ESPNIC Children’s Intensive Care Textbook

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This textbook provides the fundamental of children’s critical care from a European perspective. It offers a valuable guide for beginners as well as for clinicians working in Intensive Care and allied professionals including the role of an ICU in a modern children’s hospital, specific situations and clinical practice achievements including techniques and the more appropriate therapies to be applied in different conditions.

A section is devoted to specific organs – lung, heart and circulation, kidney and RRT, gut, brain, liver and pancreas, inflammation, immunity and sepsis, metabolism and metabolic diseases in ICU – whilst other to Cardiac Critical Care and Neuro Critical Care. Edited and written by renowned key opinion leaders in the field, all chapters use a learning-oriented style, with practical examples, key points and take-home messages, so that readers can easily learn the content and, at the same time, apply what they have learned in the clinical setting.

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Útgefandi: Springer Nature

ISBN: 9783031647628

Print ISBN: 9783031647611

Format: ePub

Útgáfa: 0

Höfundar

Tungumál: English

Útgefið: 2025-07-01

Prent takmörkun á líftíma: 100

Prent takmörkun: 2

Afritunar takmörkun: 2

Flokkar: Heilbrigðisvísindi

Efnisflokkar: Læknisfræði › Barnalækningar Læknisfræði › Bráðalækningar Læknisfræði › Gjörgæsla Læknisfræði › Svæfingafræði

