Pediatric Critical Care Medicine

950 Pages·2006·14.499 MB·English

by  Anthony D. Slonim, Murray M. Pollack

Pediatric Critical Care
Medicine
EDITORS
ANTHONY D. SLONIM, MD, D PH, FCCM
R
ExecutiveDirector,CenterforClinicalEffectiveness
AttendingPhysician,CriticalCareMedicine
Children’sNationalMedicalCenter
AssociateProfessorandViceChairmanofPediatrics
TheGeorgeWashingtonUniversitySchoolofMedicine
Washington,DC
MURRAY M. POLLACK, MD, MBA, FCCM
ExecutiveDirector,CenterforHospital-BasedSpecialities
DivisionChief,CriticalCareMedicine
Children’sNationalMedicalCenter
ProfessorofPediatrics
TheGeorgeWashingtonUniversitySchoolofMedicine
Washington,DC
SECTIONEDITORS
MichaelJ.Bell,MD PaulKaplowitz,MD,PhD
JohnT.BergerIII,MD NaomiL.C.Luban,MD
JosephA.CarcilloJr,MD RobertE.Lynch,MD,PhD,FCCM
HeidiJ.Dalton,MD,FCCM JoAnneNatale,MD,PhD
JonathanS.Evans,MD DanielA.Notterman,MD,FCCM
MarkJ.Heulitt,MD,FAARC,FCCP DavidM.Steinhorn,MD
RichardA.Jonas,MD EdwardC.Wong,MD
AcquisitionsEditor:AnneSydor/BrianBrown
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Pediatriccriticalcaremedicine/[editedby]AnthonyD.Slonim,Murray
M.Pollack.—1sted.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN0-7817-9469-2
1.Pediatricintensivecare. I.Slonim,AnthonyD. II.Pollack,Murray
M.
[DNLM: 1.CriticalCare—Child. 2.CriticalCare—Infant.WS366
P36842006]
RJ370.P282006
618.92(cid:1)0028—dc22
2005032133
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10 9 8 7 6 5 4 3 2 1
Thiswork is dedicatedto my family,friends,colleagues,and patients,all
of whom have had a material impacton mydevelopmentas a physician.
A.D.S
This work is dedicatedto my wife, Mona, who exemplifiespersistence
and courage; my children Sethand Haley, who make me want to be a
better physician;and the Critical Care Division at CNMC who teach me
every dayaboutclinical excellenceandthe values of beinga physician.
M.M.P

Contents
ListofContributors ix 5.3 Electrophysiology 220
Preface xvii JohnT.BergerIIIandJeffreyP.Moak
Acknowledgments xix
5.4 CardiopulmonaryInteractions 225
JohnT.BergerIII
PART I: PHYSIOLOGY AND 5.5 PathophysiologyofChronicMyocardial
PATHOPHYSIOLOGY 1 Dysfunction 230
J.CarterRalphe
5.6 CardiopulmonaryResuscitation 235
1 TheCell 3
VinayNadkarniandRobertA.Berg
BarryWeinberger,NazeehHanna,DianeE.Heck,and
DanielA.Notterman 6 Pulmonology 242
2 EndocrinologyandMetabolism 32 HeidiJ.DaltonandMarkJ.Heulitt
MurrayM.PollackandPaulKaplowitz 6.1 AirwayStructuresandFunctions 243
HeidiJ.Dalton
3 Immunology,Inflammation,andInfectious
Diseases 59 6.2 EmbryologicandPostnatalAirwayandLung
AnthonyD.SlonimandNaliniSingh Development 245
AngelaT.Wratney,RonaldC.SandersJr,andHeidi
3.1 Immunology 60
J.Dalton
AnthonyD.Slonim
6.3 DefenseMechanismsofthePulmonaryTree 251
3.2 Inflammation 80 K.AlexDaneshmand,RonaldC.SandersJr,andHeidi
AnthonyD.Slonim J.Dalton
3.3 InfectiousDiseases 98 6.4 MovementofFluidsandSolutesandBloodFlow
AnthonyD.SlonimandNaliniSingh withintheLung 253
AngelaT.WratneyandHeidiJ.Dalton
FoundationsofInfectiousDiseasesinthe
PediatricIntensiveCareUnit 98 6.5 AlveolarFunction 256
AnthonyD.Slonim,WendyTurenne,and DouglasF.Willson
NaliniSingh
6.6 PulmonaryGasExchange 259
TheMicrobialAgents 102 AngelaT.WratneyandIraM.Cheifetz
