of Anti-inflammatory Cytokines in Regulating ARDS
Molecular Regulation of Cytokine Gene Expression
Conventional Therapeutics in ARDS
Conventional Mechanical Ventilation
Inverse Ratio Ventilation and High Frequency Ventilation
Lung Protective Strategies
Permissive Hypercapnia
Prone Positioning
Fluid Management
Corticosteroids
Inhaled Nitric Oxide (iNO)
Extracorporeal Life Support (ECLS)
Experimental Therapies
Targeting Cytokine Production
Cytokine Neutralization
Modulating the Regulation of Lung Edema Clearance
Blocking Adhesion Molecules
Blocking of Chemokines or Chemokine Receptors
Application of Genomics to ALI/ARDS
Conclusion
References
8: Mechanical Ventilation
Introduction
Physiology of Mechanical Ventilation
Respiratory System Equation of Motion
Children Are Not Small Adults!
I ndications for Mechanical Ventilation
Non-invasive Mechanical Ventilation
Non-invasive Positive Pressure Ventilation (NIPPV)
Non-invasive Negative Pressure Ventilation
Invasive Mechanical Ventilation
Pressure Control Versus Volume Control
Pressure Control Ventilation
Volume Control Ventilation
Adaptive Pressure Control Ventilation
Ventilator Modes
Control Mode Mechanical Ventilation (CMV)
Assist/Control Mechanical Ventilation
Synchronized Intermittent Mandatory Ventilation (SIMV)
Pressure Support Ventilation
Volume Support Ventilation
Airway Pressure Release Ventilation (APRV)
Inverse Ratio Ventilation
Automatic Tube Compensation (ATC)
Proportional Assist Ventilation (PAV)
Neurally Adjusted Ventilatory Assist (NAVA)
Determining Initial Ventilator Settings
Tidal Volume (V T)
Inspiratory Pressures
Positive End-Expiratory Pressure (PEEP)
FIO 2
Rate (Frequency)
Triggering the Ventilator
Patient-Ventilator Dyssynchrony
Adjuncts to Mechanical Ventilation
Recruitment Maneuvers
Prone Positioning
Nitric Oxide
Surfactant Administration
Complications of Mechanical Ventilation
Respiratory Complications
Upper Airway Injury
Air Leak
Ventilation Associated Respiratory Infections (VARI)
Atelectasis
Ventilator-Induced Lung Injury (VILI)
Auto-PEEP
Central Nervous System Effects
Cardiovascular Effects
Venous Return
Left Ventricular Afterload
Cardiovascular Effects of Change in Lung Volume
Ventricular Interdependence
Renal Effects
Hepatic Effects
Weaning from Mechanical Ventilation
Conclusion
References
9: Therapeutic Gases in the Pediatric ICU
Introduction
Therapeutic Gases Used in the PICU
Oxygen
Historical Perspective
The Physiology of Oxygen Delivery
Alveolar Oxygen and Carbon Dioxide Tensions
Oxygen Delivery
Oxygen Administration
Non-contact Devices and Techniques
Contact Devices and Techniques
Bag Mask Ventilation
Carbon Dioxide
Carbon Monoxide
Nitric Oxide
Background
Administration
Clinical Applications
Persistent Pulmonary Hypertension
Acute Respiratory Distress Syndrome
Pulmonary Hypertension
Toxicity and Complications
Inhaled Anesthetic Gases
Helium
References
10: High Frequency Oscillatory Ventilation
Introduction
Modalities of High Frequency Ventilation
Gas Transport and Control of Gas Exchange in HFOV
Strategies for Initiating HFOV: Diffuse Alveolar Disease and Airleak
HFOV in the Neonate and Infant
Neonatal Respiratory Distress Syndrome
Congenital Diaphragmatic Hernia
Persistent Pulmonary Hypertension of the Newborn
Air Leak Syndromes
Bronchiolitis
HFOV in the Child
Diffuse Alveolar Disease
Other Conditions
HFOV in the Adolescent and Adult
