e2 44 Shackelford M, Kudchadkar S 1312 Optimizing goal directed se dation with the state behavioral scale in the PICU Crit Care Med 2018;46(1) 639 45 Lipshutz AK, Gropper MA Acquired neuromuscular wea[.]
e2 44 Shackelford M, Kudchadkar S 1312: Optimizing goal-directed sedation with the state behavioral scale in the PICU Crit Care Med 2018;46(1):639 45 Lipshutz AK, Gropper MA Acquired neuromuscular weakness and early mobilization in the intensive care unit Anesthesiology 2013;118(1):202-215 46 Patel BK, Pohlman AS, Hall JB, Kress JP Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated Chest 2014;146(3):583-589 47 Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, et al Impact of ICU-acquired weakness on post-ICU physical functioning: a followup study Crit Care 2015;19:196 48 Wieske L, Witteveen E, Verhamme C, et al Early prediction of intensive care unit-acquired weakness using easily available parameters: a prospective observational study PLoS One 2014;9(10):e111259 49 Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G Clinical review: critical illness polyneuropathy and myopathy Crit Care 2008;12(6):238 50 Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G Interventions for preventing critical illness polyneuropathy and critical illness myopathy Cochrane Database Syst Rev 2014;(1):CD006832 51 Field-Ridley A, Dharmar M, Steinhorn D, McDonald C, Marcin JP ICU-acquired weakness is associated with differences in clinical outcomes in critically ill children Pediatr Crit Care Med 2016; 17(1):53-57 52 Shapiro MC, Donohue PK, Kudchadkar SR, Hutton N, Boss RD Professional responsibility, consensus, and conflict: a survey of physician decisions for the chronically critically ill in neonatal and pediatric intensive care units Pediatr Crit Care Med 2017;18(9): e415-e422 53 Heneghan JA, Reeder RW, Dean JM, et al Characteristics and outcomes of critical illness in children with feeding and respiratory technology dependence Pediatr Crit Care Med 2019;20(5):417-425 54 Als H Toward a synactive theory of development: promise for the assessment and support of infant individuality Infant Ment Health J 1982;3(4):229-243 55 Lehner DC, Sadler LS Toddler developmental delays after extensive hospitalization: primary care practitioner guidelines Pediatr Nurs 2015;41(5):236-242 56 Pathways Awareness National Survey of Pediatric Experts Indicates Increase in Infant Delays; More Tummy Time is Key, 2014 https:// pathways.org/wp-content/uploads/2014/09/ttposterhandoutversion.pdf 57 Elser HE Positioning after feedings: what is the evidence to reduce feeding intolerances? Adv Neonatal Care 2012;12(3):172-175 58 Adolph KE, Franchak JM The development of motor behavior Wiley Interdiscip Rev Cogn Sci 2017;8(1-2):10.1002/wcs.1430 59 Bergman NJ Historical background to maternal-neonate separation and neonatal care Birth Defects Res 2019;111(15):1081-1086 60 Feldman R, Weller A, Sirota L, Eidelman AI Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration Dev Psychol 2002;38(2):194-207 61 Feldman R, Rosenthal Z, Eidelman AI Maternal-preterm skin-toskin contact enhances child physiologic organization and cognitive control across the first 10 years of life Biol Psychiatry 2014;75(1):56-64 62 Vittner D, McGrath J, Robinson J, et al Increase in oxytocin from skin-to-skin contact enhances development of parent-infant relationship Biol Res Nurs 2018;20(1):54-62 63 Costello JM, Patak L, Pritchard J Communication vulnerable patients in the pediatric ICU: Enhancing care through augmentative and alternative communication J Pediatr Rehabil Med 2010;3(4):289-301 64 American Speech-Language-Hearing Association Augmentative and Alternative Communication, 2019 https://www.asha.org/public/ speech/disorders/AAC/ 65 Happ MB, Garrett KL, Tate JA, et al Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial Heart Lung 2014;43(2):89-98 66 Radtke JV, Tate JA, Happ MB Nurses’ perceptions of communication training in the ICU Intensive Crit Care Nurs 2012;28(1): 16-25 67 Eeles AL, Anderson PJ, Brown NC, et al Sensory profiles of children born , 30 weeks’ gestation at years of age and their environmental and biological predictors Early Hum Dev 2013;89(9):727-732 68 Batt J, dos Santos CC, Cameron JI, Herridge MS Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms Am J Respir Crit Care Med 2013;187(3):238-246 69 Lupton-Smith A, Argent A, Rimensberger P, Frerichs I, Morrow B Prone