Steven E Lucking Frank A Maffei Robert F Tamburro Arno Zaritsky Editors PEDIATRIC CRITICAL CARE TEXT AND STUDY GUIDE Second Edition 123 Pediatric Critical Care Steven E Lucking • Frank A Maffei Robert F Tamburro • Arno Zaritsky Editors Pediatric Critical Care Text and Study Guide Second Edition Editors Steven E Lucking Penn State Hershey Children’s Hospital Pediatric Critical Care Medicine Hershey, PA USA Robert F Tamburro Department of Pediatrics/Divisions of Pediatric Critical and Palliative Care Medicine Janet Weis Children’s Hospital at Geisinger, Geisinger Commonwealth School of Medicine Danville, Pennsylvania USA Frank A Maffei Division of Pediatric Critical Care, Department of Pediatrics Janet Weis Children’s Hospital, Geisinger Medical Center Danville, PA USA Geisinger Commonwealth School of Medicine Scranton, PA USA Arno Zaritsky Department of Pediatrics Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters Norfolk, Virginia USA ISBN 978-3-030-53362-5 ISBN 978-3-030-53363-2 (eBook) https://doi.org/10.1007/978-3-030-53363-2 © Springer Nature Switzerland AG 2021 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland V Preface The multidisciplinary nature of pediatric critical care medicine creates a considerable challenge to those who seek to master the discipline The knowledge that the critical care pediatrician must possess encompasses aspects of many different organ-based specialties Our goal for this text is to help young critical care physicians review and master fundamental principles of our specialty for the purpose of achieving certification In addition, we hope that the text will be a practical resource for the practice of pediatric critical care incorporating concepts of pathophysiology, therapeutic theory, and management principals We are indebted to our authors for their willingness to share their considerable expertise and contribute to this labor We are grateful for their efforts and their patience as we navigated the pitfalls in getting the work completed We hope that the text will help the practitioner achieve success in the practice of pediatric critical care medicine The care of children is both a privilege and a blessing To care for children at their most vulnerable time cannot help but provide the practitioner with awe for the beauty of life and the resilience of the child’s spirit, a respect for the power of a parent’s love, and an appreciation of the blessing of our own children’s health Steven E. Lucking, MD Hershey, PA, USA Acknowledgments When we first began this endeavor years ago, we were told by many experienced colleagues that putting together a quality textbook is a labor of love, a greater truth has not been told However, when we were told a second edition would be so much easier than the first, that turned out to be not so true The work has been difficult at times, but always rewarding and worthwhile As editors, we are proud of the textbook, but clearly recognize that the project would never have come to fruition without key individuals who have supported us through this arduous process To our wives: Lynn, Tricia, Janet, and Peggy, who supported and guided us throughout the entire project Without their love, wisdom, and tireless support, this book would have never reached completion To our children, who serve as the inspiration and guiding force for each of us To the authors of every chapter Without their intellect, hard work, and drive to teach, the dissemination of this important knowledge to the next generation of pediatric intensivists would not be possible We particularly want to thank our authors for their efforts during the late stages of the publication when many of them assumed increased clinical and administrate duties in response to the COVID-19 pandemic On that note, the editors decided not to include a separate section on the SARS CoV-2 virus and the pandemic as the data was still in evolution and publication of an evidence based chapter would have been premature Two additional special acknowledgements: We want to thank and acknowledge our Co-editor, Dr Steven Lucking After 35 years of service as a Pediatric Intensivist, Steve will be turning his attention to travel, baseball, and serving as a pediatrician on medical missions Steve has been a foundational and transformative leader in the field of pediatric critical care He has been the quintessential bedside intensivist—shepherding our sickest children through the rigors of critical illness He has served as a mentor to many—always placing the academic achievements of his colleagues above his own Always an advocate, critical thinker, and most importantly a selfless friend Lastly, my wife Lynn Maffei, who during the writing of the second edition, developed a health crisis She has been the model of courage, perseverance, and faithfulness Our love can and will overcome all »» God watches over small children and fools…he has us all covered Frank A. Maffei, MD Robert F. Tamburro, MD, MSc Arno L. Zaritsky, MD Steven E. Lucking, MD VII Contents Volume I I Essential Physiologic Principles enomics and Genetic Predisposition to Critical Illness in the G Pediatric Intensive Care Unit ������������������������������������������������������������������������������������� 3 Mary K Dahmer and Michael W Quasney xygen Delivery and Oxygen Consumption in Pediatric O Critical Care�������������������������������������������������������������������������������������������������������������������������� 27 Juan A Gutierrez and Andreas A Theodorou Endothelial Interactions and Coagulation ������������������������������������������������������ 55 Trung C Nguyen and Joseph A Carcillo The Inflammatory Response�������������������������������������������������������������������������������������� 77 Mark W Hall Nutrition in Critical Illness������������������������������������������������������������������������������������������ 105 Margaret A Satchell Pharmacology �������������������������������������������������������������������������������������������������������������������� 123 Robert P Kavanagh, Lindsay C Trout, and Gretchen L Brummel II Respiratory Pulmonary Structure and Function���������������������������������������������������������������������� 155 Jonathan Spahr undamentals of Gas Exchange and the Assessment F of Oxygenation and Ventilation������������������������������������������������������������������������������ 173 John S Sullivan and Toah Nkromah Alafita Upper Airway Obstruction������������������������������������������������������������������������������������������ 193 Steven E Lucking 10 Severe Asthma�������������������������������������������������������������������������������������������������������������������� 219 Ronald Wong and Frank A Maffei 11 Pediatric Acute Respiratory Distress Syndrome ������������������������������������������ 251 Garrett Keim and Nadir Yehya Contents VIII 12 Conventional Mechanical Ventilation ���������������������������������������������������������������� 273 Guillaume Emeriaud, Christopher Newth, Robinder Khemani, and Philippe Jouvet 13 Nonconventional Mechanical Ventilation�������������������������������������������������������� 313 Michael D Dettorre III Cardiovascular 14 Hemodynamics������������������������������������������������������������������������������������������������������������������ 333 Scott A Hagen, Awni M Al-Subu, Nathan Thompson, and Timothy E Corden 15 Regional Circulations ���������������������������������������������������������������������������������������������������� 367 Arno L Zaritsky, Demetri Yannopoulos, and Vinay M Nadkarni 16 Assessment of Cardiovascular Function������������������������������������������������������������ 413 Frank A Maffei 17 Circulatory Failure/Shock�������������������������������������������������������������������������������������������� 469 Stephen Pfeiffer and Hector R Wong 18 Disorders of Cardiac Rhythm������������������������������������������������������������������������������������ 493 C James Smith and William G Harmon 19 Postoperative Cardiac Care���������������������������������������������������������������������������������������� 523 Orkun Baloglu, William Hanna, and Mohammed Hamzah 20 Cardiovascular Agents�������������������������������������������������������������������������������������������������� 559 Frank A Maffei, Jennifer E L Diep, and Arno L Zaritsky 21 Mechanical and Electrical Myocardial Support �������������������������������������������� 607 Adrian D Zurca, Duane C Williams, Jason R Imundo, and Gary D Ceneviva IV Central and Peripheral Nervous System 22 entral and Peripheral Nervous Systems: Development, C Structure, and Function������������������������������������������������������������������������������������������������ 639 Daniel J Rogers, Kiran M Sargar, and Frank A Maffei 23 hysiology of Skeletal Muscle and the Neuromuscular P Junction���������������������������������������������������������������������������������������������������������������������������������� 677 Michael T Davis and Michael P Eaton 24 Assessment of Neurologic Function �������������������������������������������������������������������� 689 Elizabeth E Scarlett and Jill M Gotoff IX Contents 25 erebral Resuscitation and Traumatic and Hypoxic-Ischemic C Brain Injury �������������������������������������������������������������������������������������������������������������������������� 729 Ericka L Fink, Alicia K Au, Dennis Simon, Patrick M Kochanek, and Robert S B Clark 26 Neurological Diseases in Pediatric Critical Care ������������������������������������������ 767 Anne Marie Morse, Michael J Bell, and Frank A Maffei 27 Sedation and Analgesia������������������������������������������������������������������������������������������������ 797 Richard L Lambert and Frank A Maffei 28 Neuromuscular Blockade�������������������������������������������������������������������������������������������� 831 Michael T Davis and Michael P Eaton V Renal and Electrolyte 29 Overview, Structure, and Function of the Nephron ���������������������������������� 863 George J Schwartz and Megan Rashid 30 Fluid/Electrolyte/Acid-Base Abnormalities ���������������������������������������������������� 911 Michael L Moritz 31 Acute Kidney Injury �������������������������������������������������������������������������������������������������������� 955 William S Varade and Elif Erkan 32 Renal Replacement Therapies���������������������������������������������������������������������������������� 983 Timothy E Bunchman Volume II VI Infectious Disease 33 Acute Pulmonary Infections�������������������������������������������������������������������������������������� 1003 Karen S Powers and Erin E Barker 34 Sepsis���������������������������������������������������������������������������������������������������������������������������������������� 1035 Erin Carlton, Angela Lorts, Thomas P Shanley, and Timothy T Cornell 35 Overwhelming Infections in Pediatric Critical Care������������������������������������ 1059 Swathi Gowtham, Raghuveer Puttagunta, and Jennifer Vodzak 36 Multiple Organ Dysfunction Syndrome ������������������������������������������������������������ 1085 Nikoleta S Kolovos 37 Healthcare-Associated Infections�������������������������������������������������������������������������� 1105 Elise W van der Jagt and S Rhodes Proctor Short Contents X VII Hematology 38 Disseminated Intravascular Coagulation���������������������������������������������������������� 1147 Robert F Tamburro, Ahmad Al-Huniti, Mariella Vargas-Gutierrez, Jorge Gonzalez Ulloa, and Leonardo R Brandão 39 Oncological Critical Care Considerations in Children ������������������������������ 1167 Arun Saini and Swati Karmarkar 40 are of the Critically Ill Pediatric Hematopoietic Cell C Transplant Patient������������������������������������������������������������������������������������������������������������ 1207 Sajad Jawad Khazal, Dristhi Ragoonanan, Janet Hume, Courtney Marie Rowan, and Kris Michael Mahadeo 41 Transfusion Medicine ���������������������������������������������������������������������������������������������������� 1243 Suzie A Noronha and Jill M Cholette VIII Gastrointestinal 42 Acute Liver Injury and Failure in Children�������������������������������������������������������� 1289 Richard L Lambert IX Endocrine and Metabolic 43 Critical Care Endocrinology �������������������������������������������������������������������������������������� 1317 Kecha A LynShue, Mabel Yau, and Mark A Sperling 44 Metabolic Crises���������������������������������������������������������������������������������������������������������������� 1351 Kevin A Strauss X Special Topics and Populations 45 Trauma/Burn������������������������������������������������������������������������������������������������������������������������ 1399 Brett W Engbrecht and Robert E Cilley 46 Toxicology for the Pediatric Intensivist�������������������������������������������������������������� 1425 Steven J Crellin and L Eugene Daugherty 47 The Approach to the Critically Ill Infant ������������������������������������������������������������ 1461 Frank A Maffei and Tessy A Thomas 48 Child Abuse �������������������������������������������������������������������������������������������������������������������������� 1491 Caroline L S George 1607 Index Hemorrhagic shock and encephalopathy syndrome (HSES) 1483 Henderson-Hasselbalch equation 302, 896 Hepatic dysfunction 1090 Hepatic encephalopathy (HE) 1299 Hepatic veno-occlusive disease (VOD) 1219–1222 Hepatitis B virus (HBV) 1270 Hepatitis C virus (HCV) 1270 Hepatorenal syndrome (HRS) 1305 Herpes simplex virus (HSV) 1474–1476 High flow nasal cannula (HFNC) 236, 237, 1215 High frequency oscillatory ventilation (HFOV) 263–264, 319–322 High frequency percussive ventilation (HFPV) 322, 323 High mobility group box-1 (HMGB1) 1152 High performance liquid chromatography (HPLC) 881 Histones and high mobility group box-1 (HMGB1) protein 1149 Hospital acquired hyponatremia 924, 925 Human bocavirus (HBoV) 1005, 1009 Human genetics –– copy number variations (CNVs) –– gene expression 9, 11 –– genetic mutations 8, –– genetic polymorphisms –– genetic recombination –– haplotype 8 –– linkage analysis –– linkage disequilibrium (LD) –– LOD score –– phenotype 11 –– single nucleotide polymorphism (SNP) –– structure and function of genes 4, 6, –– transcription 9 –– translocations 8 Human herpesvirus (HHV-6) 1227 Human immunodeficiency virus (HIV) 1270 Human leukocyte antigen (HLA) mismatch 1073 Human metapneumovirus (hMPV) 1005, 1009 Human T-lymphotrophic virus (HTLV) 1271 Hydromorphone 820 Hyperammonemia 1377 Hypercalcemia 1340 Hyperglycemic hyperosmolar state (HHS) –– clinical manifestations 1328 –– morbidities 1328 –– pathophysiology 1328 –– treatment 1328 Hyperkalemia 1172 –– causes of 936–937 –– clinical effects 938 –– definition 936 –– treatment 938–940 Hyperkalemic periodic paralysis (hyperPP) 791 Hyperleukocytosis 1173, 1174 Hypermagnesiemia 941 Hypernatremia –– CDI 920 –– clinical manifestations 918, 919 –– definition 916 –– diagnosis 916, 918 –– edematous patient 920, 921 –– pathogenesis 916 –– treatment 919, 920 Hyperosmolar therapy 754 Hyperphosphatemia 942, 1172 Hyperuricemia 1171, 1172 Hypoalbuminemia 930 Hypocalcemia 967, 1173, 1339, 1340 –– acute management 933, 934 –– calcium homeostasis 930, 931 –– critical care setting 933 –– etiology 931–933 Hypokalemia –– clinical effects 934–936 –– potassium homeostasis 934 –– treatment 936 Hypokalemic periodic paralysis (hypoPP) 791 Hypomagnesemia 940, 941 Hyponatremia –– diagnostic approach 922–924 –– edema 929, 930 –– encephalopathy –– age 925 –– cerebral demyelination complication 928, 929 –– cerebral salt wasting 927 –– clinical symptoms 925 –– hypoxia 925 –– SIADH 925, 926 –– treatment 927, 928 –– hospital acquired hyponatremia and prevention 924, 925 –– pathogenesis 921, 922 Hypophosphatemia 941, 942 Hypoplastic left heart syndrome (HLHS) 1477 Hypothalamus 656 Hypothermia 754 Hypothyroidism 1337 Hypovolemic shock 470, 472, 473 Hypoxia 925 Hypoxic acidosis 31 Hypoxic-ischemic encephalopathy 745 I Ice water caloric testing 695 Idiopathic thrombocytopenic purpura (ITP) 64, 1256 Immune effector cell associated neurotoxicity syndrome (ICANS) 1236, 1237 Immunoparalysis 528 Immunosuppression 814 Impella 618 Inadequate oxygen delivery index (IDO2) 451 Inborn errors of metabolism (IEMs) 1352, 1354, 1484 Individual donation (ID) testing strategy 1271 Infectious Disease Society of America (IDSA) 1130 Inflammatory response –– acute phase response 89, 90 –– adaptive immune system 81 –– adaptive immunity 84, 85 –– CARS 80 –– chemokines 87 –– clinical immunomodulation 93–95 –– complement system 87–89 –– critical illness 98 –– cytokines 85, 86 –– glucocorticoids (GC) 90 –– heat shock proteins (HSP) 90 –– ICU pharmacopeia 98, 