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Paediatric Intensive Care PDF

944 Pages·2010·2.93 MB·English
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OXFORD MEDICAL PUBLICATIONS Paediatric Intensive Care Oxford Specialist Handbooks published and forthcoming General Oxford Specialist Oxford Specialist Handbooks in Handbooks Neurology A Resuscitation Room Guide Epilepsy Addiction Medicine Parkinson’s Disease and Other Hypertension Movement Disorders Perioperative Medicine, Second Stroke Medicine Edition Oxford Specialist Handbooks in Post-Operative Complications, Paediatrics Second Edition Pulmonary Hypertension Paediatric Dermatology Renal Transplantation Paediatric Endocrinology and Diabetes Oxford Specialist Handbooks in Paediatric Gastroenterology, Anaesthesia Hepatology, and Nutrition Cardiac Anaesthesia Paediatric Haematology and Day Case Surgery Oncology General Thoracic Anaesthesia Paediatric Intensive Care Neuroanaethesia Paediatric Nephrology Obstetric Anaesthesia Paediatric Neurology Paediatric Anaesthesia Paediatric Palliative Care Regional Anaesthesia, Paediatric Radiology Stimulation and Ultrasound Paediatric Respiratory Medicine Techniques Oxford Specialist Handbooks in Oxford Specialist Handbooks in Psychiatry Cardiology Child and Adolescent Psychiatry Adult Congenital Heart Disease Old Age Psychiatry Cardiac Catheterization and Coro- Oxford Specialist Handbooks in nary Intervention Radiology Cardiac Electrophysiology Cardiovascular Magnetic Resonance Interventional Radiology Echocardiography Musculoskeletal Imaging Fetal Cardiology Pulmonary Imaging Heart Failure Oxford Specialist Handbooks Nuclear Cardiology in Surgery Pacemakers and ICDs Cardiothoracic Surgery Valvular Heart Disease Colorectal Surgery Oxford Specialist Handbooks in Hand Surgery Critical Care Liver and Pancreatobiliary Surgery Advanced Respiratory Operative Surgery, Second Edition Critical Care Oral Maxillofacial Surgery Otolaryngology and Head and Oxford Specialist Handbooks in Neck Surgery End of Life Care Paediatric Surgery End of Life Care in Dementia Plastic and Reconstructive Surgery End of Life Care in Nephrology Surgical Oncology End of Life in the Intensive Care Urological Surgery Unit Vascular Surgery 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 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2010 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2010 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by Glyph International, Bangalore, India Printed in China on acid-free paper by Asia Pacifi c Offset ISBN 978–0–19–923327–4 10 9 8 7 6 5 4 3 2 1 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 information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misap- plication of material in this work. 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 This page intentionally left blank ix Acknowledgement We would like to thank Mr David Barron for providing the illustrations for the cardiac lesions described in Chapter 20.

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One in 70 children are admitted to paediatric intensive care (PIC) at some time during childhood. Most paediatric junior doctors will rotate through PIC, and will be involved in organizing acute intensive care for critically ill children. The range of children and their illnesses going through PIC i
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