positioning improves ventilation homogeneity in children with acute respiratory distress syndrome Pediatr Crit Care Med 2017;18(5):e229-e234 70 Griffiths H, Gallimore D Positioning critically ill patients in hospital Nurs Stand 2005;19(42):56-64; quiz 66 71 Parchem K, Peck A, Tales K A multidisciplinary approach to equipment use in pediatric patient mobilization Crit Care Nurs Q 2018;41(3):330-339 72 Williams TA, Leslie GD, Bingham R, Brearley L Optimizing seating in the intensive care unit for patients with impaired mobility Am J Crit Care 2011;20(1):e19-e27 73 Owens T, Tapley C Pediatric mobility: the development of standard assessments and interventions for pediatric patients for safe patient handling and mobility Crit Care Nurs Q 2018;41(3):314-322 74 Ann Adamczyk M Reducing intensive care unit staff musculoskeletal injuries with implementation of a safe patient handling and mobility program Crit Care Nurs Q 2018;41(3):264-271 75 Pronovost PJ, Berenholtz SM, Needham DM Translating evidence into practice: a model for large scale knowledge translation BMJ 2008;337:a1714 76 Choong K, Fraser D, Al-Harbi S, et al Functional Recovery in critically ill children, the “WeeCover” multicenter study Pediatr Crit Care Med 2018;19(2):145-154 77 Van Damme D, Flori H, Owens T Development of Medical Criteria for Mobilizing a Pediatric Patient in the PICU Crit Care Nurs Q 2018;41(3):323-329 78 Fink EL, Beers SR, Houtrow AJ, et al Early protocolized versus usual care rehabilitation for pediatric neurocritical care patients: a randomized controlled trial Pediatr Crit Care Med 2019;20(6): 540-550 79 Joyce CL, Taipe C, Sobin B, et al Provider beliefs regarding early mobilization in the pediatric intensive care unit J Pediatr Nurs 2018;38:15-19 80 Treble-Barna A, Beers SR, Houtrow AJ, et al PICU-based rehabilitation and outcomes assessment: a survey of pediatric critical care physicians Pediatr Crit Care Med 2019;20(6):e274-e282 81 Choong K, Canci F, Clark H, et al Practice recommendations for early mobilization in critically ill children J Pediatr Intensive Care 2018;7(1):14–26 82 U.S National Library of Medicine A Pilot Stepped-Wedge Trial of a Multicomponent Early Mobility Intervention for Critically Ill Children (PICU Up!), 2019 https://clinicaltrials.gov/ct2/show/ NCT03860168 83 Society of Critical Care Medicine ICU Liberation, 2020 https:// www.sccm.org/ICULiberation/Home 84 Ely EW The ABCDEF Bundle: science and philosophy of how ICU liberation serves patients and families Crit Care Med 2017;45(2): 321-330 85 U.S National Library of Medicine Early Rehabilitation in Critically Ill Children: The PICU Liber8 Study (PICULiber8) 2018 https:// clinicaltrials.gov/ct2/show/NCT03573479 86 Needham DM, Korupolu R Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model Top Stroke Rehabil 2010;17(4):271-281 87 Nydahl P, Sricharoenchai T, Chandra S, et al Safety of patient mobilization and rehabilitation in the ICU: systematic review with meta-analysis Ann Am Thorac Soc 2017;14(5):766-777 e3 Abstract: As pediatric intensive care unit (PICU) survival rates increase so, too, have the rate of short- and long-term morbidities for survivors of critical illness Infants and children undergoing rapid neurocognitive and physical development are particularly vulnerable to the risks of immobility Multicomponent and interdisciplinary approaches to engage in rehabilitation early in the ICU stay have the potential to improve outcomes This chapter provides an overview of acute rehabilitation in the PICU, including key team member roles and strategies for optimizing early mobilization for critically ill children Key Words: acute rehabilitation, pediatric critical care, physical therapy, occupational therapy, mobility, speech language pathology, sedation, sleep, delirium, early mobilization SECTION VII Pediatric Critical Care: Renal 70 Renal Structure and Function, 856 71 Fluid and Electrolyte Issues in Pediatric Critical Illness, 866 72 Acid-Base Disorders, 882 73 Tests of Kidney Function in Children, 896 74 Glomerulotubular Dysfunction and Acute Kidney Injury, 907 75 Pediatric Renal Replacement Therapy in the Intensive Care Unit, 923 76 Pediatric Renal Transplantation, 930 77 Renal Pharmacology, 937 78 Acute Severe Hypertension, 945 855 70 Renal Structure and Function MATTHEW M GRINSELL AND VICTORIA F NORWOOD PEARLS • • • Development of the definitive human kidney or metanephros begins