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ESPNIC Children’s Intensive Care Textbook
Introduction
Contents
Contributors
I: Introduction
1. Paediatric and Neonatal Intensive Care: Quo Vadis
1.1 Introduction
1.2 Cell-Based and Genetic Therapy
1.3 Extracorporeal Support Devices
1.4 Brain and Critical Illness
1.5 Evidence Base Pharmacotherapy
1.6 Long-Term Outcome
1.7 Reflection
II: Why Do Children Need Critical Care
2. Elective Admission to Critical Care
2.1 Introduction
Case Study 1
Questions to Consider
Case Study 2
2.2 Preparing the Child and Family Psychologically for an Elective Critical Care Unit (CCU) Admission
2.3 Optimising the Physical Condition of the Child Prior to Surgery and Critical Care Unit Admission
III: Mortality Predictions and Severity of Illness Scores
3. Severity of Illness and Organ Dysfunction Scoring in Pediatric Intensive Care Units: Developments in 2020
3.1 Introduction
3.1.1 Which Severity Scores Are Available for Use in Pediatric Intensive Care?
3.1.2 What Organ Dysfunction Scores Are Currently Available?
3.1.3 Probabilities of Death
3.1.4 ICU Score Quality
3.2 Performance and Adaptation of the Scores
3.2.1 Score Performance: What Is Evaluated and How to Measure Performance?
3.2.2 Adaptation of the Scores
3.2.3 Why Use a Severity or Organ Dysfunction Score in Pediatric Intensive Care?
3.2.3.1 Objective Assessment of the Severity and Organ Dysfunctions for Each Patient
3.2.3.2 Use in Studies
Description of Tools Used
Study Inclusion Criteria
Comparing Illness Severity in Randomized Trials
3.3 Evaluation of the Recruitment and Performance of a Service
3.4 Future Considerations
3.4.1 Health Quality of Life Scores
3.4.2 Evaluation of Practices in Pediatric Intensive Care Units
3.5 Conclusion
4. Paediatric Early Warning Scores
4.1 Introduction
4.2 What Is a Paediatric Early Warning Score?
4.3 Why Might We Need a PEWS?
4.4 Types of PEWS
4.4.1 Score-Based System
4.4.2 Trigger-Based Systems
4.4.3 Which Type of PEWS Is Best?
4.5 What Is the Evidence for PEWS?
4.5.1 A Landmark Study: The EPOCH Trial
4.6 How Might We Assess the Quality of a PEWS?
4.7 PEWS as Part of a Wider System Response
4.8 What’s the Future for PEWS?
4.9 Practical Tips for Maximising the Effectiveness of PEWS
IV: ICU Structure
5. ICU: Gas, Humidity, Power and Airflow
5.1 Introduction
5.2 Single Family Rooms Versus Open-Bay Units
5.3 NICU/PICU Location Within the Hospital
5.4 Support Areas
5.5 Specialized Procedure Spaces
5.6 Noise, Light, Temperature and Humidity
5.7 Electrical, Gas Supply and Mechanical Needs
5.8 Handwashing Facilities
5.9 Airborne Infection Isolation Room
5.10 Access to Nature and Other Positive Distraction
5.11 Ceiling Finishes, Wall Surface and Floor Surface
6. Basic Patient Safety and Quality in PICU
6.1 Introduction
6.2 Culture
6.3 Data, Data, Data!
7. Handover from Operating Theatre
7.1 Why Are Effective Handovers So Important for the Patient’s Safety?
7.2 Team Performance and Commons Errors
7.2.1 Communication Team Performance
7.2.2 Inputs
7.2.3 Processes
7.2.4 Outcomes
7.2.5 Mains Parameters of Ineffective Handover
7.3 How to Manage an Effective Handover?
8. Infection Prevention and Control in the Paediatric Intensive Care Unit
8.1 Introduction
8.2 Prevention of Infection in PICU
8.3 Modes of Transmission of Infectious Agents
8.4 Prevention for Transmission of Infectious Agents
8.4.1 Standard Infection Control Precautions (SICPs)
8.4.1.1 Hand Hygiene
8.4.1.2 Personal Protective Equipment (PPE)
8.4.1.3 Prevention of Invasive Device-Associated Infections
8.4.2 Care Bundles
8.4.2.1 VAP Care Bundle in Children
8.4.2.2 Central Line Care Bundle (Insertion and Care and Maintenance)
8.5 Aseptic Technique
8.6 Aseptic Non-Touch Technique (ANTT)
8.7 Environment Build, Materials and Equipment for IPC in PICU
Case Study: IPC for SARS CoV-2 in PICU
8.8 Cleaning Standards
9. Information Technology in PICU
9.1 Introduction
9.2 Electronic Health Records
9.2.1 Clinical Documentation
9.2.2 Electronic Charting
9.3 Computerised Physician Order Entry (CPOE) Systems
