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: 620
• Edition: 2
• Category: Library

✦ Table of Contents

Foreword to the First Edition
Preface to the Second Edition
References
Preface to the First Edition
Promises to Keep
Acknowledgements
Contents
Contributors
Part I: The Gastrointestinal System in Critical Illness and Injury
1: Gastrointestinal Bleeding
Introduction
Definitions
Etiology
Specific Causes of UGIB
Hemorrhagic Disease of the Newborn
Coagulation Disorders
Peptic or Esophageal Ulcerations
Mallory-Weiss Tears
Variceal Bleeding
Specific Causes of LGIB
Juvenile Polyps
Henoch Schonlein Purpura (HSP)
Meckels Diverticulum
Intussusception
Stress ulcers and their prevention
Management of GI Bleeding
Initial Management and Evaluation
Placement of a Nasogastric (NG) Tube
Laboratory Evaluation
Testing for Occult Blood
Radiologic Investigation
X-ray
Ultrasound
Air Contrast Enema
CT Scan
Tagged Red Blood Cell Scan
Meckel Scan
Angiography
Diagnostic Interventions (and Management)
Upper Endoscopy
Colonoscopy
Double Balloon Endoscopy
Capsule Endoscopy
Medical Therapy
Proton Pump Inhibitors (PPI)
H-2 Blockers
Vasoactive Drugs
Sucralfate
Recombinant Activated Factor 7
Antibiotic Therapy
Surgical Therapy
Management of Variceal Bleeding
Transjugular Intrahepatic Porto Systemic Shunt
Summary and Recommendations
References
2: Liver Failure in Infants and Children
Introduction
Etiology
Liver Failure and its Effects on Organ Function
Hepatic Encephalopathy
Clinical Manifestations
Pathophysiology
Management
Acute Kidney Injury
Pathogenesis of Hepatorenal Syndrome
Management of Hepatorenal Syndrome
Coagulopathy and Bleeding Disorders
Respiratory Dysfunction
Acute Respiratory Distress Syndrome
Hepatopulmonary Syndrome
Respiratory Support
Circulatory Derangements
Plasmapheresis in Fulminant Hepatic Failure
Liver Transplantation
Artificial Support Devices
References
3: Acute Pancreatitis
Introduction
Epidemiology
Pathophysiology
Etiology
Genetics
Diagnosis
Outcome
Assessment of Severity
Treatment
Objectives and Methods of Conservative Treatment
Objectives and Indication of Surgical Treatment
Refeeding in the Mild Form of Acute Pancreatitis
Conclusion
References
4: Abdominal Compartment Syndrome in Children
Introduction
Definitions
Intra-abdominal Pressure and Abdominal Perfusion Pressure
Intra-abdominal Hypertension (IAH)
Abdominal Compartment Syndrome
Incidence
Etiology and Risk factors of ACS
Pathophysiology of ACS
Organ System Dysfunction and the Clinical Presentation of ACS
Cardiovascular Effects
Respiratory Effects
Renal Effects
Gastrointestinal Effects
CNS Effects
Diagnosis
IAP Measurement in Children
Imaging Findings
Management of IAH and ACS
Prevention of IAH and ACS
Medical Management of IAH (Fig.  4.5)
Optimizing Fluid Balance
Improving Abdominal Compliance
Decreasing Intraluminal and Abdominal Contents
Surgical Management
Decompressive Laparotomy (DL)
Critical Care Management of the Child with ACS
Outcome of ACS
Summary
Appendix
References
5: Obesity in Critical Illness
Introduction
General Considerations for Dealing with the Critically Ill Obese Patient
Difficulties with Routine Bedside Care and Procedures
Effects of Obesity on Pharmacology
Airway Management and Obesity
Pulmonary Physiology and Obesity
Cardiovascular Physiology and Obesity