Adjuncts to HFOV: Non-invasive Assessment of Lung Volume
Weaning from HFOV
Other Developments: Revisiting High Frequency Percussive Ventilation
Conclusions
References
11: Surfactant Therapy
Overview of Lung Surfactant and Exogenous Surfactant Therapy
Pulmonary Surfactant and Its Functions
Surface Tension and Surfactants
Effects of Lung Surfactant on Respiratory Physiology
Biophysically-Functional Composition of Lung Surfactant
Surfactant Proteins and Innate Immune Function
Surfactant Metabolism and Recycling
Acute Lung Injury/Acute Respiratory Distress Syndrome (ALI/ARDS)
Surfactant Dysfunction in ALI/ARDS
Surfactant Therapy in ALI/ARDS
Pharmaceutical Surfactants
Relative Activity and Inhibition Resistance of Exogenous Surfactant Drugs
New Synthetic Lung Surfactant Development
Animal Studies of Surfactant Therapy in ALI/ARDS
Human Studies of Surfactant Replacement Therapy in ALI/ARDS
Infant Investigations
Pediatric and Adult Investigations
The Future of Surfactant Therapy and Related Combination Therapies in ALI/ARDS
References
12: Extracorporeal Life Support
History of Extracorporeal Life Support (ECLS)
Patient Selection for ECLS
Modes of ECMO Support
Venoarterial ECMO
Venovenous ECMO
ECMO Circuit Components and Equipment
Venous Reservoir
Venous Saturation Monitor
ECMO Pumps
Roller-Head Pumps
Centrifugal Pumps
Oxygenators
Gas Exchange
Hemodynamics of Venoarterial ECMO
Management of the Patient Supported with ECMO
Anticoagulation
Ventilator Management
Nutrition and Fluid Management
Sedation and Analgesia
Weaning of ECMO Support
Complications of ECMO
Mechanical Complications
Central Nervous System Complications
Bleeding
Infection
Outcomes of Patients Supported with ECMO
Septic Shock
“Non-traditional” Patients with Respiratory Failure
ECPR
ECMO Support for Adults with Respiratory Failure
Long-Term Outcome After ECMO Support
Inter-hospital Transport of Patients Supported with ECMO
Future Directions in ECMO Support
References
13: Ventilator-Induced Lung Injury
Introduction
Low Tidal Volume Lessens Ventilator-
High Positive End-Expiratory Pressure Protects Against Injury with Low Tidal Volumes
Recruitment Is Essential to Lung Protection
Susceptibility to Ventilator-Induced Lung Injury: Adults vs. Infants
Bronchopulmonary Dysplasia and Ventilator-Induced Lung Injury
Stretch Increases Production of Biochemical Mediators (Mechanotransduction)
Does Ventilator-Induced Lung Injury Lead to Multiple-Organ Dysfunction Syndrome?
Potential Targeted Therapy of Ventilator-
Conclusion
References
14: Neonatal Lung Diseases
Introduction
Lung Development
Neonatal Respiratory Physiology
Lung Liquid
Pulmonary Vessels and Pulmonary Blood Flow
Collateral Airways
Chest Wall and Respiratory Muscles
Clinical Presentation of Respiratory Disorders in the Neonate
Respiratory Monitoring of the Neonate
Respiratory Diseases of the Neonate
Respiratory Distress Syndrome
Transient Tachypnea of the Newborn
Meconium Aspiration Syndrome
Respiratory Dysfunction in Infants Born by Elective Cesarean Section
Neonatal Pneumonia
Persistent Pulmonary Hypertension
Bronchopulmonary Dysplasia
Apnea of Prematurity
Pulmonary Air Leaks
Congenital Diaphragmatic Hernia
Conclusion
References
15: Pulmonary Hypertension
Introduction
Clinical Classification and Etiology
Diagnosis
Pathophysiology
Hemodynamics and Morphology
Pulmonary Vascular Endothelium
Pulmonary Vascular Smooth Muscle