AnthonyYunLeeandAnthonyD.Slonim
6.7 RespiratorySystemPhysiology 264
TheClinicianandtheClinicalMicrobiology MarkJ.HeulittandPaulOuellet
Laboratory 124
6.8 MechanicalBreathing 277
JosephM.Campos
MarkJ.Heulitt,PaulOuellet,andRichardT.Fiser
TheAntimicrobialAgents 134
6.9 CardiorespiratoryInteractions 303
SumatiNambiarandJohnN.vandenAnker
CindySuttonBarrettandIraM.Cheifetz
4 HematologyandOncology 157
6.10 AcuteLungInjury 308
EdwardC.WongandNaomiL.C.Luban
RonaldC.SandersJrandK.AlexDaneshmand
5 CardiacPhysiologyandPathophysiology 196 7 Neurosciences 318
JohnT.BergerIIIandRichardA.Jonas MichaelJ.BellandJoAnneE.Natale
5.1 CardiomyocyteFunction 197 8 Nephrology 378
StevenM.Schwartz RobertE.Lynch
5.2 CardiacPerformance 205 9 Gastroenterology 416
JohnT.BergerIII DavidM.SteinhornandJonathanS.Evans
vi Contents
10 ShockandShockSyndromes 438 26 CoagulationDisorders 577
JosephA.Carcillo,JeffersonPedroPiva,NealJ. W.TaitStevens
Thomas,YongY.Han,JohnC.Lin,and 27 OncologicEmergencies 585
RichardAndrewOrr EdwardC.WongandAnneL.Angiolillo
28 TherapeuticApheresis 597
AnneF.Eder
PART II: CLINICAL DISORDERS 473
29 BoneMarrowTransplantation 605
SectionA:EndocrineDisorders 474 EdwardC.Wong,EvelioD.Perez-Albuerne,and
MurrayM.PollackandPaulKaplowitz NayneshR.Kamani
11 EndocrineDisordersofWaterRegulation 475 SectionD:CardiacDiseases 615
SusanB.Nunez JohnT.BergerIIIandRichardA.Jonas
12 DiabeticKetoacidosis 481 30 PrinciplesofPostoperativeCare 616
RajaniPrabhakaranandLynneL.Levitsky MelvinC.Almodovar
31 CongenitalHeartDisease 623
13 ThyroidDisorders 488
JohnT.BergerIII,StevenM.Schwartz,andDavid
AudreyAustin
P.Nelson
14 AdrenalDisorders 492 32 MyocardialDisease 633
ChristianeO.Corriveau ChristopherF.Spurney
15 DisordersofMicronutrients 497 33 PericardialandEndocardialDisease 639
AngelaA.HsuandCynthiaL.Gibson GeorgeOfori-Amanfo
16 InbornErrorsofMetabolism 505 34 Dysrhythmias 644
DinaJ.ZandandCynthiaJ.Tifft JeffreyP.Moak
SectionB:DisordersofHostDefense 517 35 Pacemakers 659
Anthony D.Slonim RussellR.CrossandJeffreyP.Moak
36 VasoactiveAgents 664
17 ImmuneComplicationsofTransplantation 518
RonaldA.BronickiandPaulA.Checchia
MarkD.Sorrentino
SectionE:RespiratoryDisorders 670
18 ImmunosuppressionInducedbyTherapeutic
HeidiJ.DaltonandMark J.Heulitt
Agents 522
37 PulmonaryDiagnosticProcedures 671
WilliamT.TsaiandJohnN.vandenAnker
NatanNoviskiandParthakProdhan
19 Allergic,Vasculitic,andRheumatologic
38 Asthma 678
Illnesses 527
ReginaOkhuysen-CawleyandJamesB.Fink
DavidC.StockwellandAditiSharangpani
39 DisordersoftheLungParenchyma 683
20 ImmunodeficiencySyndromesinChildren 539 AngelaT.Wratney,IraM.Cheifetz,James
ThomasJ.CholisIIIandAnthonyD.Slonim D.Fortenberry,andMatthewL.Paden
21 PediatricAcquiredImmunodeficiencySyndrome 40 PulmonaryHypertension 694
inthePediatricIntensiveCareUnit 547 AsrarRashidandD.DunbarIvy
SophiaR.SmithandHansM.L.Spiegel 41 DisordersoftheChestWallandRespiratory
Muscles 705
22 HealthCare–AssociatedInfections 553
AngelaT.WratneyandIraM.Cheifetz
JenniferHurstandNaliniSingh
42 GasesandDrugsUsedinSupportofthe
23 SystemicInflammatoryResponseSyndrome 559
RespiratorySystem 717
M.NiluferYalindag-OzturkandOralAlpan
AngelaT.WratneyandIraM.Cheifetz