at weeks’ gestation and is complete by 34 to 36 weeks’ gestation, with an average of million nephrons per kidney While humans are born with a full complement of nephrons, functional maturation of the nephron is not complete until the second year of life As a result of maturational differences in expression of angiotensin II and other vasoactive mediators, infants have a decreased capacity to tightly regulate renal blood flow, with subsequent increased susceptibility to renal ischemia and acute kidney injury, particularly in hypovolemic or hypotensive states Renal Anatomy Normal human kidneys are paired organs that reside in the retroperitoneal space adjacent to the spine The upper poles of the kidneys typically reside around the level of the T12 vertebrae and extend down to the L3 vertebrae The liver is superior to the right kidney and thus displaces it lower than the kidney on the left side The spleen and stomach overlie the superior aspect of the left kidney Kidneys, however, can be found in a variety of other locations and have altered morphologies as a result of alterations of the normal developmental program (reviewed by Schedl).1 For example, failure of the kidney to ascend normally results in a pelvic kidney with abnormal vascular supplies from the aorta and/or iliac vessels Mesenchymal regions of the two kidneys coming in contact during early development likely cause fused kidneys, most commonly seen as a “horseshoe” kidney Partial or complete renal duplications comprise a variety of abnormalities that may arise from aberrant branching of the ureteric bud into the developing mesenchyme.2 Unilateral agenesis likely results from failure of ureteric bud development or abnormal mesenchymal induction, leading to regression of the metanephric mesenchyme and failed renal development Renal Development Human kidneys develop as three distinct sets beginning in the third week of gestation The first primitive kidneys, the pronephros and mesonephros, are composed of simple tubules and the pronephric duct As gestation continues into the fourth week, the pronephros regresses and the second primitive kidney, the 856 • • The efferent blood supply from a single glomerulus contributes to the capillary vascular supply of tubules from different nephrons This arrangement of the vascular supply explains the patchy distribution of tubular damage after ischemic injury Combinations of angiotensin-converting enzyme inhibitors and nonsteroidal antiinflammatory drugs inhibit afferent arteriolar vasodilation and efferent arteriolar vasoconstriction In low-flow states, these agents can cause a precipitous loss of glomerular filtration pressure and kidney function mesonephros, forms from parallel strips of mesoderm along the paravertebral axis The mesonephros contains nephrons and the mesonephric duct It begins functioning between the sixth and tenth week of gestation before involution in a cranial-caudal direction beginning at 10 weeks’ gestation (Fig 70.1) The definitive human kidney, or metanephros, begins development at the fifth week of gestation and begins functioning between the 10th and 14th week The metanephros develops in the pelvis when the branching ureteric bud and undifferentiated metanephric mesenchyme interact in a complex series of reciprocal inductions.3–5 These interactions lead to the formation of glomeruli Vessels and tubules arise from mesenchymal precursors; distal tubules and collecting ducts derive from ureteric bud epithelium This process occurs in a centrifugal fashion so that deeper corticomedullary nephrons form earliest in organogenesis, whereas the more peripheral cortical nephrons form later As the metanephros develops, the maturing kidney ascends into the retroperitoneal space to its final location, with the upper poles around the T12 vertebrae During the ascent, the blood supply is derived from more cranial aspects of the aorta and from the lumbar renal arteries at the final position of the kidney The ureters elongate and canalize during the ascent to maintain drainage to the bladder By the time human nephrogenesis is complete, between 34 to 36 weeks’ gestation, repeated cycles of mesenchymal induction, ureteric branching, and morphogenesis result in approximately million nephrons per kidney.6 While differentiation of new nephrons is complete at the time of term delivery, functional maturation of nephrons continues into the second