Management Strategies and Therapeutic Options
Prevention and/or Treatment of Active Pulmonary Vasoconstriction
Vasodilator Therapy
NO-cGMP Cascade
Prostanoids
Endothelin-1
The Support of Right Ventricular Function
Treatment of Underlying Disease
Future Directions
Conclusions
References
16: Neuromuscular Respiratory Failure
Introduction
General Anatomic and Physiologic Considerations
Respiratory Muscle Function
Chest Wall Function
Interactions Between Respiratory Muscles, Chest Wall, and Lungs in NMD
Measurement of Respiratory Muscle Function
Neuropathies
Spinal Muscular Atrophy
Spinal Cord Injury
Guillain-Barré Syndrome
Diseases of the Neuromuscular Junction
Myasthenia Gravis
Botulism
Myopathies
DMD
Myotonic Dystrophy
Pompe Disease
Critical Illness Polyneuropathy and Myopathy
Management Approach
Secretion Clearance
Feeding and Nutrition
Non-invasive Ventilation
Invasive Mechanical Ventilation and Strategy for Extubation
Tracheostomy
Palliative Care
Conclusion
References
Part II: The Cardiovascular System in Critical Illness and Injury
17: Applied Cardiovascular Physiology in the PICU
Introduction
Developmental Cardiac Anatomy
Chambers of the Heart
Pericardium
Coronary Circulation
Peripheral Vasculature
From Fetus to Newborn: The Transitional Circulation
Cardiac Contraction and Relaxation: From Cell to Function
Cardiac Myocyte
Myocardial Bioenergetics
Excitation Contraction Coupling (ECC)
Determinants of Cardiac Output
Stroke Volume
Preload
Contractility
Afterload
Venous Return
Mean Circulatory Filling Pressure
Venous Resistance (R V)
Right Atrial Pressure (P RA)
Control of Circulation
The Afferent Limb of the Neuroendocrine Stress Response
The Efferent Limb of the Neuroendocrine Stress Response
Conclusion
References
18: Cardiopulmonary Interactions
Introduction
Volume-Pressure and Pressure-Flow Relationships
The Effects of Respiration on Cardiovascular Function
The Effects of Respiration on Right Ventricular Preload
The Effects of Respiration on Right Ventricular Afterload
The Effects of Respiration on Left Ventricular Preload
The Effects of Respiration on Left Ventricular Afterload
The Effects of Respiration on Cardiovascular Function in Patients with Cardiac Disease
Left Ventricular Systolic Heart Failure
Diastolic Heart Failure
Cavopulmonary Anastomosis
The Effects of Respiration on Cardiopulmonary Resuscitation
The Effects of Heart Failure on Respiratory Function
The Effects of Respiratory Disease on Cardiovascular Function
Conclusion
References
19: The Classification and Nomenclature of Congenital Heart Disease
Introduction
Van Praagh’s Segmental Approach
Anderson’s Sequential Segmental Approach
International Congenital Heart Surgery Nomenclature and Database
Functional Classification
References
20: Shunt Lesions
Introduction
Atrial Septal Defect (ASD)
Embryology
Secundum ASD’s
Pathophysiology
Clinical Features
Natural History
Surgical Management
Postoperative Management
Transcatheter Device Closure
Sinus Venosus ASD’s
Coronary Sinus ASD’s
Ventricular Septal Defects (VSD’s)
Embryology
Anatomy
Pathophysiology
Clinical Features
Natural History
Management
Surgery
Postoperative Management
Transcatheter Device Closure of VSD
Hybrid Procedures
Patent Ductus Arteriosus (PDA)
Embryology
Anatomy and Physiology
Epidemiology
Pathophysiology
Clinical Features
Natural History
Management
Aortopulmonary (AP) Window
Embryology
Anatomy
Pathophysiology