99 –– immunoparalysis 95–97 –– innate immune system 80 –– antigen presentation 84 –– cellular components 82 –– migration 83, 84 –– NK cells 84 –– pathogen recognition 81, 83 –– pattern recognition receptors 81 Index 1608 Inflammatory response (cont.) –– intracellular signaling –– G-protein-mediated signaling 93 –– JAK/STAT signaling 91, 92 –– mitogen-activated protein kinases (MAPK) 92 –– toll-like receptors and NFκB pathway 91 –– macrophage activation syndrome (MAS) 97 –– multiple cellular processes 93 –– secondary hemophagocytic lymphohistiocytosis (HLH) 97 –– SIRS 79, 80 Influenza –– adenoviruses 1023, 1024 –– Avian influenza 1022 –– complications 1021 –– immunoprophylaxis 1021 –– novel H1N1 influenza A 1022, 1023 –– observational study 1021 –– serotypes 1020 –– Zanamivir 1021 Influenza A and B 1010 Inhaled nitric oxide (iNO) 544 Institute of Medicine (IOM) 1538, 1542 Intercellular adhesion molecule (ICAM) 56 Interferon gamma release assays (IGRA) 1077 International Society for the Study of Vascular Anomalies (ISSVA) 1154 Interosseous (IO) access 1469 Interrupted Aortic Arch (IAA) 543 Interstitial nephritis 966 Intraaortic balloon pumps (IABP) 616, 617 Intracellular acidosis 31 Intracranial pressure (ICP) 707 –– cerebrovascular pressure 709, 710 –– components 709, 710 –– CPP 738–740 –– external ventricular drain 708 –– intraparenchymal systems 707 –– intraventricular and parenchymal pressure 709 –– intraventricular catheters 707 –– neurointensive care monitoring 738 –– plateau waves 709 –– ventriculostomy catheter 708 –– volume relationship 707, 708 Intravenous lipid emulsion (ILE) therapy 1435 Invasive aspergillosis 1185, 1186 Invasive fungal infections (IFI) 1184 Ischemia 733 J Junctional ectopic tachycardia (JET) 535, 536, 622 –– cannon A-waves 513 –– definition 512 –– His–Purkinje complex 512 –– slow automaticity 513 –– temporary atrial pacing 513 K Ketamine –– adverse effects 812, 813 –– clinical effects 812 –– clinical indications 812 –– pharmacology 812 Kidney Disease Improving Global Outcomes (KDIGO) 959 Kids’ Inpatient Database (KID) 1541 kinin-kallikrein system 90 Knowledge errors 1492 Krebs cycle 29, 31 L Lactic acidosis 905 Langerhans cell histiocytosis (LCH) 1340 Laryngeal braking 1464 Laryngeal dystonia 201 Laryngeal mask airways (LMA) 1405 Laryngomalacia 195 Left Ventricular Assist Device (LVAD) 617 Lemierre syndrome 198, 1064 Length of stay (LOS) 1560, 1561 Levetiracetam 781 Liddle syndrome 888 Lidocaine 516 Lipopolysaccharide (LPS) 1064 Lissencephaly 642, 643 Lithium dilution cardiac output (LiDCO™) system 450 Long-QT Syndrome (LQTS) 517–519 Long-term mechanical ventilation (LTMV) 325, 326 Lorazepam 809 Low cardiac output syndrome (LCOS) 531 Low oxygen delivery 895 Lung development –– airspace 158 –– airways 158 –– airways resistance 166–168 –– alveolar-arterial (A-a) gradient 169, 170 –– alveolar gas equation 168 –– biology/anatomy 156, 157 –– compliance 161, 162, 164, 165 –– elastance 161, 162 –– functional residual capacity 166 –– gas exchange 168 –– hypoxemia 169 –– hysteresis 163–165 –– laminar vs turbulent flow 167 –– physiology 160 –– pleura/chest wall/diaphragm 160 –– pulmonary lobule and acinus 158, 159 –– pulmonary vasculature 159, 160 –– surfactant 162 –– transmural pressure and volume 163 –– ventilation/perfusion (V/Q) mismatch 169 Lymphoproliferative diseases 1296 M Macroglossia 197 Magnesium –– hypermagnesiemia 941 –– hypomagnesemia 940, 941 Malignant hyperthermia (MH) 839 Mallampati (MP) classification 805 Mannose binding lectin (MBL) 16 Masseter muscle rigidity 840 Mechanical assist devices –– IABP 616, 617 –– type of 616 –– VADs –– Berlin EXCOR pulsatile pump 618 –– BiVAD 617 –– complications 619 1609 Index –– design and flow characteristics 618 –– Impella 618 –– indications 619 –– LVAD 617 –– outcomes 619, 620 –– TandemHeart 618, 619 Mechanical ventilation 530, 531 Metabolic acidosis –– anion gap 942, 943 –– cardiac arrest 947 –– clinical effects of acidemia 945 –– definition 942 –– dilutional acidosis 943 –– DKA 946 –– elevated anion gap acidosis 944 –– gastrointestinal losses of bicarbonate 943 –– hyperchloremic 943–944 –– lactic acidosis 945–947 –– net protein anabolism 1377 –– RTA 944 –– toxic ingestions 945 –– treatment 946 Metabolic alkalosis –– adverse clinical effects of alkalemia 949, 950 –– causes 947 –– chloride resistant alkalosis 949 –– chloride sensitive alkalosis 948 –– definition 947 –– etiology 948 –– post-hypercapnic metabolic alkalosis 949 –– treatment 950 Metabolic crises –– acid–base chemistry –– ammonia 1363 –– organic acids 1362 –– ammonia –– carglumic acid 1390 –– description 1379, 1380, 1388, 1389 –– enteral citrulline 1390 –– intravenous arginine 1379, 1390 –– intravenous nitrogen scavengers 1389 –– biological stress response 1353–1355 –– clinical presentation 1363–1368 –– complications 1383 –– counterregulatory response 1357, 1358 –– deficiency 1353, 1354 –– EGPR 1357, 1359 –– evidence 1374, 1375 –– fatty acid oxidation 1378, 1379 –– fuel metabolism 1377 –– glucose infusions 1385, 1386 –– glycogen 1357 –– goals 1354 –– hemodialysis 1390, 1391 –– hypoglycemia 1355–1357 –– hypoketotic hypoglycemia 1358, 1359 –– IEMs 1352, 1354 –– insulin infusions 1386 –– infections and physiological challenges 1377, 1379 –– intermediary metabolic reactions 1352, 1353 –– interventions 1382 –– laboratory studies 1368–1372 –– L–carnitine therapy 1378, 1382, 1386–1388 –– net protein anabolism 1380 –– neuroimaging 1370, 1373, 1374 –– protein turnover 1359–1362 –– rate–limiting metabolic enzymes 1352, 1353 –– REE 1356, 1361, 1380–1381, 1383–1385 –– stereotyped adaptation 1356–1358 –– total nutritional goals 1379 Metabolic crisis –– clinical presentation 1367, 1484 –– diagnosis 1484–1486 –– IEM 1484 Methadone 821 Methicillin-resistant Staphylococcus aureus (MRSA) 1019, 1110 Methohexital (Brevital) 814 Michaelis-Menten kinetics 139 Michaelis-Menten pharmacokinetics 129 Midazolam 808, 809 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) 1024 Midface hypoplasia 197 Miller-Fisher Syndrome (MFS) 789 Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) 777 Molecular adsorbents recirculation system (MARS) 1306, 1307 Monro–Kellie doctrine 753 Morphine 819 Moyamoya disease 773 Multidrug-resistant organisms (MDROs) 1110 Multi-minicore disease (MmD) 783 Multiple organ dysfunction syndrome (MODS) –– benefit 1100 –– clinical presentation –– blood glucose levels 1091 –– cardiovascular dysfunction 1089 –– gastrointestinal aberrations 1090 –– hematologic aberrations 1091 –– infection barrier 1091 –– mechanisms 1091 –– musculoskeletal system 1092 –– neurologic injury 1089, 1090 –– primary MODS 1088 –– renal failure 1091 –– respiratory 1089 –– sepsis, inflammation, and multiple organ failure 1088 –– shock 1089 –– SIRS 1088 –– skin care 1092 –– temperature regulation 1091 –– critical pertussis-associated multiple organ failure 1098 –– diagnostic criteria 1086, 1087 –– IL-1 receptor antagonist 1100 –– immunoparalysis-associated multiple organ failure 1098 –– incidence of 1087, 1088 –– infiltration 1100 –– macrophage activation syndrome 1099 –– neutrophils and activated macrophages 1095 –– outcomes 1092–1094 –– pathobiologic phenotypes 1098 –– pediatric intensive care unit 1099 –– septic shock 1101 –– sequential multiple organ failure 1098 –– severity of 1100 –– spina bifida and neurogenic bladder 1100 –– supportive care –– abnormal hematologic findings 1097 –– acute kidney injury 1096, 1097 –– anticipation and initiation 1095 –– antimicrobials 1097 –– cardiovascular manifestations 1095, 1096 –– colonizing flora 1097 –– critical illness myopathy 1095 –– endocrine issues 1097 Index 1610 Multiple organ dysfunction syndrome (MODS) (cont.) –– long term cognitive follow-up 1095 –– neurologic sequelae 1095 –– nutritional support 1098 –– prevention techniques 1095, 1096 –– respiratory failure 1096 –– therapeutic plasma exchange 1098 Multiple-dose activated charcoal (MDAC) 1433 Multivariable model 1584 Myasthenia gravis (MG) 790, 791 Mycoplasma pneumoniae 1018 Myelin 643 Myeloablative (MAC) 1211 Myocardial depressant factors 1045 Myocardial depression 814 Myopathy –– development 847 –– differential diagnosis 846 –– disuse atrophy/acute myopathy 846, 847 –– incidence 845, 847 –– physical activity and corticosteroid therapy 847 –– prolonged weakness 847, 848 –– risk factors 846 Myotubular myopathy (MTM) 783 N N-acetylcysteine (NAC) therapy 1438–1440 N-acetyl-p-aminophenol (APAP) 1437, 1438, 1440 