year of life, and growth of the kidneys completes when somatic growth ceases CHAPTER 70 Renal Structure and Function Arterial 857 Venous Remnant of pronephros Mesonephros Developing liver C Nephrogenic cord Mesonephric duct Cloaca Metanephrogenic blastema OS Ureteric bud Primordium of metanephros (permanent kidney) • Fig 70.1 Five-week embryo with regression of pronephros, mesoneph- IS ros, and mesonephric duct and early ureteric bud (From Smith SJ, Lampl BS, Dillman R Embryology, anatomy, and variants of the kidneys and genitourinary tract In: Coley BD, ed Caffey’s Pediatric Diagnostic Imaging 13th ed Philadelphia: Elsevier; 2019:1065–1075.e2.) Renal Vasculature Vascular Anatomy Each kidney is typically supplied by a single renal artery traversing from the lateral aorta to the renal hilum, although anatomic variations in the origin and number of renal arteries are found in 25% to 60% of individuals.7 Upon entering the kidney, the renal artery splits into segmental arteries that further bifurcate into the interlobar arteries The interlobar vessels travel to the corticomedullary junction and then branch horizontally to run parallel to the surface of the kidney as arcuate arteries The arcuate arteries run between the cortex and medulla and give rise to the interlobular arteries, which extend to the outer cortex (Fig 70.2) As the interlobular arteries ascend toward the cortex, the afferent arterioles branch off and enter the Bowman capsule, after which they split to form the glomerular capillary bed After passing through the glomerular tuft, blood exits the glomerulus via the efferent arterioles, which feed the peritubular capillary beds and the vasa rectae The efferent arteriole of a single nephron can supply blood to multiple vasa rectae The postglomerular vasculature of the cortex is supplied by efferent arterioles from midcortical and superficial cortical nephrons, while the blood supply to the medulla is entirely derived from juxtamedullary efferent arterioles The vasa rectae of the medulla branch as they descend toward the papilla of the kidney and form the complex meshwork of the medullary capillary vascular beds Only a few vessels of the vasa rectae reach the papillary tip Venous drainage of the vasa rectae is divided into two types: the vessels of the deep medulla ascend to join the arcuate veins at the corticomedullary junction, and those of the superficial medulla ascend into the cortex to join the cortical peritubular capillary network and, ultimately, the interlobular and arcuate veins (see Fig 70.2) The arcuate veins join with the interlobar veins via the interlobular veins and finally drain into the main renal vein to join the main circulation IM • Fig 70.2 The microvasculature of the mammalian kidney Arterial supply (left): The arcuate artery (arrow) travels parallel to the surface of the kidney, branching into interlobular arteries that travel toward the kidney surface and further branching into afferent arterioles supplying each glomerulus The efferent arterioles travel to the medulla forming the vasa rectae Venous drainage (right): Interlobular veins receive blood from the vasa rectae of the medulla and superficial cortex Interlobular veins drain into arcuate veins and ultimately rejoin the systemic circulation via the renal vein C, Cortex; IM, inner medulla; IS, inner stripe; OS, outer stripe (Modified from Kriz W, Lever AF Renal countercurrent mechanisms: structure and function Am Heart J 1969;78:101–118.) Vascular Function The kidneys are extraordinarily vascular organs; they receive 15% to 18% of cardiac output in the neonate and up to 20% of cardiac output in the adult.8 Blood flow to the kidney is tightly regulated to ensure continued renal function over a range of blood pressures Renal blood flow is regulated by a complex system of ... approaches to engage in rehabilitation early in the ICU stay have the potential to improve outcomes This chapter provides an overview of acute rehabilitation in the PICU, including key team member... renal development Renal Development Human kidneys develop as three distinct sets beginning in the third week of gestation The first primitive kidneys, the pronephros and mesonephros, are composed... single glomerulus contributes to the capillary vascular supply of tubules from different nephrons This arrangement of the vascular supply explains the patchy distribution of tubular damage after