9.4 Clinical Decision Support Systems (CDSS)
9.5 Automated Alerting Systems and Early Warning Scores
9.6 Telemedicine
9.7 Machine Learning, Big Data and Artificial Intelligence
9.8 Human–Technology Interface
9.9 Conclusion
V: The Lung and Mechanical Ventilation in ICU
10. Basic Respiratory Physiology
10.1 Foetal and Postnatal Development
10.2 Surfactant and Foetal Lung Fluid
10.3 Transition from Foetal to Postnatal Cardiorespiratory Function
10.4 Postnatal Development
10.5 How Structure Serves Function
10.6 Ventilation and Lung Volumes
10.7 Diffusion
10.8 Pulmonary Perfusion
10.9 Ventilation–Perfusion Relationships
10.10 Mechanics of Breathing
10.11 Control of Respiration
10.12 Ventilator Waveform Monitoring
Summary
Take-Home Messages
11. Basics of Mechanical Ventilation
11.1 The Mechanical Behaviour of the Respiratory System (in the Ventilated Patient)
12. Oxygen Therapy and Acute Noninvasive Ventilation in Children
12.1 Noninvasive Ventilation
12.1.1 Introduction
12.1.2 Indications
12.1.2.1 Long-Term Ventilatory Support
12.1.2.2 Short-Term Ventilatory Support
Hypoxemic Respiratory Failure (Type I)
Hypercapnic Respiratory Failure (Type II)
12.1.3 Contraindications
12.1.4 Equipment
12.1.4.1 Types of NIV Ventilators
12.1.4.2 Circuits (◘ Fig. 12.1)
12.1.4.3 Humidification
12.1.4.4 Exhalation Port (◘ Fig. 12.2)
12.1.4.5 Anti-Asphyxia Valve (◘ Fig. 12.3)
12.1.4.6 Interfaces (◘ Table 12.3)
12.1.5 Ventilation Modes
12.1.5.1 Volume-Controlled Modes
12.1.5.2 Pressure-Controlled Modes (◘ Table 12.4)
12.1.5.3 Initial Settings
12.1.6 Installation
12.1.7 Analysis
12.1.7.1 Efficiency
12.1.7.2 Tolerance
12.1.8 Next Steps
12.2 HFNC
12.2.1 Introduction
12.2.2 Mechanism of Action
12.2.2.1 Gas Mixture Conditioning
12.2.2.2 High Flow
12.2.2.3 Generated Pressures
12.2.3 Side Effects and Monitoring
12.2.4 HFNC Initiation in Practice (◘ Fig. 12.5)
12.2.4.1 Where to Initiate HFNC
12.2.4.2 Cannula
12.2.4.3 Generator
12.2.4.4 Settings (◘ Table 12.7)
12.2.5 Indications for HFNC
12.2.5.1 Acute Viral Bronchiolitis
12.2.5.2 Withdrawal of Invasive Ventilation
12.2.5.3 Asthma
12.2.5.4 ARDS
12.2.5.5 Preoxygenation and Intubation
12.2.6 Conclusion
13. Paediatric Acute Respiratory Distress Syndrome (pARDS)
13.1 Introduction
13.2 Definition of Paediatric ARDS (pARDS) (◘ Table 13.1)
13.3 Epidemiology
13.4 Pathophysiology
13.5 Monitoring
13.5.1 General
13.5.2 Respiratory System Mechanics
13.5.3 Oxygenation and CO2 Monitoring
13.5.4 Chest Imaging
13.5.5 Hemodynamic Monitoring
13.6 Treatment
13.6.1 Non-Invasive Respiratory Support (NRS)
13.6.1.1 High Flow Nasal Cannula (HFNC)
13.6.1.2 Non-Invasive Ventilation (NIV): Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP)
13.6.1.3 NRS in Resource-Limited Settings (RLS)
13.6.2 Invasive Mechanical Ventilation (IMV)
13.6.2.1 VT
13.6.2.2 Pressures
13.6.2.3 PEEP
13.6.2.4 Lung-Protective Ventilation (LPV) Bundles
13.6.2.5 Oxygenation Target
13.6.2.6 Ventilation Target
13.6.2.7 Mode of Ventilation
13.6.2.8 Recruitment Manoeuvres (RMs)
13.6.3 Ancillary Treatments [16, 17]
13.6.3.1 Prone Positioning
13.6.3.2 Inhaled Nitric Oxide (iNO)
13.6.3.3 Surfactant
13.6.3.4 Corticosteroids
13.6.3.5 Neuromuscular Blockade (NMB)
13.6.4 Other Ancillary Treatments [17]
13.6.4.1 Fluid Management
13.6.4.2 Nutrition
13.6.4.3 Transfusion
13.7 ECMO
13.7.1 Indications/Initiation
13.7.2 Ventilation Management
13.8 Outcomes
14. Physiology of Modes of Ventilation in Severe Acute Lung Injury (ALI)
14.1 Introduction
14.2 Taxonomy of Mechanical Ventilation
14.3 Conventional Mechanical Ventilation Approaches During Acute Lung Injury
14.4 High-Frequency Oscillatory Ventilation
14.4.1 What Is HFOV?
14.4.2 Clinical Evidence in Children
14.4.3 Clinical Evidence in Adults
14.4.4 Indications for and Timing of HFOV
14.4.5 Lung Volume Optimization Manoeuvres
14.4.6 Achieving the Lowest Stroke Volume
14.4.7 HFOV Titration Weaning
14.5 Airway Pressure Release Ventilation
14.5.1 Description of APRV
14.5.2 Physiologic Benefits
14.5.3 Clinical Evidence in Children
14.6 Liquid Ventilation
14.7 Conclusions