Additional Disease-Specific Considerations for the Critically Ill Obese Patient
Mechanical Ventilation
Acute Lung Injury/ARDS
Asthma
Obstructive Sleep Apnea
Cardiopulmonary Arrest
Venous Thromboembolic Disease
Obesity and Infection
Surgical Site Infections
Obesity and H1N1
Trauma
Burn Injury
Cancer
Bariatric Surgery
References
6: Nutrition in the PICU
Introduction
Nutritional Deficiencies During Critical Illness
Nutritional Assessment
Macronutrient Goals During Critical Illness
Energy Goals
Energy Balance in the PICU
Protein Goals
Nutrient Delivery in the PICU
Enteral Nutrition: Practical Considerations
Role of Transpyloric Enteral Feeding in the PICU
Barriers to EN in the PICU
Strategies to Optimize Macronutrient Intake in the PICU
Immunonutrition in the PICU
Conclusions
References
Part II: The Endocrine System in Critical Illness and Injury
7: Diabetic Ketoacidosis
Introduction
Pathophysiology
Ketoacidosis
Hyperglycemia
Dehydration
Hyperosmolarity
Electrolytic Disorders
Sodium
Potassium
Phosphorus
Calcium
Clinical and Laboratory Diagnosis of Diabetic Ketoacidosis
Treatment
Correction of Dehydration and Electrolytic Disorders
Initial phase – Fluid Expansion (1–4 h)
Maintenance phase – Rehydration stage (20–22 h)
Insulin Therapy
Complications
Electrolyte Disorders
Cardiac Arrhythmias
Aspiration of Gastric Content
Pulmonary Edema
Cerebral Edema
Prevention
References
8: Hyperglycemia, Dysglycemia and Glycemic Control in Pediatric Critical Care
Introduction
Incidence and Associations of Hyperglycemia in Pediatric Critical Care
Hypoglycemia in the PICU
Glycemic Variability
Glycemic Control Protocols in the PICU
Randomized Controlled Trial in Glycemic Control in Pediatric Critical Care
Conclusion
References
9: Hypoglycemia
Introduction
Definition
Pathophysiology
Differential Diagnosis
Clinical Manifestations
Management
References
10: The Adrenal Glands in Critical Illness and Injury
Introduction
Historical Perspective
Normal Adrenal Anatomy and Function
Adrenal Gland
Hypothalamic-Pituitary Adrenal Axis
Actions of Cortisol
Normal Response to Stress
Adrenal Insufficiency
Primary Adrenal Insufficiency
Secondary Adrenal Insufficiency
Tertiary Adrenal Insufficiency
Relative and Absolute Adrenal Insufficiency
Adrenal Insufficiency in Critical Illness
Definition of Adrenal Insufficiency
Prevalence of Adrenal Insufficiency in Pediatric Critical Illness
Possible Mechanisms for Adrenal Insufficiency in Critical Illness
Diagnosis of Adrenal Insufficiency in Critical Illness
Measurement of Cortisol Levels
Risk Factors for Adrenal Insufficiency
Pharmacokinetics of Corticosteroids in Critical Illness
Adverse Effects of Corticosteroids in Critical Illness
Management of Adrenal Insufficiency in Pediatric Critical Illness
Outcomes of Adrenal Insufficiency in Pediatric Critical Illness
Conclusion
References
11: Thyroid and Growth Hormone Axes Alteration in the Critically Ill Child
Introduction
The Thyroid Axis in Critical Illness
Thyroid Physiology
Thyroid Hormones During Critical Illness
Thyroid Function in Critically Ill Children
Evaluation of Thyroid Function in the PICU
Thyroid Hormone Treatment in PICU
Sepsis
Cardiac Surgery
The Growth Hormone Axis in Critical Illness
Growth Hormone Physiology
Growth Hormone During Critical Illness
References