N-acetyl-p-benzoquinone imine (NAPQI) 1437 Naloxone 822 National Association of Children’s Hospitals and Related Institutions (NACHRI) 1546 National Healthcare Safety Network (NHSN) 1107, 1547 Necrotizing enterocolitis (NEC) 1273 Necrotizing skin and soft tissue infections (SSTI) 1064–1066 Needle cricothyroidotomy 1405 Negative pressure ventilation (NPV) 315 Nemaline myopathy 782 Neonatal alloimmune thrombocytopenia (NAIT) 1256 Neonatal hemochromatosis (NH) 1296 Neonatal hypocalcemia 931 Neonatal sepsis 1473 Nephrogenic diabetes insipidus (NDI) 1341, 1342 Nephron –– acid base –– acidification, defects in 901–904 –– ammonia and ammonium 900 –– bicarbonate 898, 899 –– Henderson-Hasselbalch equation 897 –– lactic acidosis 905 –– maintenance of pH 897 –– production of ammonium 900 –– proton concentration 896 –– renal hydrogen excretion 900, 901 –– secretion 899 –– sources for 897, 898 –– time course 897 –– titratable acids 899 –– treatment 905 –– antidiuretic hormone 869, 872 –– diuretics 893–895 –– energy requirement, normal kidney 895, 896 –– functional unit 864, 867 –– GFR –– changes in 877, 878 –– creatinine clearance 878, 880 –– cystatin C 884, 885 –– exogenous markers 878, 879 –– filtration fraction 875 –– inulin 875–877 –– serum creatinine 880–883 –– urea 883, 884 –– glomerulus functions 864, 869 –– Na+-K+-2Cl- carrier 868, 871 –– Na+-K+ATPase 866, 868, 870 –– potassium 892, 893 –– renal anatomy 864, 865 –– renal blood flow 872–876 –– renal length 864, 867 –– segment 865, 870 –– urine 865 –– water and salt balance –– aldosterone 887–889 –– ANP 890 –– definition 890, 891 –– effective circulating volume 886, 887 –– osmolality 885, 886 –– prostaglandins 891, 892 –– regulation of volume status 886 –– renal sodium handling 889 –– renin/angiotensin II 887 Nephrotoxic Injury Negated by Just-in-time Action (NINJA) 964 Nephrotoxins 964 Neurally adjusted ventilatory assist (NAVA) ventilation 293 Neurogenesis 641, 642 Neurointensive care monitoring –– brain tissue oximetry 742–744 –– cerebral blood flow 740, 741 –– cerebral metabolic monitoring 741, 742 –– cerebral microdialysis 744 –– computed tomography 745–747 –– CPP 738–740 –– electroencephalogram 744 –– intracranial pressure 738 –– magnetic resonance imaging/spectroscopy 745, 748 –– non-invasive monitoring 736, 737 –– transcranial Doppler ultrasonography 741 –– values for 736 Neurologic function –– biomarkers 724 –– brain death –– ancillary studies 704, 705 –– apnea test 704, 705 –– checklist 705–707 –– definition 703 –– examination 703 –– guidelines 703 –– brainstem activity 692 –– hemodynamic changes 698 –– herniation syndromes 697–699 –– motor responses 696 –– respiratory patterns 696, 697 –– cerebral blood flow 707 –– cerebrospinal fluid –– beta-2 transferrin 712 –– interpretation 712, 713 –– lumbar puncture 710, 711 –– RBCs 711 –– computed tomography 716–719 –– consciousness 691, 692 –– cranial nerve 692, 693 1611 Index –– corneal reflex 694 –– eye movements 694, 695 –– gag reflex 696 –– pupillary light response 693, 694 –– dermatomal distribution 700 –– electroencephalogram 712–714 –– intracranial pressure monitoring 707 –– cerebrovascular pressure 709, 710 –– components 709, 710 –– external ventricular drain 708 –– intraparenchymal systems 707 –– intraventricular and parenchymal pressure 709 –– intraventricular catheters 707 –– plateau waves 709 –– ventriculostomy catheter 708 –– volume relationship 707, 708 –– magnetic resonance imaging –– advantages 724 –– anatomy and pathology 721 –– diffusion tensor imaging 722, 723 –– diffusion weighted imaging 721, 722 –– FLAIR 721 –– paramagnetic agents and gadolinium 723 –– radiofrequency 718 –– T1 and T2 relaxation 720 –– timing and relaxation time 721 –– multimodality monitoring 716 –– PNS 701, 702 –– SEPs 714, 715 –– spinal cord injury 699 –– spinal syndromes 700, 701 –– train of four 715, 716 Neuromuscular blocking agents (NMB) –– indications and general issues 832–834 –– monitoring –– clinical assessment 853 –– double burst 850 –– electrical stimulation 848, 849 –– facial nerve 852 –– HFOV 850 –– mechanomyography and electromyography/ acceleromyography 850 –– PICUs 853 –– sedation and pain management strategies 853 –– tetanic stimulation 849 –– train of four 848–850 –– ulnar nerve 851, 852 –– NMJ 835, 836 –– non-depolarizing (ND) –– aminosteroids 844 –– benzylisoquinolines 842, 844 –– characteristics 842, 843 –– interactions and adverse effects 845, 846 –– myopathy 845–848 –– tolerance 845 –– pharmacology of muscle relaxants 834, 835 –– reverse 853–855 –– succinylcholine –– autonomic effects 840 –– cholinesterase deficiency and dysfunction 837, 838 –– histamine release 841 –– hyperkalemia 838, 839 –– intracranial, intraocular and intragastric pressures 840, 841 –– malignant hyperthermia 839 –– masseter muscle rigidity 840 –– mechanism of action and kinetics 836, 837 –– myalgias and fasciculation 841 –– phase block 841 –– recommendations 841, 842 Neuromuscular junction –– abnormalities 684, 685 –– acetylcholine receptor 678–680 –– depolarizing neuromuscular blockers 683 –– electromechanical coupling 680 –– in newborn 682 –– muscle action potential 680 –– muscle tension 681, 682 –– non-competitive inhibition 683, 684 –– non-depolarizing neuromuscular blockers 682, 683 –– presynaptic nerve terminal 678–680 –– sensitivity 684 Neuromuscular junction (NMJ) 835, 836 Neutrophil engraftment 1212 New and progressive MODS (NPMODS) 1092, 1093 Nicardipine 602 Nitric oxide (NO) 1045 Non cardiovascular effects of vasoactive agents 578 Non-benzodiazepines –– propofol –– adverse effects 811, 812 –– clinical effects 810, 811 –– clinical indications 811 –– pharmacology 810 Non-consumptive secondary thrombotic microangiopathy 64 Nonconventional mechanical ventilation –– airway pressure-release ventilation (APRV) 323–325 –– high frequency oscillatory ventilation 319–322 –– high frequency percussive ventilation (HFPV) 322, 323 –– long-term mechanical ventilation 325, 326 –– negative pressure ventilation (NPV) 315–317 –– noninvasive positive pressure ventilation (NPPV) 317, 318 –– noninvasive ventilation 314 Non cardiovascular effects of vasoactive agents 578 Non-depolarizing neuromuscular blockers 682, 683 Noninvasive positive pressure ventilation (NPPV) 317, 318 Non-invasive ventilation (NIV) 237, 314, 1215, 1218 Non-myeloablative (NMA) 1211 Non-opioid analgesics 821 Non-steroidal anti-inflammatory (NSAID) 821 Norwood procedure 546–548 Novel influenza A (H1N1) virus 1022, 1023 Null hypothesis 1573 Number needed to harm (NNH) 1578 Number needed to treat (NNT) 1577, 1578 Nutrition 551, 552 –– calorie measurement 109 –– calorimetry 107 –– energy 106, 107 –– enteral nutrition 114 –– Fick equation 108 –– formulas and tables 108, 110 –– glycemic control 113 –– in healing 106 –– immunonutrition 112 –– micronutrients 111, 112 –– modified enteral formulas 115 –– monitoring 112 –– nutrition delivery 114 –– parenteral nutrition 116, 117 –– probiotics 116 –– protein and nitrogen balance 110, 111 –– respiratory quotient 108 –– specialized enteral formulas 116 –– standard enteral formulas 115 Index 1612 O Oligodendrocytes 643 Oliguria 966 Oncocritical care 1202–1204 –– AHC 1184 –– anticancer therapies –– alkylating agents 1195, 1196 –– antimetabolites 1196 –– antitumor antibiotics 1196 –– bispecific monoclonal antibodies 1199 –– cancer immunotherapy 1197, 1198 –– CAR T-cell therapy 1199, 1200 –– carcinogenesis 1192–1195 –– checkpoint inhibitors 1197, 1199 –– CRES 1200, 1201 –– CRS 1200 –– kinase inhibitors 1197 –– monoclonal antibodies 1199 –– non-transformed heterogeneous factors 1192 –– radiation therapy 1201 –– taxanes 1196 –– topoisomerase enzymes 1196 –– vinca alkaloids 1196 –– bloodstream infections 1184 –– cardiac emergencies –– management 1179, 1180 –– monitoring and diagnosis 1179 –– overview 1179 –– pathophysiology 1179 –– CNS infections 1186 –– febrile neutropenia 1186, 1187 –– HLH syndrome 1190–1192 –– host defenses 1181 –– hyperleukocytosis 1173, 1174 –– IFI 1184 –– invasive aspergillosis 1185, 1186 –– mediastinum –– anesthesia 1178 –– definition 1174 –– diagnostic work up 1177, 1178 –– high-risk patients 1175–1177 –– malignant diagnoses 1175 –– pathophysiology 1175 –– neurological complications 1180, 1181 –– PJP 1186 –– pulmonary infections 1185 –– sepsis 1187–1189 –– tumor lysis syndrome –– anti-cancer therapy 1169 –– clinical and laboratory variables 1168, 1170 –– complication 1168, 1169 –– hyperkalemia 1172 –– hyperphosphatemia 