Clinical Features
Natural History
Management
References
21: Cyanotic CHD Lesions with Decreased Pulmonary Blood Flow
Initial Evaluation and Stabilization of the Cyanotic Neonate
Tetralogy of Fallot
Anatomy
Pathophysiology and Clinical Presentation
Preoperative Evaluation
Surgical or Transcatheter Intervention
Postoperative Care
Tetralogy of Fallot: Complex Variants
Outcomes
Pulmonary Valve Stenosis
Anatomy
Pathophysiology and Clinical Presentation
Preoperative Evaluation
Surgical or Transcatheter Intervention
Postoperative Care and Outcome
Pulmonary Atresia with Intact Ventricular Septum
Anatomy
Pathophysiology and Clinical Presentation
Preoperative Evaluation
Surgical or Transcatheter Intervention
Postoperative Care and Outcome
Ebstein’s Anomaly
Anatomy
Pathophysiology and Clinical Presentation
Preoperative Evaluation
Surgical or Transcatheter Intervention
Postoperative Care and Outcome
References
22: Cyanotic Lesions with Increased Pulmonary Blood Flow
Introduction
Transposition of the Great Arteries
Anatomy
Pathophysiology
Clinical Presentation and Diagnosis
Pre-operative Care
Surgical Intervention
Post-operative Care
Complications
Truncus Arteriosus
Anatomy
Associated Lesions
Pathophysiology
Clinical Presentation
Pre-operative Care
Surgical Intervention
Post-operative Care
Prognosis
Total Anomalous Pulmonary Venous Connections (TAPVC)
Anatomy
Pathophysiology
Clinical Presentation
Pre-operative Care
Surgical Intervention
Post-operative Care
Prognosis
Lesions with Physiology of Single Ventricle and Unobstructed Pulmonary Blood Flow
References
23: Congenital Heart Disease: Left Ventricular Outflow Tract Obstruction
Valvar Aortic Stenosis
Clinical Presentation
Management
Postoperative Management
Coarctation of the Aorta
Clinical Presentation
Management
Postoperative Care
Interrupted Aortic Arch
Clinical Presentation
Management
Postoperative Care
Supravalvar Aortic Stenosis
Clinical Presentation
Management
Postoperative Care
Subvalvar Aortic Stenosis
Clinical Presentation
Management
Postoperative Care
References
24: Single Ventricle Lesions
Introduction
Single Ventricle Physiology in the Newborn Before and After Surgery
Perinatal Management
Preoperative Management
General Considerations
Management of Pulmonary Over-Circulation
Lesion-Specific Management
Systemic Outflow Obstruction
Pulmonary Outflow Obstruction
Obstructed Venous Return
Other Considerations
Surgical Management
Post-operative Management
Management of Low Total Cardiac Output
Other Management Considerations
Interstage Management
A Rationale Approach to Single Ventricle Physiology in the Older Infant and Child
The Bidirectional Cavo-Pulmonary Anastomosis (BCPA)
Total Cavo-Pulmonary Anastomosis
Conclusion
References
25: Long-Term Outcomes in Congenital Heart Disease
Introduction
Categories of Lesions
Left-to-Right Shunts
Atrial Septal Defects (ASD)
Ventricular Septal Defects (VSD)
Atrioventricular Canal Defects (AVCD)
Right Sided Obstructive Lesions
Tetralogy of Fallot (TOF)
Tetralogy of Fallot with Pulmonary Atresia (TOF/ PA)
Tetralogy of Fallot with Absent Pulmonary Valve
Ebstein Anomaly of the Tricuspid Valve
Left Sided Obstructive Lesions
Aortic Stenosis
Subaortic Stenosis
Coarctation of the Aorta
Mixing Lesions
D-Transposition of the Great Arteries
Atrial Switch
Arterial Switch
Congenitally Corrected Transposition of the Great Arteries (L-TGA)
Truncus Arteriosus