Part III: The Renal System in Critical Illness and Injury
12: Applied Renal Physiology in the PICU
Introduction
Embryology and Development
Renal Hemodynamics
Renal Blood Flow
Regulation of Afferent and Efferent Arterioles
Maintenance and Modulation of Renal Hemodynamics in Disease States
Filtration
Glomerulus
The Glomerular Tuft and Cellular Elements
Glomerular Filtration and Tubuloglomerular Feedback
Glomerular Disease
Tubules
The Proximal Tubule
Sodium
Bicarbonate
Chloride
Water
Potassium
Glucose
Phosphate
Proteins
Organic Ions
Uric Acid
Dysfunction in Acute Illness
The Loops of Henle
Dysfunction in Critical Illness
The Distal Tubule and Collecting Ducts
Dysfunction in Critical Illness
The Endocrine Kidney
Known Renal Mediators of Extra-Renal Homeostasis
Organ Syndromes in Critical Illness
Conclusion
References
13: Electrolyte Disorders in the PICU
Introduction
Disorders of Sodium Homeostasis
Hyponatremia
Pathophysiology
Hyponatremia that Is Not Mediated by ADH
Hyponatremia that Is Mediated by ADH
Management
Prevention of Acute Hyponatremia
Acute Versus Chronic Hyponatremia
Treatment of SIADH
Hypernatremia
Pathophysiology
Decreased Water Intake
Renal Water Loss (A Disorder of Urinary Concentration)
Diagnosis and Management
Acute vs Chronic Hypernatremia
Disorders of Potassium Homeostasis
Hypokalemia
Pathophysiology
Clinical Manifestations (Table  13.4)
Management
Hyperkalemia
Pathophysiology
Clinical Manifestations
Management
Disorders of Magnesium Homeostasis
Hypomagnesemia
Pathophysiology
Clinical Manifestations
Management
Hypermagnesemia
Pathophysiology
Clinical Manifestations
Management
Disorders of Calcium Homeostasis
Hypocalcemia
Pathophysiology
Clinical Manifestations
Management
Hypercalcemia
Pathophysiology
Clinical Manifestations
Management
Disorders of Phosphorus Homeostasis
Hypophosphatemia
Pathophysiology
Clinical Manifestations
Management
Hyperphosphatemia
Pathophysiology
Clinical Manifestations
Management
References
14: Acid-Base Disorders in the PICU
Introduction
Acid-Base Physiology
Respiratory Compensation: Volatile Acids (CO 2)
Metabolic Compensation and Nonvolatile Acids/Strong Ion Difference (SID)
Nonvolatile Weak Acid Buffers
Quantification of Acid-Base Status
Differential Diagnosis and Basic Management of Acid-Base Disorders
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Elevated Anion Gap Acidosis
Non-anion Gap Acidosis
Metabolic Alkalosis
Mixed Acid-Base Disorders
Special Acid-Base Situations
Cardiopulmonary Bypass and Hypothermia: pH Stat and Alpha Stat Concepts
Hypercapnic Acidosis and Permissive Hypercapnia in Ventilatory Management
Choice of Intravenous Fluid Composition and Acid-Base Balance
References
15: Acute Kidney Injury
Introduction
Pathophysiology of AKI
Glomerular Perfusion
Filtrative Impairment
Disrupted Endothelial Function
Apoptosis and Necrosis
Iatrogenic Toxicity
Predisposition and the “at-risk” Patient: Renal Angina
Cardinal Pathophysiology: Cardiopulmonary Bypass and Sepsis
Cardiopulmonary Bypass and AKI
Sepsis and AKI
Epidemiologic Characteristics of AKI: Incidence, Definition, Classification
Incidence and Classification
Impact of AKI on Outcomes
Immediate Effects
Extra-Renal Effects
Diagnosis
Serum Testing for AKI
Creatinine
Urea
Cystatin C
Serum GFR Estimation
Urinary Testing for AKI
Output