1172 –– hyperuricemia 1171, 1172 –– hypocalcemia 1173 –– monitoring 1173 –– pathophysiological mechanism 1169 –– prevention and treatment 1169 –– typical and atypical infections 1181–1183 Operation brain trauma therapy (OBTT) 752 Opioid analgesics –– adverse effects 817 –– clinical effects and indications 817 –– pharmacology 817 Opioid and benzodiazepine withdrawal scale (OBWS) 823 Opioid withdrawal 823, 824 Ordinary linear regression 1581, 1582 Organ dysfunction 527–529 Osmotic demyelination Syndrome 651, 652 Outcome measurement –– accidental extubation 1544–1546 –– adverse events 1542–1544 –– best practices 1565 –– CAUTI 1548, 1549 –– CLABSI –– care bundles 1546, 1547 –– chlorhexidine bathing 1548 –– chlorhexidine-based products 1546 –– clinical decision-making 1546 –– collaborative efforts 1548 –– costs of 1547 –– institutions 1547 –– midline catheters 1547, 1548 –– propensity score matching 1547 –– rate tracking 1548 –– semiquantitative culture 1546 –– cost assessment 1560 –– functional outcomes 1557–1559 –– goal 1551 –– good critical care medicine 1566 –– LOS 1560, 1561 –– medical errors 1542 –– morbidity 1557 –– mortality 1557 –– practice development 1563, 1564 –– process 1562 –– quality 1538–1540 –– reflective learning 1537, 1538 –– resources 1562, 1563 –– risk adjustment 1551, 1552 –– safety performance 1544 –– standards of care 1564, 1565 –– STS 1556, 1557 –– transplantation services 1562 –– value 1540–1542 –– VAP 1549–1551 –– VPICU 1552–1555 Oxidative stress 734 Oxygen consumption (VO2) –– affecting factors 45, 46 –– assessment 47, 48 –– cellular hypoxia 41 –– definition 41 –– energy expenditure 41 –– measurement techniques 42–44 –– mixed venous and central venous oxygen saturation 44, 45 –– oxygen consumption curve 42 –– pathologic supply dependency 42 Oxygen delivery –– arterial oxygen content 32, 34, 35 –– assessment 47 –– capillary beds 40 –– cardiac output 35–38 –– compensatory mechanisms 40 –– definition 32 –– determinants and physiologic alterations 33 –– equation 32 –– fetal hemoglobin 39 –– hemorrhagic shock 40 –– hypoxemia 38, 39 –– hypoxia-inducible factors (HIF) 40 –– oxygen debt 32 –– oxygen demand 32 1613 Index –– oxygen extraction (O2ER) 32 –– oxygen hemoglobin dissociation curve 39, 40 –– sympathetic-mediated compensatory responses 39 Oxygen extraction ratio (O2ER) 46, 47 P Pacemaker-mediated tachycardia (PMT) 630, 631 Palivizumab 1013 Palliative care –– bereavement –– critical care health professionals 1527, 1528 –– definition 1525 –– health outcomes 1526 –– interventions 1528, 1529 –– risk factors 1526, 1527 –– support for siblings 1529, 1530 –– brain death 1517 –– cardiopulmonary death 1516, 1517 –– chronic conditions 1516 –– congenital malformations/chromosomal abnormalities 1515 –– diagnosis 1516 –– EOL care –– communication 1522 –– comprehensive and time-intensive care 1517 –– environmental needs 1521 –– physical needs 1517–1520 –– psychosocial needs 1520, 1521 –– ethical issues –– DCD 1525 –– disagreements 1524 –– DNR 1522, 1523 –– Doctrine of Double Effect 1524 –– goal of 1523 –– life-sustaining therapies 1522, 1523 –– pain, anxiety, and dyspnea 1523 –– recommendations 1524 –– solid organ transplantation 1524, 1525 –– injuries and acute illness 1515, 1516 –– mortality rates 1514, 1515 –– multiple organ failure 1515 Pancuronium 844 Panton valentine leukocidin (PVL) 1019 Parainfluenza 1009 Parasympathetic nervous system 669, 670 Paroxysmal sympathetic hypersensitivity (PSH) 652, 654 Parvovirus B19 1272 Patent ductus arteriosus (PDA) 540 Pattern-recognition receptors (PRR) 1041 Pediatric Acute Liver Failure Study Group (PALFSG) 1291 Pediatric Acute Lung Injury Consensus Conference (PALICC) 252, 253 Pediatric acute respiratory distress syndrome (PARDS) 184, 1215 –– Berlin ARDS 252, 253 –– clinical presentations 254 –– definition 252 –– degree of genetic predisposition 254 –– epidemiology 253, 254 –– etiology 254 –– functional residual capacity (FRC) 258 –– indirect and direct PARDS 254 –– inflammatory mediators 260 –– intrapulmonary shunting 258, 259 –– management –– airway pressure release ventilation (APRV) 264 –– corticosteroids 266 –– exogenous surfactant 267 –– extracorporeal membrane oxygenation (ECMO) 268 –– fluid balance 265, 266 –– high frequency oscillatory ventilation (HFOV) 263, 264 –– inhaled nitric oxide 267 –– neuromuscular blockade (NMB) 267 –– oxygen delivery 264, 265 –– PEEP 262, 263 –– prone positioning 266 –– ventilatory management 262 –– VILI 263 –– PALICC definition 252, 253 –– pathogenesis and treatment –– alveolar surface tension 256, 257 –– lung compliance 257, 258 –– lung fluid 255 –– Starling’s hypothesis 254 –– pathologic phases –– acute exudative phase 260 –– fibrosis and remodeling 261 –– subacute proliferative phase 261 –– time-dependent histopathological phases 260, 261 Pediatric critical care –– altered mental status –– coma 769 –– consciousness 768 –– evaluation of child 777, 778 –– infectious causes of 769 –– inflammatory causes of 770–772 –– metabolic/toxic causes of 776, 777 –– structural causes of 777 –– vascular causes of 772–776 –– infants –– botulism 784, 785 –– CCD 782 –– MTM 783 –– multi-minicore disease 783 –– nemaline myopathy 782 –– SMA 783, 784 –– older children and adolescents –– AFM 787, 788 –– GBS 788–790 –– myasthenia gravis 790, 791 –– neuromuscular weakness 785–787 –– skeletal muscle channelopathies 791 –– transverse myelitis 785, 787 –– status epilepticus –– algorithm for 779 –– benzodiazepine 780, 781 –– CSE 778 –– guideline 778, 779 –– levetiracetam 781 –– pathophysiology 778 –– phenobarbital 780, 781 –– phenytoin 780 –– VPA 781 Pediatric Early Warning Score (PEWS) 1543 Pediatric Index of Mortality– (PIM2) 1093 Pediatric Index of Mortality (PIM) 1552 Pediatric Logistic Organ Dysfunction Score (PELOD) 1092 Pediatric model for end-stage liver disease (PELD) 1309 Pediatric obesity 145 Pediatric Risk of Mortality (PRISM) 1552 Pediatric Risk of Mortality (PRISM) II scores 1547 Pediatric Risk of Mortality III (PRISM III) 1093 Pediatric Sedation State Scale (PSSS) 803 Pendelluft effect 292 Index 1614 Pentobarbital (Nembutal) 813 Perfluorocarbon based oxygen carriers (PFBOC) 1281 Performance improvement (PI) intervention 1543 Peripheral nervous system (PNS) 701, 702 –– components 646, 647 –– enteric nervous system 669 –– parasympathetic nervous system 669, 670 –– somatic nervous system 668 –– sympathetic nervous system 669 Peripherally inserted central catheters (PICCs) 1111 Peritoneal dialysis (PD) 538, 539, 974 –– access 985, 986 –– antibiotics 987 –– complications 987 –– initiation 986 –– solute clearance 987 –– solutions for 986 –– tubing 986 –– ultrafiltration 988 Periventricular leukomalacia (PVL) 644 Pertussis 1019, 1020 Pharmaceutics –– definition 147 –– hyperosmolar solutions 148 –– management of tissue extravasation 148 –– preservatives and solubilizing agents 148 –– vasoconstrictive medications 148 Pharmacodynamics –– antifungal agents 143 –– antimicrobial agents 141, 143 –– description 141 –– physiologic drug receptors 142 –– receptor-mediated mechanisms 141 Pharmacokinetics (PK) –– absorption 126, 127 –– active transport 127 –– ADME processes 124 –– bioavailability (F) 128 –– blood-brain barrier 132, 133 –– capillary permeability of drug 132 –– clearance (CL) 140, 141 –– compartmental pharmacokinetics 124, 125 –– cyclosporine 129 –– cytochrome p450 enzymes 135–137 –– distribution of drug 131 –– drug-drug interactions 131 –– drug interactions 130 –– drug metabolism 134, 135 –– enterohepatic recirculation 138 –– facilitated diffusion 127 –– first order elimination 138, 139 –– first-pass metabolism 129 –– gastric pH 128 –– glomerular filtration 138 –– half-life and steady state 140 –– hydrophilic drugs 132 –– induction/inhibition of CYP enzymes 135 –– intra-arterial administration 130 –– intramuscular (IM) absorption 131 –– intranasal (IN) delivery of sedatives/analgesics 131 –– intrathecal (IT) administration of drugs 131 –– ionized drugs 130 –– lipid soluble drugs 132 –– lipophilic (hydrophobic) drugs 132 –– medications, absorption of 128 –– Michaelis-Menten pharmacokinetics 129 –– multi-compartment model 125 –– non-organ dependent metabolism 137 –– parenteral routes of administration 130 –– passive diffusion 127 –– patient-specific parameters 130 –– perfusion-based physiologic pharmacokinetic model 126 –– pharmaceutical formulations 129 –– physiologic models 126 –– protein binding and displacement 132 –– salt factor (S) 