15. Paediatric Ventilator Liberation
15.1 Introduction
15.2 Operational Definitions: A Common Language
15.2.1 Respiratory Support
15.2.2 Liberation from Invasive MV
15.2.3 Assessment for Liberation from Invasive MV
15.2.4 Post-extubation NRS
15.3 The Liberation Process
15.3.1 Gradual Adjustment of Respiratory Support
15.3.2 Protocol-Based Screening
15.3.2.1 Clinical Criteria
15.3.2.2 Respiratory Support
15.3.3 Extubation Readiness
15.3.3.1 Anticipate and Prevent Post-extubation UAO
15.3.3.2 Airway Protection
15.3.3.3 Anticipate Post-extubation Non-invasive Respiratory Support
15.3.4 Spontaneous Breathing Test (SBT)
16. Ventilation of the Infant
16.1 Introduction
16.2 Indications
16.3 Ancillary Therapies During Infant Ventilation
16.4 Monitoring During Infant Ventilation
VI: Fluids and Hemodynamics
17. Hemodynamic Physiology
17.1 Introduction
Case Study 1
17.2 The Heart
17.2.1 Preload
17.2.2 Afterload
17.2.3 Contractility
17.2.4 Other Aspects
17.3 Venous Return
17.4 Arterial Pressure
17.5 Venous Pressure
Case Study 2
17.6 Oxygen Transport
17.7 Microcirculation
17.8 Specific Aspects of Young Children
Summary
18. Hemodynamic Monitoring in the PICU
18.1 Introduction
18.2 Cardiovascular Instability Is Common in Critically Ill Children
18.3 Basic Bedside Assessment
18.4 Blood Pressure
18.4.1 Central Venous Pressure (CVP)
18.4.2 Central Venous Oxygen Saturation Measurement
18.4.3 Cardiac Output Monitoring and Transpulmonary Indicator Dilution
18.4.4 Pulmonary Artery Pressure
18.4.5 Serum Lactate Measurement
18.4.6 Near-Infrared Spectroscopy
18.4.7 Microcirculation
18.4.8 Echocardiography/Ultrasonography
18.4.9 Prediction of Volume Resuscitation and Fluid Responsiveness
19. Fluids on PICU (Paediatric Intensive Care Unit)
19.1 Introduction
19.2 History of Intravenous Fluids
19.3 The Body Fluid Compartments
19.3.1 What Is the Total Body Water Content of a Child?
19.3.2 Fluid Input and Output
19.3.2.1 Definitions
19.3.3 Isotonic, Hypotonic, and Hypertonic Fluids
19.4 Regulation of Extracellular Fluid Osmolarity and Sodium
19.5 Intravenous Fluids Commonly Used on PICU
19.5.1 Crystalloid
19.5.2 Colloid
19.5.2.1 5% Human Albumin Solution
19.5.2.2 Gelatin-Based Solutions
19.5.2.3 Starch-Based Solutions
19.5.3 What Happens During Rapid Infusion 10–20 mL/kg 0.9% Saline into a Patient?
19.5.3.1 Distribution
19.5.3.2 Changes to Plasma Oncotic Pressure
19.5.3.3 Excretion
19.5.3.4 Acid–Base Effects
19.5.3.5 Possible Deleterious Effects
19.5.3.6 Rationale for Intravenous Fluids
19.6 Fluid Resuscitation in Shock
19.6.1 What Is a Fluid Bolus? How Much to Give?
19.6.2 Haemodynamic Targets of Fluid Bolus Therapy
19.6.3 What Fluid to Use for Acute Resuscitation?
19.6.4 What Are the Potential Harms of Fluid Bolus Therapy?
19.7 Intravenous Fluid Maintenance in PICU
19.7.1 Paediatric Fluid Requirements
19.7.2 Neonatal Fluid Requirements
19.7.3 Dealing with Fluid Losses
19.7.4 What Maintenance Fluid to Use?
19.7.5 Glucose Requirements
19.7.6 What Maintenance Fluid to Use Postoperatively?
19.7.7 How Is Fluid Balance Assessed?
19.8 Phases of Fluid Therapy: The “ROSE” Concept
19.8.1 What Is Fluid Overload and Is It Important?
19.8.2 How Do I Deresuscitate My Patient?
20. Vasoactive Agents
20.1 Introduction
20.2 What Are Inotropes?
20.3 Some Terms
20.4 Cardiovascular System
20.4.1 Recognition and Assessment of Shock
20.4.2 Targets
20.4.3 How Do Inotropes Work
20.4.3.1 Polymorphisms
20.4.3.2 Receptor Downregulation
20.4.4 Physiologic Mechanisms of Vasoconstriction
20.5 Endogenous Inotropes and Vasoactive Agents: Sympathomimetic Amines
20.5.1 Adrenaline
20.5.2 Noradrenaline
20.5.3 Vasopressin
20.5.4 Dopamine
20.6 Exogenous Inotropes and Vasoactive Agents
20.6.1 Dobutamine
20.6.2 Phenylephrine
20.6.3 Phosphodiesterase Inhibitors
20.6.4 Levosimendan
20.7 Selection of Inotropic and Vasoactive Agents in Shock
20.7.1 Septic Shock
20.7.2 Cardiogenic Shock
20.7.3 Neurogenic Shock
20.8 Failure of Shock Reversal
20.9 Conclusion
VII: Specific Organ System Failure
21. The Lung
21.1 Introduction