Total Anomalous Pulmonary Venous Return (TAPVR)
Miscellaneous Lesions
Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Vascular Rings and Sling
Left Pulmonary Artery Sling
Double Aortic Arch
Right Aortic Arch with Aberrant Left Subclavian Artery
Single Ventricle Physiology
Ventricular Dysfunction
Hypoxemia
Protein-Losing Enteropathy
Thromboembolism
Arrhythmias
Liver Dysfunction
Neurodevelopmental Outcomes
Genetic Anomalies and Associated Congenital Heart Disease
References
26: Ventricular Assist Device Support in Children
Introduction
Preoperative Considerations
Timing
Biventricular Assist Devices (BiVADs) Versus Left Ventricular Assist Device (LVAD)
Device Options
Adult Ventricular Assist Devices
Berlin Heart EXCOR Ventricular Assist Device
The Micromed Heart Assist 5
HeartWare Ventricular Assist System
The National Heart, Lung, and Blood Institute (NHLBI) Pediatric Circulatory Support Program
Operative and Postoperative Considerations
Surgical Procedure
Anticoagulation
Complications
Sensitization
Saint Louis Children’s Hospital Berlin Heart Experience
Patients
Preoperative Status
Management During Support
Outcomes
Sensitization
Conclusion
References
27: Arrhythmias
Introduction
Interpretation of Electrocardiograms
Basic Mechanisms of Cardiac Arrhythmias
Bradycardia Mechanisms
Tachycardia Mechanisms
Mechanisms of Arrhythmia with Normal Heart Rate
Treatment of Bradyarrhythmia
Treatment of Tachyarrhythmia
Immediate Treatment, Cardioversion, Defibrillation and Pacing
Antiarrhythmic Medications
Special Circumstances Involving Arrhythmia in the PICU
Electrolyte Imbalance
Thermal Imbalance
Endocrine Imbalance
CNS Injury
Infection
Toxins
References
28: Inflammatory Diseases of the Heart
Infectious Endocarditis
Epidemiology
Pathogenesis
Diagnosis
Clinical Findings
Risk Factors
Laboratory Findings
Echocardiography
Antimicrobial Management
Surgical Management
Complications
Prophylaxis
Kawasaki Disease
Epidemiology
Etiology
Pathogenesis
Diagnosis
Clinical
Laboratory Manifestations
Incomplete Kawasaki Disease
Cardiac Findings
Management
Thrombosis
Prevention of Coronary Thrombosis
Treatment of Coronary Thrombosis
Long-Term Management
Myocarditis
Epidemiology
Etiology
Pathogenesis
Diagnosis
Clinical
Biomarkers
Imaging and Testing
Endomyocardial Biopsy
Treatment
References
29: Cardiomyopathies in Children
Dilated Cardiomyopathy
Clinical Features, Epidemiology, and Diagnosis
Definition and Incidence
Clinical Signs and Symptoms
Classification of Heart Failure
Biomarkers
Histology
Etiology
Familial and Genetic Causes of DCM
Infectious Causes of DCM
Peripartum DCM
Toxicity-Related DCM
Other Causes of DCM
Management
Pharmacologic Therapy
Cardiac Resynchronization and Implantable Cardiac Defibrillators
Mechanical Circulatory Support
Surgical Intervention
Heart Transplantation
Special Considerations: Anesthesia
Outcomes
Hypertrophic Cardiomyopathy
Clinical Features and Diagnosis
Clinical Signs and Symptoms
Echocardiography/MRI
Electrocardiography/Holter
Exercise Testing
Histology
Etiology
Familial and Genetic Causes of HCM
Other Causes of HCM
Management
Special Considerations: Sudden Cardiac Death
Restrictive Cardiomyopathy
Clinical Features, Epidemiology, and Diagnosis
Etiology
Management
Left Ventricular Noncompaction
Clinical Features, Epidemiology, and Diagnosis
Etiology
Management
Outcomes
References
30: Acute Decompensated Heart Failure