SectionC:HematologicandOncologic
Oxygen,Monitoring,HypoxicGasorCarbon
Disorders 564
Dioxide,andHeliox 717
NaomiL.C.Luban andEdwardC.Wong
AngelaT.WratneyandIraM.Cheifetz
24 SickleCellDisease 565 InhaledNitricOxide 722
KarenE.King EmilyL.DobynsandEvaNozikGrayck
25 ThromboticandFibrinolyticDisorders 571 Surfactant 724
GuyYoung DouglasF.Willson
Contents vii
43 MechanicalVentilation 730 55 MaintenanceandSupportofKidneyFunctionin
MarkJ.Heulitt,BasemZaferAlsaati,RichardT.Fiser, CriticalIllness 816
andSylviaGo¨thberg MohammadIlyasandEileenEllis
44 ExtracorporealTechniques 744 56 AcuteRenalFailure 821
StevenA.ConradandHeidiJ.Dalton CraigWilliamBelsha
SectionF:NeurologicDisorders 754
57 HemolyticUremicSyndrome 826
MichaelJ.BellandJoAnne E.Natale
EllenG.Wood
45 Global/RegionalIschemia 755 58 RenalReplacementTherapy 831
RebeccaN.Ichord StuartL.Goldstein
46 DisordersofMuscle 760 59 RenalPharmacology 836
JoAnneE.NataleandMichaelJ.Bell DouglasL.BloweyandJamesD.Marshall
47 NeurologicalEmergencies 767 SectionH:GastrointestinalDisorders 842
RogerJ.PackerandDerekA.Bruce DavidM.SteinhornandJonathan S.Evans
48 AlteredMentalStatus 773 60 GastrointestinalBleeding 843
LeticiaManningRyanandStephenJ.Teach FranziskaMohrandMarshaKay
49 CentralNervousSystemInfections 778 61 RefluxandOtherMotilityDisorders 850
AndrewM.Bonwit VictorM.Pineiro-Carrero
50 StatusEpilepticus 783 62 GastrointestinalTrauma 855
TammyNorikoTsuchida,StevenL.Weinstein,and RiccardoA.SuperinaandLisaP.Abramson
WilliamDavisGaillard
63 HepaticFailure 862
51 BrainDeath 790 DavidM.Steinhorn
I.DavidTodres
64 GastrointestinalFailure 868
52 BrainandSpinalCordTrauma 796 DavidM.Steinhorn
JoAnneE.NataleandMichaelJ.Bell
65 NutritionalSupportinCriticalIllness 872
53 SedationforProceduresandMechanical DonaldE.George,LauraT.Russo,andDavid
VentilationinChildrenwithCriticalIllness 804 M.Steinhorn
YewandeJ.JohnsonandJuliaC.Finkel
66 AcutePancreatitis 878
SectionG:RenalDisorders 810
RubaK.AzzamandMiguelSaps
RobertE.Lynch
54 FluidManagementandElectrolyte
Disturbances 811 Appendix 884
AlokKaliaandAmitaSharma Index 891

List of Contributors
LISAP.ABRAMSON,MD CRAIGWILLIAMBELSHA,MD
PediatricSurgeryFellow,DivisionofPediatricSurgery, AssociateProfessor,DepartmentofPediatrics,St.Louis
Children’sMemorialHospital,Chicago,Illinois University;Director,HypertensionProgram,Divisionof
PediatricNephrology,SSMCardinalGlennon
MELVINC.ALMODOVAR,MD Children’sHospital,St.Louis,Missouri
AssistantProfessor,DepartmentofPediatrics,Universityof
ROBERTA.BERG,MD
ColoradoHealthandScienceCenter;DirectorofCardiac
AssociateDeanforClinicalAffairs,Professor,Department
IntensiveCare,TheChildren’sHospitalHeartInstitute,
ofPediatrics,TheUniversityofArizonaCollegeof
TheChildren’sHospitalDenver,Denver,Colorado
Medicine;PediatricIntensivist,DepartmentofPediatrics,
UniversityMedicalCenterandTucsonMedicalCenter,
ORALALPAN,MD
Tucson,Arizona
Director,CenterforAllergy,Asthma,andImmune
Disorders,SouthRiding,Virginia JOHNT.BERGERIII,MD
AssistantProfessor,DepartmentofPediatrics,TheGeorge
BASEMZAFERALSAATI,MD WashingtonUniversitySchoolofMedicine;Director,
AssistantProfessor,DepartmentofPediatrics,Queen’s CardiacIntensiveCare,DepartmentofCriticalCare
