Paediatric Intensive Care

944 Pages·2010·2.93 MB·English

by  Peter Barry

OXFORD MEDICAL PUBLICATIONS
Paediatric
Intensive Care
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Oxford Specialist Handbooks
in Paediatrics
Paediatric
Intensive Care
Edited by
Peter Barry
Consultant in Paediatric Intensive Care,
University Hospitals of Leicester NHS Trust,
Honorary Senior Lecturer, Department of Child Health,
University of Leicester, UK
Kevin Morris
Consultant in Paediatric Intensive Care,
Birmingham Children’s Hospital,
Honorary Senior Lecturer,
University of Birmingham, UK
Tariq Ali
Consultant in Paediatric Intensive Care and Anaesthesia,
John Radcliffe Hospital,
Honorary Senior Lecturer,
Oxford University, Oxford, UK
With Special PICU Nursing Advisor Yvonne Heward
1
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Oxford University Press makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check the product
information and clinical procedures with the most up-to-date published product
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v
Preface
In writing this book, we have aimed to provide a comprehensive, practical
guide to the care of the critically ill child, both on an intensive care unit
and in other clinical areas—wherever children need to be stabilized and
failing organ systems need to be supported. Throughout, we have tried to
stick to the underlying principles that guide us in everyday practice—the
application of applied physiology; an understanding of disease processes; a
reckoning of what is likely and what is possible; and the provision of care
driven by compassion for our patients and their families.
The book is not just for intensivists and intensive care trainees. We hope
that it will help clinicians who provide care to sick children outside the
intensive care unit as well, in emergency departments, on paediatric wards
and adult units that are occasionally asked to support a critically ill child. Of
course, we hope that it will also prove to be a useful resource for doctors
and nurses who do work in intensive care, either as specialists or on rota-
tion. It is a book to be picked up to fi nd the answers to specifi c problems
and for guidance on how to manage specifi c issues. Where appropriate,
we have tried to provide more in-depth information, h ighlighting areas of
controversy and stimulating further reading.
The preparation of the book has been made easy by the work of the
various contributors, who delivered chapters on time and to length. They
are listed on page xv. We hope that in editing their work we have not
taken too many liberties.
Whilst writing the handbook, we were saddened by the deaths of Heinrich
Werner and David Todres, colleagues who we hoped would contribute
and comment on our work. Children’s intensive care, and this handbook,
are less without them.
We thank Julie Edge, James Greening, and David Luyt for their comments and
help with specifi c chapters. We would also like to thank Susan Crowhurst,
Anna Winstanley, and Helen Liepman at the Oxford University Press for
keeping us on track and seeing the project through from conception to
publication.
Finally, we thank our families for their support and forbearance.
PWB, KM, TA.
Oxford, Leicester, and Birmingham, 2009
vi SUBJECT OF THIS PAGE
Additional disclaimer
We have checked all drugs and dosages suggested in this handbook, but
the ultimate responsibility for their use in a particular patient rests with
the prescriber.
vii
Foreword
The specialty of paediatric critical care medicine has come of age. When
it began to emerge as a specialty in its own right in the 1970s, much of
what was done was learnt from adult intensive care medicine. Paediatric
intensive care units (PICUs) were largely run by anaesthetists because
they were the experts in airway and ventilation management and under-
stood cardiac and respiratory physiology. In those days, diseases like Reye
syndrome and Haemophilus infl uenzae acute epiglottitis were diseases
that presented unique challenges to those involved in paediatric critical
care, where the use of recently introduced invasive monitoring and skilful
airway management could dramatically infl uence survival. It also saw the
dawn of a new era in surgery for congenital heart disease which saw major
improvements in survival and the eventual evolution of paediatric cardiac
critical care as a specialty. Thirty years ago, little of the evidence for the
therapies we used was ever subjected to the rigor of clinical trials, there
was little formalized training, and paediatric critical care was a part-time
specialty. Much has changed. Many countries have established formalized
training schemes with specialty examinations, full-time career intensivists
with academic positions are being appointed, and the specialty has its own
journal. There are also a number of published textbooks in paediatric
critical care medicine. Do we need another and, if so, how is Paediatric
Intensive Care different? The answer is yes, we do, if it presents knowledge
in a different and more accessible format. I particularly appreciate the way
it deals with the important issues in an abbreviated arrangement which
presents knowledge in an easily accessible layout. It has a comprehensive
coverage of the important physiological principles and, as someone from
the previous era where anaesthesia was the entry into PICU, I am pleased
to see that prominence is given to airway management and the use of
anaesthetic drugs.
We are entering a new era in the specialty where what we do will be
judged by our results. The public and profession are rightly less tolerant
of errors and less than optimal care. At the same time the intensive care
specialist is dealing with increasing amounts of new knowledge which he
or she has to absorb in a very demanding clinical specialty. Having access
to a reference source such as Paediatric Intensive Care which gives them
vital information presented in such an easy to navigate format will make
that task less burdensome.
Desmond Bohn MB MRCP FRCPC FFARCS
Professor of Anaesthesia and Paediatrics
University of Toronto;
Chief, Department of Critical Care Medicine
The Hospital for Sick Children, Toronto, Canada
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ix
Acknowledgement
We would like to thank Mr David Barron for providing the illustrations for
the cardiac lesions described in Chapter 20.