Introduction
Heart Diseases Leading to ADHF
Congenital Heart Disease
Excessive Pulmonary Blood Flow
Critical Aortic Stenosis
Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA)
Arrhythmias
Dilated Cardiomyopathy
Pathophysiology of ADHF
Clinical Approach to ADHF
Advanced Hemodynamic Monitoring of Patients with ADHF
PAC
PiCCO
NIRS
Biomarkers
Care of the Pediatric ADHF Patient
Conclusion
References
31: Diseases of the Pericardium
Introduction
Pericarditis
Etiology
Clinical Presentation and Diagnosis
Management
Cardiac Tamponade
Pathophysiology
Clinical Presentation and Diagnosis
Management
References
32: Hypertensive Emergencies
Definitions of Terms Related to Hypertension
Measurement of Blood Pressure
Pathophysiology
Renal Regulation of Blood Pressure
Hemodynamics of the Kidney
Renin-Aldosterone-Angiotensin System
Hormonal Mediators
Endothelial Control over Systemic Vascular Resistance
Nitric Oxide
Endothelin
Autoregulation of Cerebral Blood Flow
Etiologies
Obesity and Metabolic Syndrome
Clinical Presentation
Neurologic Manifestations
Cardiovascular Manifestations
Renal Manifestations
Ophthalmologic Manifestations
Evaluation
Management
Therapeutic Goals
Therapeutic Agents by Class
Vasodilators
Adrenoreceptor Antagonists
Alpha-Adrenergic Antagonists
Beta-Adrenergic Antagonists
Calcium-Channel Antagonists
Angiotensin Converting Enzyme Inhibitors
References
Part III: The Central Nervous System in Critical Illness and Injury
33: Molecular Biology of Brain Injury: 2012
Neurotransmitters and Their Receptors
Introduction
Neurotransmitters: Definition
Neurotransmitter Receptors
Acetylcholine
The Cholinergic Anti-inflammatory Response
Serotonin
GABA and Glycine
Glutamate
Glutamate Receptors
Excitotoxicity
Metabotropic Glutamate Receptors in Acute CNS Injury
Cell Death After Acute Brain Injury
Necrosis
Caspase-Dependent Apoptosis
Intrinsic Pathway of Apoptotic Cell Death
The Extrinsic Cell Death Pathway
The PARP Suicide Hypothesis
The Mitochondrial Permeability Transition Pore
Oxidative Damage in Acute Brain Injury
Reactive Oxygen Species (ROS)
Reactive Nitrogen Species (RNS)
Oxidative Stress and Neuroinflammation: Mediators of Neurologic Dysfunction After Brain Injury
Oxidative Stress, Oxidative Lipidomics, and Apoptosis
Extracellular Matrix Proteases
Matrix Metalloproteinases in Acute CNS Injury
Matrix Metalloproteinases in CNS Recovery
Matrix Metalloproteinases as Stroke Biomarkers
Tissue Plasminogen Activator
References
34: Tumors of the Central Nervous System
Brain Tumors
Incidence
Presenting Signs and Symptoms
Gliomas
Medulloblastomas
Ependymomas
Craniopharyngiomas
Peri-operative Care of Brain Tumors
Malignant Spinal Cord Compression
References
35: Intracranial Hypertension
Introduction
Intracranial Pressure: The Outcome of Multiple Factors
Cerebrospinal Fluid Dynamics
Circulatory System
The Cranial Vault (the Significance of the Fontanelle)
Intracranial Pressure Under Abnormal Circumstances
Intracranial Pressure Waveforms
“Normal” Intracranial Pressure
Pressure Regulation
Metabolic Regulation
Carbon Dioxide Regulation
Causes of Intracranial Hypertension
Cerebral Edema
Mass Lesions
Hydrocephalus
Clinical Manifestations of Intracranial Hypertension
ICP Measurement
Indications for Monitoring
Invasive Measurement
Non-invasive Measurement
Management of Intracranial Pressure
Setting Targets
How Do You Approach an ICP Number?