University;AttendingPhysician,DepartmentofPediatrics, MedicineandCardiology,Children’sNationalMedical
KingstonGeneralHospital,Kingston,Ontario,Canada Center,Washington,DC
DOUGLASL.BLOWEY,MD
ANNEL.ANGIOLILLO,MD
AssociateProfessor,DepartmentsofPediatricNephrology
AssociateProfessor,DepartmentofPediatrics,TheGeorge
andClinicalPharmacology,Universityof
WashingtonUniversitySchoolofMedicine;Attending
Missouri—KansasCitySchoolofMedicine,Children’s
Physician,DivisionofHematologyandOncology,Center
MercyHospitalsandClinics,KansasCity,Missouri
forCancerandBloodDisorders,Children’sNational
ANDREWM.BONWIT,MD
MedicalCenter,Washington,DC
AssistantProfessor,DepartmentofPediatrics,TheGeorge
AUDREYAUSTIN,MD WashingtonUniversitySchoolofMedicine;Attending
AssistantProfessor,DepartmentofPediatrics,TheGeorge Pediatrician,Children’sNationalMedicalCenter,
WashingtonUniversitySchoolofMedicineandHealth Washington,DC
Sciences;Endocrinologist,DepartmentofPediatrics, RONALDA.BRONICKI,MD
Children’sNationalMedicalCenter,Washington,DC AssistantClinicalProfessor,DepartmentofPediatrics,
Harbor—UniversityofCaliforniaLosAngelesMedical
RUBAK.AZZAM,MD Center,UniversityofCaliforniaLosAngelesSchoolof
AssistantProfessor,DepartmentofPediatric Medicine;AttendingPhysician,CardiacIntensiveCare,
GastroenterologyandHepatology,TheUniversityof Children’sHospitalofOrangeCounty,Orange,California
Chicago,ComerChildren’sHospital,Chicago,Illinois
DEREKA.BRUCE,MB,CHB
ProfessorofNeurosurgeryandPediatrics,Departmentof
CINDYSUTTONBARRETT,MD
Neurosurgery,TheGeorgeWashingtonUniversitySchool
SeniorFellowinPediatricCriticalCare,PediatricCritical
ofMedicine;AttendingNeurosurgeon,Departmentsof
CareFellow,DepartmentofPediatricCriticalCare,Duke
NeuroscienceandBehavioralMedicine,Children’sNa-
UniversityMedicalCenter,Durham,NorthCarolina
tionalMedicalCenter,Washington,DC
MICHAELJ.BELL,MD JOSEPHM.CAMPOS,PhD
AssociateProfessorofPediatricsandCriticalCare Professor,DepartmentsofPediatrics,Pathology,and
Medicine,DepartmentofPediatrics,DivisionofCritical Microbiology/TropicalMedicine,TheGeorgeWashington
CareMedicine,TheGeorgeWashingtonUniversitySchool UniversityMedicalCenter;Director,Microbiology
ofMedicine;Director,NeurocriticalCare,Departmentof LaboratoryandLaboratoryInformatics,Departmentof
Pediatrics,DivisionofCriticalCareMedicine,Children’s LaboratoryMedicine,Children’sNationalMedicalCenter,
NationalMedicalCenter,Washington,DC Washington,DC
x ListofContributors
JOSEPHA.CARCILLO,MD K.ALEXDANESHMAND,DO
AssociateProfessor,DepartmentofCriticalCareMedicine, PediatricIntensiveCareFellow,DepartmentofPediatric
UniversityofPittsburgh,CenterforClinical CriticalCareMedicine,UniversityofFlorida;Pediatric
Pharmacology;AssociateDirector,PediatricIntensive IntensiveCareFellow,DepartmentofPediatricCritical
CareUnit,DepartmentofCriticalCareMedicine, CareMedicine,ShandsChildren’sHospital,
Children’sHospitalofPittsburgh,Pittsburgh, Gainesville,Florida
Pennsylvania
EMILYL.DOBYNS,MD
AssociateProfessor,SectionofCriticalCareMedicine,
PAULA.CHECCHIA,MD
AssistantProfessorofCriticalCareandCardiology, DepartmentofPediatrics,UniversityofColoradoDenver
DepartmentofPediatrics,WashingtonUniversitySchool HealthSciencesCenter;MedicalDirector,PediatricCritical