Derived Indices
Electrolytes
Microscopy
Biomarkers for AKI
Identification of Established AKI
Prediction of AKI
Prediction of AKI Associated Morbidity
Technologic Adjuncts for AKI Diagnosis
Renal Angina and AKI
Management of AKI
Prevention Strategies
Therapeutic Strategies
Target: Aberrant Renal Vascular Tone
Target: Renal Preload
Target: Direct Cellular Injury
Target: Oxidative and Inflammatory
Target: Nutrition
Recovering from AKI
Conclusion
References
16: Kidney Disorders in the PICU: Thrombotic Microangiopathies and Glomerulonephritis
Thrombotic Microangiopathies
Thrombotic Thrombocytopenic Purpura (TTP)
Pathophysiology
Clinical Manifestations and Diagnosis
Treatment
Prognosis
Thrombocytopenia Associated Multi-organ Failure (TAMOF)
Typical Hemolytic Uremic Syndrome
Pathophysiology
Clinical Manifestations and Diagnosis
Treatment (Table  16.1)
Prognosis
Atypical HUS
Pathophysiology
Clinical Manifestations and Diagnosis
Treatment
Prognosis
Associated TMA: “xHUS”
Glomerulonephritis
Alport’s Syndrome
Anti-glomerular Basement Membrane Disease
IgA Nephropathy
Henoch-Schönlein Purpura
Systemic Lupus Erythematosis (SLE)
Membranoproliferative Glomerulonephritis
References
17: Kidney Pharmacology
Introduction
Dosage Adjustment for Renal Dysfunction
Renal Replacement Therapy and Medication Dosing
Continuous Renal Replacement Therapy (CRRT) Adjustment
Diuretics
Pharmacokinetics of Commonly Used Diuretics
Categories of Diuretics
Diuretic Resistance
References
18: Renal Replacement Therapy
Introduction
Nutritional Support in AKI
Peritoneal Dialysis
Dialysate Solutions
PD Prescription
Complications of PD
CRRT
Modes
Vascular Access
Dialysate Solution
Anticoagulation
Special Circumstances
Cancer and Bone Marrow Transplantation
Intoxications and Poisonings
Inborn Errors of Metabolism
Multiple Organ Dysfunction Syndrome (MODS)
Plasmapheresis
Neonatal CRRT and Outcome
ECMO and CRRT
CRRT Complications
Technical and Equipment Malfunction
Bleeding
Infection
Hypotension
Electrolyte Disturbances
Hypothermia
Nutritional Losses
Medication Errors
CRRT Survival
Intermittent Hemodialysis
Hemodialysis Equipment
Anticoagulation
Hemodialysis Use in Clinical Situations
Outcome in Hemodialysis
Complications of Hemodialysis
Conclusions
References
Part IV: The Hematologic System in Critical Illness and Injury
19: Transfusion Medicine
Transfusion of Red Blood Cells
Anemia in the PICU
Adaptive Mechanisms to Acute Anemia in Critically Ill Patients
Impairment of Adaptive Mechanisms to Anemia
Long-Term Adaptive Mechanisms to Anemia
Management of Anemia in the PICU
Effects of Transfused RBC on Oxygen Delivery
Immunologic Effects of Allogeneic RBC Transfusions
Length of Storage of RBC Units
Practice Patterns: Determinants of RBC Transfusion
Goal-Directed RBC Transfusion Therapy
Red Blood Cell Transfusions in Non-cardiac Patients
Stable Critically Ill Children
Unstable Critically Ill Children
Red Blood Cell Transfusions in Cardiac Patients
Limiting Blood Product Transfusion
The “Nuts and Bolts” of Packed RBC Transfusion
Whole Blood
Specific Types of Packed RBC Units
Transfusion of Frozen Plasma
Indications for Frozen Plasma Transfusion
The “Nuts and Bolts” of Frozen Plasma Transfusion
Transfusion of Platelets
Indication for Platelet Transfusion
The “Nuts and Bolts” of Platelet Transfusion