Basic Measures
Sedation and Analgesia
Drainage of CSF
Removal of Mass Lesions
Hyperventilation
Osmotherapy
Treatment Directed as Cerebral Perfusion Pressures
Barbiturate Therapy
Decompressive Craniectomy
Hypothermia
Future Directions
References
36: Stroke
Introduction
Epidemiology
Etiology
Arterial Ischemic Stroke (AIS)
Vascular Causes
Thrombotic Causes
Metabolic Causes
Treatment of AIS
Outcome from AIS
Hemorrhagic Stroke
Neonatal Stroke
Cerebral Sinovenous Thrombosis (CSVT)
Diagnostic Imaging in Stroke
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Cerebral Angiography
Cardiac Imaging
Conclusion
Approach to a Patient with a Suspected Stroke
References
37: Inflammatory Brain Diseases
Introduction
Vasculitic Inflammatory Brain Diseases
Primary CNS Vasculitis
Angiography-Positive Nonprogressive cPACNS (NP-cPACNS)
Angiography-Positive Progressive cPACNS (P-cPACNS)
Angiography-Negative, Small Vessel cPACNS (SV-cPACNS)
Secondary CNS Vasculitis
Infection-Associated Secondary CNS Vasculitis
Secondary CNS Vasculitis in Rheumatic and Systemic Inflammatory Diseases
Secondary CNS Vasculitis in Other Systemic Diseases/Exposures
Non-vasculitic Inflammatory Brain Diseases
Demyelinating Diseases
Neuronal Antibody Mediated Inflammatory Brain Diseases
T-cell Mediated Inflammatory Brain Diseases; Rasmussen Encephalitis
Granulomatous Inflammatory Brain Diseases
Febrile Infection-Related Epilepsy Syndrome (FIRES)
Non-inflammatory Brain Disease Mimics
Posterior Reversible Encephalopathy Syndrome
Diagnostic Approach to Inflammatory Brain Diseases
Laboratory Testing
Neuroimaging
Brain Biopsy
Management of Inflammatory Brain Diseases
Disease Modifying Drugs
Novel Biologic Therapies
Conclusion
References
38: Abusive Head Trauma
Introduction
Terminology
Epidemiology
Clinical Presentation
Mechanism of Injury and Pathophysiology
Evaluation of Suspected AHT
Intracranial Injuries
Extra-Cranial Injuries
Fractures
Retinal Hemorrhages
Abdominal Injury
Evaluation for Bleeding Disorders
Evaluation for Disorders Which Can Mimic AHT
Management and Treatment of AHT
Outcomes After AHT
Reporting and Legal Issues
Conclusion
References
39: Toxic Metabolic Encephalopathy
Introduction
Central Nervous System Physiology
Toxic-Metabolic Encephalopathy and Altered Levels of Consciousness
Definitions of Altered Levels of Consciousness
Clinical Assessment of Altered Levels of Consciousness
Diagnosis of Severity
Topographic Diagnosis
Syndromic Diagnosis
Etiologic Diagnosis
General Management of Altered Levels of Consciousness
Toxic-Metabolic Encephalopathies in the PICU
Disorders of Glucose Metabolism
Hypoglycemic Coma
Diabetic Ketoacidosis
Disorders of Sodium Homeostasis
Hyponatremia
Hypovolemic Hyponatremia
Euvolemic Hyponatremia
Hypervolemic Hyponatremia
Hypernatremia
Hyperammonemia
Acute Liver Failure (ALF)
Reye’s Syndrome
Inborn Errors of Metabolism and Mitochondrial Disorders
Post-transplant Encephalopathy
Immune-Mediated Encephalopathies
References
40: CNS Infections
Introduction
Meningitis
Acute Bacterial Meningitis
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Partially Treated Bacterial Meningitis
Treatment
Neuroprotective Strategies and the Management of Raised Intracranial Pressure
Antibiotic Therapy
Streptococcus pneumonia
Neisseria meningitidis
Haemophilus influenzae Type B
Evaluation of Newer Antibiotics
Anti-Inflammatory Agents
Adjunctive Corticosteroids
Inhibition of Leukocyte Recruitment
Non-bacteriolytic Antibiotics
Hypothermia
Other Agents
Duration of Therapy
Prevention of Bacterial Meningitis
Hib
N. meningitidis