ofMedicine;Chief,PediatricCardiacCriticalCareService, CareUnit,DepartmentofPediatricCriticalCareMedicine,
Co-director,PediatricIntensiveCareUnit,St.Louis TheChildren’sHospital,Denver,Colorado
Children’sHospital,St.Louis,Missouri
ANNEF.EDER,MD,PhD
ExecutiveMedicalOfficer,BiomedicalHeadquarters,
IRAM.CHEIFETZ,MD,FCCM,FAARC
AmericanRedCross,Washington,DC
DivisionChief,CriticalCareMedicine,Associate
Professor,DepartmentofPediatrics,DukeUniversity
EILEENELLIS,MD
SchoolofMedicine,DukeUniversityMedicalCenter;
Professor,DepartmentofPediatrics,Universityof
MedicalDirector,PediatricIntensiveCareUnit,Medical
ArkansasforMedicalSciences,LittleRock,Arkansas;
Director,PediatricRespiratoryCareandECMO,
Professor,DepartmentofPediatrics,Arkansas
DepartmentofPediatrics,DukeChildren’sHospital,Duke
Children’sHospital,LittleRock,Arkansas
UniversityMedicalCenter,Durham,NorthCarolina
JONATHANS.EVANS,MD
THOMASJ.CHOLISIII,MD StaffPhysician,DivisionofPediatricGastroenterologyand
ClinicalInstructor,DepartmentofPediatrics,TheGeorge Nutrition,NemoursChildren’sClinic,Jacksonville,
WashingtonUniversitySchoolofMedicine,Children’s Florida
NationalMedicalCenter,Washington,DC
JAMESB.FINK,MS,RRT,FAARC
STEVENA.CONRAD,MD,PhD,FCCM Fellow,RespiratoryScience,DepartmentofScientific
Professor,DepartmentsofMedicine,Pediatrics, Affairs,Aerogen,Inc.,MountainView,California
EmergencyMedicine,andAnesthesiology,LouisianaState
JULIAC.FINKEL,MD
UniversityHealthSciencesCenter;Director,CriticalCare
AssociateProfessor,DepartmentsofAnesthesiologyand
Service,andExtracorporealLifeSupportProgram,
Pediatrics,TheGeorgeWashingtonUniverstiySchoolof
LouisianaStateUniversityHospital,Shreveport,
Medicine;Director,AnesthesiaPainManagementService,
Louisiana
Children’sNationalMedicalCenter,Washington,DC
CHRISTIANEO.CORRIVEAU,MD
RICHARDT.FISER,MD
AssistantProfessor,DepartmentofPediatrics,TheGeorge
AssociateProfessor,DepartmentsofPediatricCriticalCare
WashingtonUniversityMedicalCenter;Director,
andCardiology,UniversityofArkansasforMedical
DepartmentalEducationandFellowshipTraining,Divison
Sciences—CollegeofMedicine,LittleRock,Arkansas;
ofCriticalCareMedicine,Children’sNationalMedical
MedicalDirector,ECMO,ArkansasChildren’sHospital,
Center,Washington,DC
LittleRock,Arkansas
RUSSELLR.CROSS,MD,MSBME JAMESD.FORTENBERRY,MD,FCCM,FAA
AssistantProfessor,DepartmentofPediatrics,TheGeorge ClinicalAssociateProfessor,DepartmentofPediatrics,
WashingtonUniversitySchoolofMedicine;Attending EmoryUniversitySchoolofMedicine;DivisionDirector,
Physician,DepartmentofPediatricCardiology,Children’s DepartmentofCriticalCareMedicine,ECMO,Children’s
NationalMedicalCenter,Washington,DC HealthcareofAtlanta,Atlanta,Georgia
HEIDIJ.DALTON,MD,FCCM WILLIAMDAVISGAILLARD,MD
Professor,DepartmentofPediatrics,TheGeorge Professor,DepartmentsofNeurologyandPediatrics,The
WashingtonUniversitySchoolofMedicineandHealth GeorgeWashingtonUniversitySchoolofMedicine;
Sciences;Director,PediatricIntensiveCareUnitand Director,ComprehensivePediatricEpilepsyProgram,
PediatricECMO,DepartmentofCriticalCareMedicine, DepartmentofNeurology,Children’sNationalMedical
Children’sNationalMedicalCenter,Washington,DC Center,Washington,DC