128 –– three-compartment model 125 –– topical application 131 –– transdermal (TD) patches 131 –– tubular secretion 138 –– volume of distribution (Vd) 133, 134 –– zero order elimination 139 Phencyclidine (PCP) 812 Phenobarbital 780, 781 Phentolamine 603 Phenytoin (Fosphenytoin) 780 Pheochromocytoma –– clinical presentation 1328 –– diagnosis 1329 –– treatment 1329, 1330 Phosphorus –– hyperphosphatemia 942 –– hypophosphatemia 941, 942 Pia mater 668 Plan-do-check-act (PDCA) 1543 Plan-do-study-act (PDSA) 1544 Plasma exchange (PE) 1307 Plasminogen activator inhibitor-1 (PAI-1) 17, 56, 1152 Pneumococcal conjugate vaccines (PCV) 1017 Pneumocystis jiroveci (PCP) 1226 Pneumocystis jiroveci pneumonia (PJP) 1025, 1026, 1186 Pneumonia –– bacterial pneumonia –– bordetella pertussis 1019, 1020 –– Chlamydia pneumoniae 1018 –– Chlamydia trachomatis 1017, 1018 –– GABHS 1019 –– group B streptococcus 1019 –– Mycoplasma pneumoniae 1018 –– Staphylococcus aureus 1018, 1019 –– Streptococcus pneumoniae 1017 –– clinical presentation 1014 –– diagnosis of 1026, 1027 –– epidemiology 1014, 1015 –– normal host defense mechanisms 1016 –– pathophysiology 1016 –– treatment 1027–1029 –– viral pneumonias –– HCPS 1024, 1025 –– immunocompromised host 1025 –– influenza 1020–1022, 1024 –– MERS-CoV 1024 –– PJP 1025, 1026 –– SARS-CoV 1024 Poiseuille’s law 754 Polymerase chain reaction (PCR) assessment 1226 Polymorphonuclear leukocyte (PMN) transfusions 1259, 1260 Pontine nuclei 651 Pontine tegmentum 651, 652 Positive end-expiratory pressure (PEEP) 1177, 1464 Postcentral gyrus 660 Posterior reversible encephalopathy syndrome (PRES) 774, 1180, 1181, 1210 Postoperative cardiac care 1615 Index –– –– –– –– –– –– AKI 538, 539 CHD 526 chylothorax 552 CPB 526–529 diaphragmatic paresis 552, 553 ductal independent mixing lesions –– D-TGA, ASO 543 –– TAPVR 544 –– truncus arteriosus 544 –– heart transplantation 551 –– immediate postoperative encounter 539, 540 –– LCOS 531 –– left sided obstructive lesions –– aortic stenosis 542 –– CoA 542, 543 –– IAA 543 –– left to right shunting defects –– ASD 540, 541 –– AVSD 542 –– PDA 540 –– VSD 541 –– mechanical ventilation 530, 531 –– nutrition 551, 552 –– PAH –– definition 532 –– diagnosis 533 –– factors 532 –– management 533, 534 –– pathophysiology 532, 533 –– perioperative monitoring 529, 530 –– postoperative arrhythmias –– AET 536 –– bradyarrhythmias 537, 538 –– intrinsic and extrinsic catecholamine stimulation 534 –– JET 535, 536 –– sinus tachycardia 535 –– SVT 536, 537 –– single ventricle lesions –– atresia 545 –– BDG 548, 549 –– Fontan operation 549, 550 –– Norwood procedure 546–548 –– optimal clinical management 546 –– prostaglandin E1 545 –– pulmonary blood flow obstruction 545 –– pulmonary vascular resistance 546, 547 –– systemic blood flow obstruction 545 –– TOF 544, 545 –– vocal cord paresis/paralysis 553 Post‐transplant lymphoproliferative disease (PTLD) 1234 Potassium 892, 893 Pre-B cell colony enhancing factor (PBEF) 18 Preconceived bias 1492 Pre-engraftment syndrome (PES) 1228 Pre-storage leukoreduction 1264 Propofol –– adverse effects 811, 812 –– clinical effects 810, 811 –– clinical indications 811 –– pharmacology 810 Propofol infusion syndrome (PRIS) 811, 812 Propylthiouracil (PTU) 1335 Protease-activated receptors (PARs) 1152 Prothrombin complex concentrates (PCC) 1258 Prothrombin time (PT) 1258 Proximal renal tubular acidosis (pRTA) 902 Pulmonary arterial hypertension (PAH) –– definition 532 –– diagnosis 533 –– factors 532 –– management 533, 534 –– pathophysiology 532, 533 Pulmonary embolism (PE) 1415 Pulmonary structure and function 157 Pulse pressure variation (PPV) 1051 Pulseless electrical activity (PEA) 1516 Pupillary light reflex 693 Pupillary light response 693, 694 Pyruvate metabolism 29 Q Quality of life (QOL) 1557 Quantitative EEG (qEEG) algorithms 714 R Randomized controlled trials (RCTs) –– generalizability 1588 –– hypothesis testing 1588, 1589 –– interpreting results 1570 –– alternative hypothesis 1573 –– clinical studies 1574–1576 –– clinical vs statistical significance 1577 –– confidence interval 1573 –– NNT 1577, 1578 –– null hypothesis 1573 –– p-value 1574 –– statistical power 1574, 1576, 1577 –– level of evidence 1570–1572 –– limitations 1587 –– logistic regression –– categorical predictor 1579 –– categorical variable 1582, 1583 –– continuous variables 1583–1585 –– controlling variable 1584, 1585 –– Cox proportional hazards regression 1582 –– explanatory variables 1585, 1586 –– odds of mortality 1578, 1579 –– ordinary linear regression 1581, 1582 –– results 1578 –– ROC curve 1579–1581 –– outcomes 1589, 1590 –– study design 1570 –– study limitations 1570 –– treatment assignment 1587 –– uncontrolled confounding 1587, 1588 Raphe nuclei 651 Rapid eye movement (REM) 1452 Rapid response teams (RRT) 1543 Receiver operating characteristic (ROC) curve 1579–1581 Receptor for advanced glycation end products (RAGE) 1045 Recombinant Factor VIIa (rFVIIa) 1263 Recombinant human activated Protein C (rhAPC) 1263 Recombinant nematode anticoagulant protein c2 (rNAPc2) 1160 Red blood cell (RBC) transfusion –– acute anemia results 1246 –– administration 1254, 1255 –– alloimmunization 1253 –– indications 1250–1253 –– physiology 1246, 1248–1250 –– storage 1253, 1254 Index 1616 Reduced intensity conditioning (RIC) 1211 Reentrant supraventricular tachycardia (SVT) 536, 537 Reentry disorder 496, 497 Reflex tachycardia 814 Regional cerebral oximetry (rScO2) 743 Regional circulations –– cerebral circulation –– anatomy and histology 384, 385 –– autoregulation 385, 386 –– with brain injury 387 –– flow-mediated regulation 387 –– hypoxia and carbon dioxide 386, 387 –– coronary circulation –– adrenergic control 383 –– α-adrenergic activation 383 –– anatomy, histology and physiology 378, 379 –– β-adrenergic activation 383 –– during CPR 384 –– hypercapnia 384 –– local regulation 380, 381 –– metabolic regulation 381, 382 –– myocardial tissue acidosis 384 –– respiratory acidosis 384 –– transmural distribution 381 –– cutaneous circulation 407, 408 –– during stress and pathologic conditions 376–378 –– at major tissue beds –– blood flow and oxygen consumption 375, 376 –– endothelium-derived vasoactive factors 373, 374 –– local/systemic mediators 371, 372 –– myogenic response 370 –– potassium channels 374, 375 –– sympathetic and parasympathetic nervous system 371 –– temperature regulation of blood flow 375 –– tissue hypoxia 370 –– vascular smooth muscle cells (VSMC) activation 370, 371 –– vascular system components 369 –– pulmonary circulation –– anatomy, histology and physiology 387–389 –– hypoxic pulmonary vasoconstriction 390–392 –– normal pulmonary pressures 389 –– pulmonary vascular bed 392 –– pulmonary vascular resistance (PVR) 389, 390 –– pulmonary vascular tone, autonomic regulation 393–395 –– vasoconstrictors 392 –– vasodilators 392, 393 –– vasomediators 393 –– renal circulation –– adenosine 402 –– cortical blood flow 400 –– glomerular filtration rate (GFR) 395 –– major renal arteries 395–397 –– medullary blood flow and oxygen demand 399–401 –– nitric oxide 402 –– RAAS activation 401 –– renal blood flow and autoregulation 396, 398, 399 –– renal vasoconstriction 403 –– SNS activation 401 –– vasoactive mediators 402 –– splanchnic circulation –– baseline vascular tone regulation 404, 405 –– direct effects of absorbed nutrients 405 –– enteric nervous system and reflexes 405 –– hormones and peptides 406 –– local metabolic mediators 406 –– local non-metabolic mediators 406 –– pathologic states 406, 407 –– postprandial blood flow regulation 404, 405 –– vascular anatomy and distribution 403, 404 Remifentanil 820 Renal failure 1305, 1306 Renal plasma flow (RPF) 874–876, 895 Renal replacement therapy (RRT) 973 –– CFPD 988 –– CRRT –– anticoagulation 993, 994 –– ECMO 994 –– extracorporeal blood volume 991 –– features 991 –– modes of 991 –– selection of modality 993 –– hemodialysis –– anticoagulation 990 –– blood flow rate 989 –– dialysate flow rate 989 –– extracorporeal blood volume 990 –– standard prescription 990 –– vascular access 988, 989 –– inborn errors of metabolism 995 –– indications 985, 995 –– intoxications 995, 996 –– medication clearance 994, 995 –– modalities 996, 997 –– nutrition losses 994 –– peritoneal dialysis –– access 985, 986 –– antibiotics 987 –– complications 987 –– initiation 986 –– solute clearance 987 –– solutions for 986 –– tubing 986 –– ultrafiltration 988 –– SLED 991 Renal sodium handling 889 Renal