Serious Hazards of Transfusion
Acute Reactions
Transfusion-Related Acute Lung Injury (TRALI)
Transfusion-Associated Circulatory Overload (TACO)
Hypotensive Reaction
Fever
Acute Hemolytic Transfusion Reactions
Non-immunologic Hemolysis
Allergic Reactions
Infections
Acute Leukocytosis
Acute Complications of Massive Transfusion
Hypothermia
Coagulopathy
Citrate Intoxication
Hyperkalemia
Late Onset Reactions and Complications
Delayed Hemolytic Reactions
Post-Transfusion Purpura (PTP)
Infections
Transfusion Associated Graft Versus Host Disease (TA-GvHD)
Non-specific Treatment of Transfusion Reactions
References
20: Hematologic Emergencies in the PICU
Introduction
Part 1: Red Blood Cell Disorders
Anemias of Underproduction and/or Impaired Maturation
Anemias of Increased Turnover or Destruction
Sickle Cell Disease
Acute Splenic Sequestration
Acute Chest Syndrome
Cerebrovascular Accidents
Vaso-Occlusive Crisis
Functional Asplenia
Transfusion Therapy in Patients with SCD
Schistocytosis
Red Cell Membrane Defects
Red Cell Metabolism Defects
Immune-Mediated Hemolysis
Thalassemias
Secondary Hemoglobinopathies
Hemophagocytosis
Erythrocytosis
Part 2: Non-malignant White Blood Cell Disorders
Part 3: Platelet Disorders
Thrombocytopenia
Increased Consumption of Platelets
Increased Destruction of Platelets
Decreased Production of Platelets
Thrombocytosis
References
21: Coagulation Disorders in the PICU
Introduction
History
Thrombus Formation Overview and Review of Normal Coagulation Components
Platelets
Platelet Activation
Platelet Receptors
Endothelial Cells
Coagulation Cascade
Contact System
Intrinsic Coagulation Pathway
Extrinsic System
Common Pathway
Physiologic Inhibitors of Coagulation
Fibrinolysis
Complement and Leukocytes
Laboratory Evaluation of Hemostasis in the Intensive Care Unit
Modulation of the Coagulation System in the Intensive Care Unit
Bleeding in the Intensive Care Unit
Disorders of Platelets
Factor Deficiencies
Massive Transfusion Syndrome
Disseminated Intravascular Coagulation
Pathophysiology of DIC
Clinical Scoring Systems in DIC
Treatment for DIC
Extracorporeal Life Support (ECLS)
Conclusion
References
22: Therapeutic Apheresis in the Pediatric Intensive Care Unit
Introduction
Automated Apheresis Technology
Principle of Separation
Quantification of Removal
Anticoagulation
Procedures
Plasmapheresis
Erythrocytapheresis
Leukapheresis
Technical Issues in Pediatrics
Access
Volume
Blood Priming
Anticoagulation (Dose)
Hypothermia
Cooperation
Disease-Specific Indications
Apheresis and ACE Inhibitors
References
23: Thromboembolic Disorders in the PICU
Introduction
Epidemiology and Incidence
Overview of Coagulation
Pathophysiology of Pulmonary Embolism
Risk Factors for VTE
Inherited Risks
Acquired Risks
Diagnosis of Venous Thrombosis
Clinical Diagnosis
Radiologic Diagnosis
Laboratory Evaluation
Treatment of Venous Thromboembolism
Anticoagulation
Unfractionated Heparin
Low Molecular Weight Heparins
Direct Thrombin Inhibitors
Vitamin K Antagonists
Duration of Anticoagulation for VTE
Thrombolysis
Thromboprophylaxis
Outcomes
References
Part V: Oncologic Disorders in the PICU
24: Care of the Oncology Patient in the PICU
Introduction
Mediastinal Mass
Introduction
Pathophysiology
Identification of High Risk Patients
Management and Approach to the Diagnostic Work-Up
