Table Of ContentDerek S. Wheeler
Hector R. Wong
Thomas P. Shanley
Editors
Pediatric Critical
Care Medicine
Volume 1:
Care of the Critically Ill
or Injured Child
Second Edition
123
Pediatric Critical Care Medicine
Derek S. Wheeler (cid:129) Hector R. Wong
Thomas P. Shanley
Editors
Pediatric Critical Care
Medicine
Volume 1: Care of the Critically Ill
or Injured Child
Second Edition
Editors
Derek S. Wheeler, MD, MMM Thomas P. Shanley, MD
Division of Critical Care Medicine Michigan Institute for Clinical and Health
Cincinnati Children’s Hospital Medical Center Research
University of Cincinnati College of Medicine University of Michigan Medical School
Cincinnati, OH Ann Arbor, MI
USA USA
Hector R. Wong, MD
Division of Critical Care Medicine
Cincinnati Children’s Hospital Medical Center
University of Cincinnati College of Medicine
Cincinnati, OH
USA
ISBN 978-1-4471-6361-9 ISBN 978-1-4471-6362-6 (eBook)
DOI 10.1007/978-1-4471-6362-6
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2014937450
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For Cathy, Ryan, Katie, Maggie, and Molly
“You don’t choose your family. They are God’s gift to you…”
Desmond Tutu
Foreword to the First Edition
T he practitioner of P ediatric Critical Care Medicine should be facile with a broad scope of
knowledge from human developmental biology, to pathophysiologic dysfunction of virtually
every organ system, and to complex organizational management. The practitioner should
select, synthesize and apply the information in a discriminative manner. And fi nally and most
importantly, the practitioner should constantly “listen” to the patient and the responses to inter-
ventions in order to understand the basis for the disturbances that create life-threatening or
severely debilitating conditions.
W hether learning the specialty as a trainee or growing as a practitioner, the pediatric inten-
sivist must adopt the mantle of a perpetual student. Every professional colleague, specialist
and generalist alike, provides new knowledge or fresh insight on familiar subjects. Every
patient presents a new combination of challenges and a new volley of important questions to
the receptive and inquiring mind.
A textbook of pediatric critical care fi lls special niches for the discipline and the student of
the discipline. As an historical document, this compilation records the progress of the spe-
cialty. Future versions will undoubtedly show advances in the basic biology that are most
important to bedside care. However, the prevalence and manifestation of disease invariably
will shift, driven by epidemiologic forces, and genetic factors, improvements in care and,
hopefully, by successful prevention of disease. Whether the specialty will remain as broadly
comprehensive as is currently practiced is not clear, or whether sub-specialties such as cardiac-
and neurointensive care will warrant separate study and practice remains to be determined.
As a repository of and reference for current knowledge, textbooks face increasing and
imposing limitations compared with the dynamic and virtually limitless information gateway
available through the internet. Nonetheless, a central standard serves as a defi ning anchor from
which students and their teachers can begin with a common understanding and vocabulary and
thereby support their mutual professional advancement. Moreover, it permits perspective,
punctuation and guidance to be superimposed by a thoughtful expert who is familiar with the
expanding mass of medical information.
P ediatric intensivists owe Drs. Wheeler, Wong, and Shanley a great debt for their work in
authoring and editing this volume. Their effort was enormously ambitious, but matched to the
discipline itself in depth, breadth, and vigor. The scientifi c basis of critical care is integrally
woven with the details of bedside management throughout the work, providing both a satisfy-
ing rationale for current practice, as well as a clearer picture of where we can improve. The
coverage of specialized areas such as intensive care of trauma victims and patients following
congenital heart surgery make this a uniquely comprehensive text. The editors have assembled
an outstanding collection of expert authors for this work. The large number of international
contributors is striking, but speaks to the rapid growth of this specialty throughout the world.
W e hope that this volume will achieve a wide readership, thereby enhancing the exchange
of current scientifi c and managerial knowledge for the care of critically ill children, and stimu-
lating the student to seek answers to fi ll our obvious gaps in understanding.
Chicago, Illinois, USA Thomas P. Green
New Haven, CT, USA George Lister
vii
Preface to the Second Edition
T he specialty of pediatric critical care medicine continues to grow and evolve! The modern
PICU of today is vastly different, even compared to as recently as 5 years ago. Technological
innovations in monitoring, information management, and even medical documentation have
seemed to change virtually overnight. We have witnessed the gradual disappearance of some
time-honored, traditional devices such as the pulmonary artery catheter. At the same time, we
have observed the rapid evolution and adoption of newer monitoring techniques such as con-
tinuous venous oximetry and near-infrared spectroscopy. Some PICUs are even now using
telemedicine to remotely provide care for critically ill children. Many of us can recall a time
when cellular phones were prohibited in the PICU – today, many of us can remotely monitor
the status of our patients from these same cellular phones! Advances in molecular biology have
led to the era of personalized medicine – we can now individualize our treatment approach to
the unique and specifi c needs of a patient. We now routinely rely on a vast array of condition-
specifi c biomarkers to initiate and titrate therapy. Some of these advances in molecular biology
have uncovered new diseases and conditions altogether! At the same time, pediatric critical
care medicine has become more global. We are sharing our knowledge with the world com-
munity. Through our collective efforts, we are advancing the care of our patients. Pediatric
critical care medicine will continue to grow and evolve – more technological advancements
and scientifi c achievements will surely come in the future. We will become even more global
in scope. However, the human element of what pediatric critical care providers do will never
change. “For all of the science inherent in the specialty of pediatric critical care medicine,
there is still art in providing comfort and solace to our patients and their families. No technol-
ogy will ever replace the compassion in the touch of a hand or the soothing words of a calm
and gentle voice” [1]. I remain humbled by the gifts that I have received in my life. And I still
remember the promise I made to myself so many years ago – the promise that I would dedicate
the rest of my professional career to advancing the fi eld of pediatric critical care medicine as
payment for these gifts. It is my sincere hope that the second edition of this textbook will edu-
cate a whole new generation of critical care professionals, and in so-doing help me continue
my promise.
Cincinnati, OH, USA Derek S. Wheeler, MD, MMM
Reference
1. Wheeler DS. Care of the critically ill pediatric patient. Pediatr Clin North Am 2013;60:xv–xvi. Copied with
permission by Elsevier, Inc.
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