Table Of Content

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 ManagingEditor:NicoleDernoski/FranMurphy DevelopmentalEditor:MollyConnors,DovetailContentSolutions ProjectManager:NicoleWalz SeniorManufacturingManager:BenRivera SeniorMarketingManager:AngelaPanetta DesignCoordinator:TerryMallon CoverDesigner:JosephDePinho ProductionServices:LaserwordsPrivateLimited Printer:EdwardsBrothers 2006byLippincottWilliams&Wilkins,aWoltersKluwerbusiness 530WalnutStreet Philadelphia,PA19106 WWW.LWW.COM Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybe reproducedinanyformorbyanymeans,includingphotocopying,orutilizingby anyinformationstorageandretrievalsystemwithoutwrittenpermissionfromthe copyrightowner,exceptforbriefquotationsembodiedincriticalarticlesandreviews. PrintedintheUnitedStates LibraryofCongressCataloging-in-PublicationData 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 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandto describegenerallyacceptedpractices.However,theauthors,editors,andpublisher arenotresponsibleforerrorsoromissionsorforanyconsequencesfromapplication oftheinformationinthisbookandmakenowarranty,expressedorimplied,with respecttothecurrency,completeness,oraccuracyofthecontentsofthepublication. Applicationofthisinformationinaparticularsituationremainstheprofessional responsibilityofthepractitioner. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrug selectionanddosagesetforthinthistextareinaccordancewithcurrent recommendationsandpracticeatthetimeofpublication.However,inviewof ongoingresearch,changesingovernmentregulations,andtheconstantflowof informationrelatingtodrugtherapyanddrugreactions,thereaderisurgedtocheck thepackageinsertforeachdrugforanychangeinindicationsanddosageandfor addedwarningsandprecautions.Thisisparticularlyimportantwhenthe recommendedagentisaneworinfrequentlyemployeddrug. SomedrugsandmedicaldevicespresentedinthispublicationhaveFoodand DrugAdministration(FDA)clearanceforlimiteduseinrestrictedresearchsettings.It istheresponsibilityofhealthcareproviderstoascertaintheFDAstatusofeachdrug ordeviceplannedforuseintheirclinicalpractice. Thepublishershavemadeeveryefforttotracecopyrightholdersforborrowed material.Iftheyhaveinadvertentlyoverlookedany,theywillbepleasedtomakethe necessaryarrangementsatthefirstopportunity. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartment at(800)638-3030orfaxordersto(301)223-2320.Internationalcustomersshould call(301)223-2300.LippincottWilliams&Wilkinscustomerservicerepresentatives areavailablefrom8:30amto6:30pm,EST,MondaythroughFriday,fortelephone access.VisitLippincottWilliams&WilkinsontheInternet:http://www.lww.com. 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