Use of Anesthesia or Deep Sedation
Conclusion
Hyperleukocytosis
Hypercalcemia
Incidence
Pathophysiology
Treatment
Acute Promyelocytic Leukemia (APL) – Leukemia-Associated Coagulopathy
Differentiation Syndrome
Lactic Acidosis of Malignancy
Balancing Therapy at the End of Life
References
25: Critical Illness as a Result of Anti-­Neoplastic Therapy
Introduction
Tumor Lysis Syndrome (TLS)
Pathophysiology
Treatment
Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
Monitoring
Classification
Chemotherapy Adverse Effects
Radiation-Associated Toxicty
Radiation Pnuemonitis
Epidemiology
Pathophysiology
Clinical Signs and Symptoms
Diagnosis
Treatment
Sporadic Radiation Pneumonitis
Typhlitis
Sepsis in OncologyPatient Population
References
26: Hemophagocytic Lymphohistiocytosis Syndromes
Introduction
Pathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
Conclusion
References
27: Hematopoietic Stem Cell Transplantation in the PICU
Introduction
Indications
Hematopoietic Stem Cell Sources
Donor Selection
Transplant Conditioning Regimens
Graft Versus Host Disease (GVHD) Prophylaxis
Infection Prophylaxis
Complications Following Hematopoietic Stem Cell Transplantation
Infections
Respiratory Failure Following Hematopoietic Stem Cell Transplantation
Non-Infectious Causes of Lung Injury
Infectious Causes of Lung Injury
Management
Outcomes
Graft Versus Host Disease
Mechanism of Disease
Clinical Features
Diagnosis
Treatment
Outcome
Sinusoidal Obstruction Syndrome (Veno-
Mechanism of Disease
Clinical Features
Diagnosis
Management
Outcomes
Transplant-Associated Thrombotic Microangiopathy
Mechanism of Disease
Clinical Features and Diagnosis
Management
Outcomes
Kidney Injury Following Hematopoietic Stem Cell Transplantation
Diagnosis
Management
Outcomes
Neurologic Complications Following Hematopoietic Stem Cell Transplantation
Conclusion
References
Part VI: The Immune System in Critical Illness and Injury
28: The Immune System in Critical Illness and Injury
Introduction
Innate Immune System
Innate Immune Sensing
Pattern Recognitions Receptors (PRRs)
Humoral Elements of Innate Immune Sensing
Effectors of the Innate Immune System: Cellular Mechanisms
Professional Phagocytes
NK Cells
Humoral Innate Immune Effectors: The Complement System
Adaptive Immune System
Cellular Immunity: T Cells
Cellular and Humoral Immunity: B Cells
Interplay Between the Innate and Adaptive Immune Systems
The Immunologic Balance in Critical Illness
Immunoparalysis
Conclusions
References
29: Primary and Secondary Immunodeficiencies
Introduction
Part I Primary Immunodeficiency Syndromes
Primary Defects of Antibody Production
X-Linked (XLA or Bruton’s) Agammaglobulinemia
Common Variable Immunodeficiency (CVID)
Hyper-IgM Syndrome
Selective IGA Deficiency
IgG Subclass Deficiencies
Transient Hypogammaglobulinemia of Infancy (THI)
Treatment of Antibody Deficiency Diseases
Combined Immunodeficiencies
Severe Combined Immunodeficiency (SCID)
X-linked Severe Combined Immunodeficiency (X-SCID)
Jak3 Deficiency
Omenn Syndrome
Adenosine Deaminase (ADA) Deficiency
Purine Nucleoside Phosphorylase (PNP) Deficiency
Cartilage Hair Hypoplasia (CHH)
Primary Defects of Cellular Immunity
DiGeorge Syndrome
Defective Expression of the T-Cell Receptor-CD3 Complex