tubular acidosis (RTA) 901, 902, 944 Renin 887 Respiratory syncytial virus (RSV) 1005, 1227 –– antibody-mediated immunity 1006 –– cell-mediated immunity 1006, 1007 –– clinical presentation and course 1007, 1008 –– high risk populations 1008 –– types 1006 Resting energy expenditure (REE) 1356, 1361, 1380–1381, 1383–1385 Restrictive RV physiology 545 Reticular activating system 654 Reticular formation functions 654 Retinal hemorrhages (RHs) 1502, 1503 Retinopathy of prematurity (ROP) 1273 Return of spontaneous circulation (ROSC) 733 Reversible hepatopathy 1368 Reversible posterior leukoencephalopathy syndrome (RPLS) 774–776 Reye Syndrome 821 Rhinovirus (RV) 1008 Ribavirin 1012 Right ventricular outflow tract (RVOT) 544 Rocuronium 844 1617 Index S Saturated solution of potassium iodide (SSKI) 1336 Saybolt seconds universal (SSU) 1453 Schwann cells 643 Secondary hemophagocytic lymphohistiocytosis (HLH) 97 Sedation 818 –– alpha adrenergic agonists 814 –– barbiturates –– adverse effects 814 –– clinical effects 813 –– clinical indications 813, 814 –– pharmacology 813 –– benzodiazepines –– adverse effects 807, 808 –– clinical effects 807 –– clinical indications 807 –– diazepam 809 –– GABA 809, 810 –– lorazepam 809 –– midazolam 808, 809 –– pharmacology 806, 807 –– prevention and treatment 823, 824 –– chloral hydrate 816, 817 –– clonidine 815 –– COMFORT scale 801–803 –– definitions 801 –– dexmedetomidine –– adverse effects 816 –– clinical effects 816 –– clinical indications 816 –– pharmacology 815 –– ketamine –– adverse effects 812, 813 –– clinical effects 812 –– clinical indications 812 –– pharmacology 812 –– levels of 800 –– non-benzodiazepines, propofol 810–812 –– non-pharmacologic measures 799, 800 –– opioid withdrawal 823 –– pain and anxiety 801 –– pharmacologic measures 799, 800 –– pre-sedation assessment –– airway assessment 804–806 –– history 803–804 –– monitoring 806 –– physical examination 804 –– PSSS 803 –– tolerance and dependence 822, 823 –– Wong-Baker Faces scale 803 Seizures 776 Selective serotonergic reuptake inhibitors (SSRIs) 1443, 1529 Sensing threshold 625 Sepsis –– AKI 963 –– clinical presentation 1039, 1040 –– definition 1037, 1038 –– epidemiology 1038, 1039 –– pathogenesis –– adhesion molecules 1044, 1045 –– anti-pathogen activities 1041 –– coagulation cascade 1046, 1047 –– genetic regulation 1047, 1048 –– host mediators 1046 –– immune system 1040 –– inflammatory cascade 1041, 1042 –– interleukin-1β 1044 –– late mediators 1045 –– nitric oxide 1045 –– PAMP 1040 –– principal gene products/mediators 1043 –– proinflammatory action 1041 –– PRRs 1041 –– signal transduction pathways 1042, 1043 –– tumor necrosis factor-α 1044 –– systematic and multifaceted approach 1036 –– treatment strategies –– elimination of pathogen 1051–1053 –– initial resuscitation 1048–1050 –– institutional level care bundles 1054, 1055 –– invasive monitoring 1050–1052 –– maintenance of oxygen delivery 1053 –– therapeutic modalities 1053, 1054 Sepsis-induced coagulopathy (SIC) 1154 Sepsis Prevalence and Outcomes (SPROUT) study 1223 Septic platelet transfusion reactions (SPTR) 1269 Septic shock 79, 470, 474, 475 Serum creatinine 880–883 Severe acute respiratory syndrome (SARS) 1272 Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) 1024 Severe hypocalcemia 931 Shaken baby syndrome 1498 Sickle cell disease 1279, 1280 Single donor platelets (SDP) 1257 Sinus tachycardia 503, 535 Sinusoidal obstruction syndrome (SOS) 1219–1222 Skeletal muscle 678 –– abnormalities 684, 685 Slow continuous ultrafiltration (SCUF) 994 Society for Thoracic Surgeons (STS) 1556, 1557 Somatic nervous system 668 Somatosensory evoked potentials (SEPs) 714, 715 Sotalol 517 Spinal cord 647, 648 Spinal cord compression 1181 Spinal cord injury, neurologic function 699 Spinal syndromes 700, 701 Starling’s law 335, 337 State Behavioral Scale (SBS) 801 Statistical power 1574, 1576, 1577 Status epilepticus (SE) 714 –– algorithm for 779, 782 –– benzodiazepine 781 –– benzodiazepines 780 –– CSE 778 –– guideline 778, 779 –– levetiracetam 781 –– pathophysiology 778 –– phenobarbital 780, 781 –– phenytoin 780 –– valproic acid 781 Streptococcus agalactiae 1066 Streptococcus pyogenes infection 1065, 1066 Stroke volume 36 Strokes 772 STS Congenital Heart Surgery Database (STS-CHSD) 1556, 1557 Subarachnoid hemorrhage (SAH) 1499, 1501 Subdural hemorrhage 1501 Subdural hemorrhage (SDH) 1496, 1501 Index 1618 Substantia nigra 653 Succinylcholine (SUX) –– autonomic effects 840 –– cholinesterase deficiency and dysfunction 837, 838 –– histamine release 841 –– hyperkalemia 838, 839 –– intracranial, intraocular and intragastric pressures 840, 841 –– malignant hyperthermia 839 –– masseter muscle rigidity 840 –– mechanism of action and kinetics 836, 837 –– myalgias and fasciculation 841 –– phase block 841 –– recommendations 841, 842 Sugammadex 683, 854 Supraventricular tachycardias (SVT) 504 –– adenosine 509 –– atenolol 511 –– atrial flutter 512 –– β-adrenergic antagonists 510, 511 –– catecholamine stress response 504 –– clinical characteristics 504 –– digoxin 510 –– electrophysiologic studies 511 –– life-threatening 508 –– paroxysmal SVT 504–506 –– propranolol 511 –– rapid hemodynamic collapse 508 –– RF ablation 511 –– suppressive pharmacologic therapy 509, 510 –– Valsalva maneuver 508 –– wide complex 507 –– WPM 506, 507 Sustained low efficiency dialysis (SLED) 991 Sympathetic nervous system 669 Synaptogenesis 642 Syndrome of inappropriate antidiuretic hormone (SIADH) secretion 891, 922, 924–926, 1070, 1342 Systemic inflammatory response syndrome (SIRS) 79, 80, 1088, 1260 Systemic lupus erythematosus (SLE) 774 Systolic pressure variation (SPV) 1051 T TandemHeart 618, 619 Temporary pacemakers –– atrial pacing wires 620, 621 –– battery 626 –– cardiac pacing 620 –– contraindications and precautions 626 –– documentation 626 –– dual-chamber pacemaker 622–624 –– intrinsic rhythm 626 –– nomenclature and parameters 624 –– normal cardiac myocardium 620, 621 –– pediatric patients 621, 622 –– single-chamber pacemaker 623 –– temporary epicardial 627 –– temporary transvenous 627 –– thresholds –– capture 624 –– sensing 625 –– sensitivity 625, 626 –– testing 625 –– transcutaneous pacing 628 –– transesophageal pacing 628 –– troubleshooting –– capture 629 –– failure 629 –– oversensing 629 –– PMT 630, 631 –– sense 629, 630 Tetanic stimulation 849 Tetralogy of Fallot (TOF) 544, 545 Thalamus 655, 656 The Canadian Critical Care Trials group (TRICC trial) 1250 Therapeutic hypothermia 147 Thermodilution techniques 36 Thiopental (Pentothal) 814 Thrombin-activatable fibrinolytic inhibitor (TAFI) 57, 1152, 1263 Thrombocytopenia-associated multiple organ failure (TAMOF) 1088 Thromboelastography (TEG) 1304 Thrombotic thrombocytopenic purpura (TTP) 61, 1157, 1256 Thyroid stimulating hormone (TSH) 1337 Tissue factor pathway inhibitor (TFPI) 1151 Tissue hypoxia 370 Torsade de pointes (TdP) 517–519 Total Anomalous Pulmonary Venous Return (TAPVR) 544 Total body surface area (TBSA) 1418 Total cost of care 1541 Total parenteral nutrition (TPN) exposure 1110 Toxic shock syndrome 1062, 1063 Toxicology –– antidotes 1435–1437 –– decontamination –– activated charcoal 1433 –– cathartics 1433 –– diuretics 1434 –– excretion 1434 –– gastric lavage 1433, 1434 –– health care professionals 1432 –– hemodialysis 1434, 1435 –– ILE therapy 1435 –– ipecac 1433 –– MDAC 1433 –– ocular decontamination 1432 –– urine alkalinization 1434 –– WBI 1434 –– epidemiology 1427 –– ingestion –– history 1429 –– laboratory evaluation 1429, 1431, 1432 –– physical examination 1429, 1430 –– overdoses –– alcohols 1446–1448 –– anticholinergics 1444, 1445 –– APAP 1437, 1438, 1440 –– β-Blockers 1448, 1449 –– calcium channel blockers 1448, 1449 –– cannabinoids/synthetic cannabinoids 1451, 1452 –– carbon monoxide 1454, 1455 –– caustics 1453 –– clonidine 1449 –– CN poisoning 1455–1457 –– dextromethorphan 1452 –– digoxin 1449, 1450 –– GHB 1452 –– hydrocarbons 1453, 1454 –– methemoglobinemia 1457, 1458 –– muscle relaxants 1445 –– NAC therapy 1438–1440 –– NAPQI 1437 –– opioids 1451 1619 Index –– organophosphates and carbamates 1445, 1446 –– salicylate 1440, 1441 –– SSRIs 1443 –– sympathomimetics 1450, 1451 –– TCA 1441–1443 –– β-Blockers 1448, 1449 –– stabilization 1432 –– substances 1427, 1428 Tranexamic acid (TXA) 1162 Transfusion and anemia expert initiative (TAXI) panel 1251 Transfusion medicine –– activated Protein C 1262, 1263 –– albumin 1260, 1261 –– anaphylactic