S. pneumonia
Viral Meningitis
Tuberculous Meningitis
Fungal Meningitis
Encephalitis
Pathophysiology
Clinical Presentation and Diagnosis
Therapy
Mycoplasma pneumoniae Encephalitis
Herpes Simplex Encephalitis
Enteroviral Encephalitis
Rabies
Arthropod-Borne Encephalitis Viruses
Japanese Encephalitis
Tick-Borne Encephalitis
West Nile Virus
Cerebral Malaria
Clinical Features and Diagnosis
Pathophysiology
Parasitic Sequestration in Cerebral Microvasculature
Cytokines, Chemokines and Excitotoxicity
Endothelial Injury, Apoptosis, BBB Dysfunction and Intracranial Hypertension
Cerebral Blood Flow and Perfusion
Seizures
Depth, Duration and Cause of Coma
Management
Brain Abscess/Subdural Empyema
Predisposing Factors, Incidence and Epidemiology
Pathophysiology
Imaging in Brain Abscesses
Surgical and Medical Management of Brain Abscesses
Medical Management
Surgical Management
Outcome and Complications
Subdural Empyema
Shunt Infection
Epidemiology
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
References
41: Status Epilepticus
Introduction
Definitions
Impending Status Epilepticus
Refractory Status Epilepticus
Super-Refractory Status Epilepticus
Second-Tier Intravenous Anticonvulsants for Refractor SE
Fosphenytoin
Phenobarbital
Valproic Acid
Levetiracetam
High-Dose Midazolam for Refractory Status Epilepticus
Pediatric Critical Care Studies of High-Dose Midazolam
Efficacy
Dosing
Electroencephalography to Guide Therapy
Breakthrough Seizure and Recurrences
Hemodynamic Instability
Strategy When Using High-Dose Midazolam
General Anesthesia for Refractory Status Epilepticus
Pentobarbital
Pediatric Critical Care Studies of Pentobarbital for Refractory Status Epilepticus
Strategy When Using Pentobarbital Anesthesia for Refractory Status Epilepticus
Inhaled Anesthetics
Isoflurane for Pediatric Refractory Status Epilepticus
Strategy When Using Isoflurane Anesthesia for Refractory Status Epilepticus
General Anesthesia for Super-Refractory SE
Duration of Anesthesia
Other Medications and Approaches During Anesthesia
Ketamine
Therapeutic Hypothermia
Ketogenic Diet
Electroencephalography and Non-
Fever-Induced Refractory Epileptic Encephalopathy and FIRES
General Anesthesia
Other Therapies for FIRES
Conclusion
References
42: Diseases of the Peripheral Nervous System
Introduction
Electromyography in the Intensive Care Unit
Peripheral Nerve Diseases Resulting in ICU Admission
Acquired Disorders
Anterior Horn Cell Disease
Disorders of Peripheral Nerve
Neuromuscular Junction Abnormalities
Botulism
Tick Paralysis
Autoimmune Myasthenia Gravis (AIMG)
Acute Muscle Disease
Hereditary Conditions
Anterior Horn Cell Disease
Spinal Muscle Atrophy with Respiratory Distress (SMARD)
Disorders of the Nerve
Neuromuscular Junction Disorders
Muscle Disease
Myotonic Muscular Dystrophy
Other Myopathies
Peripheral Nerve Diseases Acquired in the ICU
Critical Illness Neuropathy and Myopathy
Mononeuropathies Which Develop in ICU
Our Recent Experience Using EMG in the ICU
References
43: Movement Disorders in the ICU
Introduction
Hyperkinetic Movement Disorders
Dystonia
Acute Dystonic Reactions Secondary to Drugs
Spasmodic Dysphonia/Adductor Laryngeal Breathing Dystonia (ALBD)
Status Dystonicus
Sudden Withdrawal of Intrathecal Baclofen
Chorea, Athetosis and Ballismus
Myoclonus
Tremor
Akinetic-Rigid Movement Disorders
Primary and Neurodegenerative Akinetic-
Secondary Akinetic-Rigid Movement Disorders
Neuroleptic Malignant Syndrome
Parkinsonism–Hyperpyrexia Syndrome
Malignant Hyperthermia
Serotonin Syndrome
Tetanus
Strychnine Toxicity
Rabies
References
Index