Other Immunodeficiency Syndromes Associated with T Lymphocytes
Wiskott-Aldrich Syndrome (WAS)
Ataxia-Telangiectasia (A-T)
Combined Immunodeficiency (CID or Nezelof Syndrome)
Treatment of Cellular Immunodeficiency
Complement Deficiencies
Rheumatic Diseases in Complement Deficiencies
Infections in Complement Deficiencies
Hereditary Angioedema (HAE)
Treatment of Complement Deficiencies
Phagocytic Disorders
Leukocyte Adhesion Deficiency Type I (LAD)
LAD Type 2
Chronic Granulomatous Disease
Chediak-Higashi Syndrome (CHS)
Treatment of Phagocytic Disorders
Part II Secondary Immunodeficiency Syndromes
Treatment with Immunosuppressive Agents
Immunoparalysis and the Immune Response to Trauma, Surgery, Burns, and Anesthesia
Altered Immunity due to Intercurrent Illness or Insult
Treatment of Phagocytic Disorders
Part II Secondary Immunodeficiency Syndromes
Treatment with Immunosuppressive Agents
Immunoparalysis and the Immune Response to Trauma, Surgery, Burns, and Anesthesia
Altered Immunity due to Intercurrent Illness or Insult
References
30: Sepsis
Introduction
Epidemiology of Sepsis
Definition of Sepsis
Clinical Manifestations
The Immunopathobiology of Sepsis
Barrier Defenses
Molecular Events During Early Infection
Pathogen Recognition
Inflammatory Mediator Production
Complement
Coagulation Cascade
Innate Immune Cellular Contributions
PMN
Antigen-Presenting Cells (APCs)
Vascular Endothelium
Pathophysiology of Sepsis
Cardiovascular
Immune System
Pulmonary
Renal
Hepatic
Multi-organ Dysfunction Syndrome (MODS)
Management of Sepsis
Early Recognition
Early Source Control and Antibiotic Administration
Early Reversal of Shock
Fluid Resuscitation
Hemodynamic Support
Supportive Care
Corticosteroids
Conclusion
References
31: Thrombocytopenia-Associated Multiple Organ Failure Syndrome
Introduction
Thrombotic Microangiopathy (TMA)
Disseminated Intravascular Coagulation (DIC)
Mechanism of DIC
Diagnosing and Managing DIC
Thrombotic Thrombocytopenic Purpura (TTP)
Von Willebrand Factor Hyper-Adhesiveness in TTP
ADAMTS-13 (a.k.a VWF-Cleaving Protease) Deficiency in TTP
Diagnosing and Managing TTP
Hemolytic Uremic Syndrome (HUS)
Mechanisms of HUS
Diagnosing and Managing HUS
Thrombocytopenia-Associated Multiple Organ Failure (TAMOF)
Large Animal Models of VWF-Mediated Thrombotic Microangiopathy and Acquired ADAMTS-13 Deficiency
Current and Future Therapies for Thrombotic Microangiopathies
References
32: Toxic Shock Syndrome in Children
Introduction
Epidemiology
Staphylococcal Toxic Shock Syndrome
Streptococcal Toxic Shock Syndrome
Pathophysiology
Host Immunity
Clinical Manifestations
Staphylococcal Toxic Shock Syndrome
Streptococcal Toxic Shock Syndrome
Management
Staphylococcal TSS
Streptococcal Toxic Shock Syndrome
Adjunctive Therapy
Recent Developments
Conclusion
References
33: Hospital-Acquired Infections and the Pediatric Intensive Care Unit
Introduction
History and Epidemiology of Nosocomial Infections
Catheter Associated Bloodstream Infections
Scope of the Problem
Risk Factors
Diagnosis
Pathogenesis
Management and Prevention
Ventilator-Associated Pneumonia
Scope of the Problem
Diagnosis
Pathogenesis
Risk Factors
Management and Prevention
Hospital-Acquired Infections of the Urinary Tract
Scope of the Problem
Risk Factors
Diagnosis
Pathogenesis
Management and Prevention
Surgical Site Infections