transfusion reaction 1267 –– ATLL 1271 –– bleeding disorders 1278, 1279 –– CHD 1274–1277 –– citrate 1268 –– CMV 1270, 1271 –– cryoprecipitate 1259 –– ECMO 1277 –– erythropoietin 1280 –– FFP 1257, 1258 –– FNHTRs 1267 –– granulocyte transfusions 1259, 1260 –– HBV 1270 –– HCV 1270 –– hemolytic reactions 1266, 1267 –– hemostasis 1280, 1281 –– HIV 1270 –– hypothermia 1268 –– incidence of 1266 –– indications 1246 –– irradiation 1264 –– IVIG 1261, 1262 –– leukoreduction 1264 –– malaria 1272, 1273 –– neonates 1247–1249, 1273, 1274 –– oncology/transplant patients 1279 –– orthopoxviruses 1273 –– parvovirus B19 1272 –– PCC 1258 –– platelet transfusions 1269 –– administration 1257 –– indications 1255, 1256 –– platelet units 1256, 1257 –– pre-transfusion washing 1265 –– RBC transfusion –– acute anemia results 1246 –– administration 1254, 1255 –– alloimmunization 1253 –– indications 1250–1253 –– physiology 1246, 1248–1250 –– storage 1253, 1254 –– red cells lyse 1268 –– rFVIIa 1263 –– risk identification 1270 –– SARS 1272 –– sickle cell disease 1279, 1280 –– syphilis 1272 –– TRALI 1268, 1269 –– TRIM 1265, 1266 –– uremic patients 1278 –– vCJD 1273 –– volume overload 1268 –– West Nile virus 1271 –– Zika virus 1271, 1272 Transfusion-associated graft-versus-host disease (TA-GVHD) 1264 Transfusion related acute lung injury (TRALI) 1268, 1269 Transfusion-related-immune modulation (TRIM) 1265, 1266 Transplant associated thrombotic microangiopathy (TA-TMA) 1222, 1223 Transverse myelitis (TM) 785, 787 Transverse tubules (t-tubules) 680 Trauma-induced coagulopathy (TIC) 1154 Traumatic brain injury (TBI) 1496 –– acute management 748–750 –– epidemiology and clinical outcomes 758, 759 –– ICP monitoring –– barbiturates 755 –– CSF drainage 754 –– decompressive craniectomy 754 –– goal-directed therapy 752 –– guidelines 753 –– hypothermia 754 –– primary/first-tier therapies 753 –– propensity analysis 752 –– refractory intracranial hypertension 753 –– intensive care unit management 751, 752 Tricyclic antidepressants (TCA) 1441–1443 Triggered tachycardias 497 Trimethoprim-sulfamethoxazole (TMP-SMX) 1026 Truncus arteriosus (TA) 544 Tuberculosis (TB) 1077 Tumor lysis syndrome 964, 965 –– anti-cancer therapy 1169 –– clinical and laboratory variables 1168, 1170 –– complication 1168, 1169 –– hyperkalemia 1172 –– hyperphosphatemia 1172 –– hyperuricemia 1171, 1172 –– hypocalcemia 1173 –– monitoring 1173 –– pathophysiological mechanism 1169 –– prevention and treatment 1169 Type B lactic acidosis 30 Type II error 1576 U Ultra-large von Willebrand factor (ULVWF) 56 Umbilical vein catheter (UVC) 1469 Uniform Determination of Death Act (UDDA) 1516, 1525 Univariable model 1584 Upper airway obstruction –– acquired infectious causes –– acquired subglottic stenosis 200 –– acute epiglottitis 199 –– acute infectious mononucleosis 199 –– acute spasmodic croup 198 –– angioneurotic edema 202 –– bacterial tracheitis 198 –– Bulbar dysfunction 201 –– diphtheria 199 –– epiglottitis 200 –– external trauma 202 –– foreign body aspiration 201 –– Haemophilus influenzae type b infection 199 –– laryngeal dystonia 201 –– laryngeal papillomatosis 199 –– laryngotracheobronchitis 198 –– Lemierre disease 198 –– Moraxella catarrhalis 198 Index 1620 Upper airway obstruction (cont.) –– retropharyngeal abscess 198, 199 –– Staphylococcus aureus 198 –– Streptococcus and Haemophilus organisms 198 –– thermal or chemical trauma 201 –– vocal cord paralysis 201 –– anatomy and physiology 194, 195 –– clinical examination 202, 203 –– congenital causes 196 –– definitive therapies 205, 206 –– diagnostic evaluation 203, 204 –– differential diagnosis –– choanal atresia 197 –– congenital laryngeal webs 197 –– craniofacial dysmorphism 197 –– early infancy 195 –– hemangiomas 197 –– laryngeal clefts 197 –– subglottic stenosis 197 –– tracheal stenosis 197 –– vascular rings and slings 197 –– vocal cord paralysis 197 –– difficult airway 208 –– laryngeal mask airway (LMA) 209, 210 –– mechanical support 206–208 –– needle cricothyrotomy 211 –– non-conventional intubation techniques 211, 212 –– pharmacologic considerations 208, 209 –– triage and initial stabilization 204, 205 –– ventilation without intubation 209 Upper motor neuron (UMN) lesions 699 Urea 883, 884 Urea cycle defects (UCDs) 1361–1362 Urea cycle disorders 1388 Urinary tract infection (UTI) –– biofilms 1125 –– CAUTI 1125, 1127 –– comparative risks vs benefits 1125 –– critically ill children 1126 –– Gram-negative bacteria 1126, 1127 –– neonatal intensive care units 1125 –– prevention 1127, 1128 –– treatment 1128 Urinary tract infections associated with indwelling catheters (CAUTI) 1107 US Department of Health and Human Services (DHHS) 1264 US Food and Drug Administration (FDA) 1262 V Value 1540–1542 Vancomycin-resistant Enterococci (VRE) 1110 Variant Creutzfeldt-Jacob disease (vCJD) 1273 Varicella-zoster virus (VZV) reactivation 1226 Vascular cell adhesion molecule (VCAM) 56 Vasodilators 603 Vasogenic edema 735, 1302 Vasopressin 600 Vasopressin-2 antagonists (vaptans) 926 Vecuronium 844 Ventilation-induced lung injury (VILI) 279 Ventilator associated pneumonia (VAP) 1550, 1551 Ventilator-associated complication (VAC) 1107, 1119–1121 Ventilator-associated infection (VAI) 1096 Ventilator-associated pneumonia (VAP) 1117, 1118, 1122, 1549 Ventilator-associated tracheitis (VAT) 1118 Ventricular assist devices (VADs) –– Berlin EXCOR pulsatile pump 618 –– BiVAD 617 –– complications 619 –– design and flow characteristics 618 –– Impella 618 –– indications 619 –– LVAD 617 –– outcomes 619, 620 –– TandemHeart 618, 619 Ventricular ectopy and tachycardia 514, 515 Ventricular septal defect (VSD) 541 Ventriculoperitoneal (VP) shunts 1130–1132 Vermis 652 Vineland Adaptive Behavioral Scale (VABS) 1558 Viral pneumonias –– HCPS 1024, 1025 –– immunocompromised host 1025 –– influenza –– adenoviruses 1023, 1024 –– Avian influenza 1022 –– complications 1021 –– immunoprophylaxis 1021 –– MERS-CoV 1024 –– novel H1N1 influenza A 1022, 1023 –– observational study 1021 –– SARS-CoV 1024 –– serotypes 1020 –– Zanamivir 1021 –– PJP 1025, 1026 Virtual pediatric intensive care unit (VPICU) 1552–1555 Viscus organ injury 1504 Vitamin C 1458 Vitamin D deficiency 931 Vocal cord paralysis 197 Volume depletion 914–917 Von Willebrand disease (VWD) 1278, 1279 von Willebrand factor (vWF) 1278 W Weight-based dosing 145, 146 West Nile virus 1271 Whole bowel irrigation (WBI) 1434 Whooping cough 1019 Wilson disease 1293 Withdrawal Assessment Tool (WAT-1) 823 Wolff–Parkinson–White Syndrome (WPW) 506, 507 Wong-Baker Faces scale 803 World Health Organization (WHO) 1107, 1517 Wounds and injuries –– abdominal injuries –– forcible compression 1410 –– intestinal injury 1414 –– kidney injury 1412, 1413 –– liver injury 1412 –– pancreatic injury 1413, 1414 –– splenic injury 1410, 1411 –– airway evaluation 1405 –– axial skeleton 1406, 1407 –– burns –– CO poisoning 1418 –– decision for transfer 1419, 1420 –– first priorities 1417, 1418 –– fluid resuscitation 1419 –– initial evaluation 1417 1621 Index –– –– –– –– –– –– –– –– –– –– –– –– –– treatments 1418–1420 –– types 1418 cervical spine injuries 1408 chest trauma –– great vessels 1409, 1410 –– imaging assessment 1408 –– pneumothorax/hemothorax 1409 –– pulmonary contusion 1409 –– rib fractures 1409 child abuse 1415, 1416 compartment syndrome 1415 cooperation and communication 1404 critically injured, transport of 1404 DVT 1415 endotracheal intubation 1404 falls and motor vehicle collisions 1402 FES 1414 head injury 1416, 1417 hemodynamic monitoring 1405, 1406 –– –– –– –– –– –– –– –– –– –– –– –– –– –– hemorrhage 1415 hypothermia 1404 initial evaluation 1402 injury prevention strategies 1402 management of 1404 overview 1401 PCCM 1402 primary survey 1403 pulmonary embolism 1415 radiation exposure 1404 secondary survey 1403, 1404 shock 1404 vascular access 1405 vasopressors 1404 Z Zanamivir 1021 Zika virus 1271, 1272 .. .Pediatric Critical Care Steven E Lucking • Frank A Maffei Robert F Tamburro • Arno Zaritsky Editors Pediatric Critical Care Text and? ?Study Guide Second Edition Editors... University, Cleveland, OH, USA hamzahm@ccf.org William Hanna, MD Department of Pediatric Critical Care Medicine, Cleveland Clinic Children’s and Pediatric Institute, Cleveland Clinic, Cleveland Clinic... auak@upmc.edu Orkun Baloglu, MD Department of Pediatric Critical Care Medicine, Cleveland Clinic Children’s and Pediatric Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of