Scope of the Problem
Risk Factors
Management and Prevention
Specific SSIs Commonly Encountered in the PICU
Cardiothoracic Surgery
Craniofacial Surgery
Neurosurgery
Orthopaedic Surgery
Transplant Surgery
Infection Control in the PICU
Conclusion
References
34: Anaphylaxis
Introduction
Epidemiology
Pathophysiology
Triggers
Mechanism of Symptoms
Clinical Presentation
Differential Diagnosis
Diagnosis
Treatment
Epinephrine
Mechanism of Action
Modes of Administration
Patient Positioning
Oxygen Administration and Fluid Resuscitation
Inhaled β-agonists
Histamine Blockers
Corticosteroids
Other Vasopressors
Other Agents
Treatment of Cardiorespiratory Arrest in the Management of Anaphylaxis
Prevention
References
35: Rheumatologic Disorders in the PICU
Introduction
Systemic Lupus Erythematosus (SLE)
CNS Complications of SLE
Seizures
Cerebral Vein Thrombosis
Stroke
Psychosis, Delirium, and Depression
Pulmonary Complications of SLE
SLE Pneumonitis
Pulmonary Hemorrhage
Cardiac Complications of SLE
SLE Pericarditis
SLE Endocarditis
SLE Myocarditis and Cardiomyopathy
Infectious Complications of SLE
Renal Complications of SLE
Juvenile Idiopathic Arthritis (JIA)
Infectious Complications of JIA
Cardiac Complications of JIA
Macrophage Activation Syndrome
Henoch-Schoenlein Purpura (HSP)
CNS Complications of HSP
Pulmonary Complications of HSP
Gastrointestinal Complications of HSP
Nephritis in HSP
Kawasaki Disease
Kawasaki Disease Shock Syndrome
Kawasaki Disease Management
Antiphospholipid Antibody Syndrome
Goodpasture Disease
Wegener’s Granulomatosis
Churg-Strauss Syndrome
Cardiac Complications of CSS
Pulmonary Complications of CSS
Gastrointestinal Complications of CSS
Juvenile Dermatomyositis (JDM)
CNS Complications of JDM
Pulmonary Complications of JDM
Cardiac Complications of JDM
Systemic Sclerosis
Cardiopulmonary Complications of Systemic Sclerosis
Scleroderma Renal Crisis
Behcet’s Disease
Conclusion
References
36: Infectious Disease-Associated Syndromes in the PICU
Introduction
Necrotizing Fasciitis
History and Epidemiology
Pathogenesis
Diagnosis
Clinical Manifestations
Management
Hemorrhagic Shock and Encephalopathy
History and Epidemiology
Pathogenesis
Clinical Manifestations
Laboratory Findings
Management
Rocky Mountain Spotted Fever
History and Epidemiology
Pathogenesis
Clinical Manifestations
Laboratory Findings
Management
Ehrlichiosis as a Mimicker of RMSF
Lemierre’s Syndrome
References
37: Life Threatening Tropical Infections
Introduction
Imported Diseases
Locally Prevalent Diseases
Malaria
Epidemiology
Etiology
Pathophysiology of Severe Malaria
Inflammation
Interaction Between Malaria Parasites and RBCs
Sequestration
Clinical Manifestations
Cerebral Malaria
Severe Malarial Anemia
Laboratory Findings and Diagnosis
Treatment
Adjuvant Management
Cerebral Malaria
Severe Malarial Anemia
Dengue
Epidemiology
Etiology
Pathophysiology
Disease Classification and Clinical Course
Febrile Phase
Critical Phase
Recovery Phase
Diagnosis
Treatment
Management of Dengue Hemorrhagic Fever Grade 1 and 2 (Without Shock)
Management of DHF Grades 3 and 4 (Dengue Shock Syndrome)
Typhoid and Paratyphoid Fever
Epidemiology
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
Leptospirosis
Epidemiology
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
References
Index