21.2 Basics of Respiratory Physiology and Mechanics in the Neonate and the Growing Child
21.3 Gas Exchange and Its Measures
21.4 Respiratory Physiology, Mechanics and Gas Exchange Disturbances in Disease
21.5 Cardiopulmonary Interactions
22. Acute Kidney Injury in the PICU
22.1 Introduction
22.2 pAKI Definition
22.3 Epidemiology
Box 22.1: Most Common AKI-Inducing Nephrotoxins
22.4 Specific Aspects of pAKI Diagnosis
22.5 Prevention
22.6 Pharmacological Treatment
Box 22.2: Fluid Overload
22.7 Follow-Up of Patients Surviving AKI
23. The Gut
23.1 Introduction
23.2 The Gut: A Key Organ of Nutrition Physiology
23.3 Gut Dysfunction in Critically Ill Children
23.4 Main Symptoms of GI Dysfunction in Critically Ill Children: Prevalence, Causes, Prevention and Treatments
23.5 Enteral Feeding Intolerance as a Result of GI Dysfunction
23.6 Gut Damages in Case of Critical Illness
23.7 Children with History of Intestinal Condition
23.8 The Gut Microbiota
23.8.1 The Role of Gut Microbiota
23.8.2 Impact of Critical Illness on Gut Microbiota
23.8.3 The Promising Effect of Nutrition and Probiotics in Critical Care
24. Acute Liver Failure in PICU
24.1 Introduction
24.2 Definition of Paediatric Acute Liver Failure
24.3 Aetiology
24.4 Clinical Manifestation
24.5 Hepatic Encephalopathy
24.6 Management
24.6.1 General Supportive Care
24.6.2 Ventilation Strategies
24.6.3 Neuroprotective Measures
24.6.4 Ammonia Scavenging Strategy
24.6.5 Hemodynamic Monitoring
24.6.6 Fluid Requirement and Nutritional Support
24.6.6.1 Role of N-Acetyl Cysteine in Management of Non-acetaminophen (Non-APAP) ALF
24.6.6.2 Antibiotics in PALF
24.6.7 Neuro-Critical Care Monitoring and Management of Intracranial Hypertension and Cerebral Oedema
24.6.8 Indications
24.7 Medical Management of ICP
24.7.1 Hypertonic Saline
24.7.2 Mannitol
24.7.3 Thiopentone Sodium
24.7.4 Therapeutic Hypothermia
24.7.5 Hyperventilation
24.7.6 Coagulation
24.7.7 Acute Kidney Injury
24.7.8 Indication for Starting CKRT in Patients with PALF
24.7.9 Liver Support Devices
24.7.10 Liver Transplant in ALF
24.7.10.1 Models to Predict LT
24.7.10.2 Post-Liver Transplant Management
24.7.10.3 Long-Term Outcome
25. Immunology in Paediatric Intensive Care
25.1 Introduction
25.2 Mucosal Immunity
25.3 Inflammation and Innate Immunity
25.3.1 Cell Autonomous Immunity
25.3.2 Circulating Mediators of Infection
25.4 Innate Immune Cells
25.5 Adaptive Immunity
25.5.1 T-Cell-Mediated Immunity
25.5.2 B Cell-Mediated Immunity
25.5.3 T Cell-Independent B Cell Immunity
25.5.4 T Cell-Dependent B Cell Immunity
25.6 Sepsis
25.6.1 Personalised Immunomodulation in Sepsis?
26. Metabolic Emergencies in the Paediatric Intensive Care Setting
26.1 Introduction
26.2 Clinical History and Examination
26.3 Biochemical Investigations
26.4 Management Principles
26.5 Specific Scenarios
26.5.1 Hyperammonaemia
26.5.2 Metabolic Acidosis
26.5.3 Glycaemic Control
26.6 Peri-Mortem Considerations
Appendix: Other Key Drug Doses in the Intensive Care Setting
VIII: Cardiac Critical Care
27. Basics in Cardiac Intensive Care
27.1 Introduction
27.2 Hemodynamic Monitoring
27.2.1 Basic Hemodynamic Monitoring
27.2.2 Assessment of Cardiac Output
27.3 Preoperative Care of Pediatric Cardiac Surgical Patients
27.3.1 Assessment of Patient Status and Predominant Physiology [1, 14]
27.3.1.1 Defects with Left-to-Right Shunts
27.3.1.2 Cyanotic Congenital Heart Defects
27.3.1.3 Obstructive Congenital Heart Defects
27.3.2 Other General Considerations
27.4 Post-operative Care of Pediatric Cardiac Patients
27.4.1 Preoperative and Intra-Operative Course Evaluation [6]
27.4.2 General Principles of Post-Operative Care [6, 7, 14]
27.4.3 Post-operative Complications
27.4.4 Discharge from CICU
Case Study
27.4.4.1 Proposed Evaluation
28. Pre-operative Management of Neonates with Congenital Heart Disease
28.1 Lesion-Specific Management
28.2 Duct Dependent Systemic Lesions
28.2.1 Coarctation of Aorta
28.2.1.1 Pathophysiology
28.2.1.2 Clinical Signs
28.2.1.3 Pre-operative Management
28.2.2 Critical Aortic Stenosis
28.2.2.1 Pre-operative Management
28.2.3 Hypoplastic Left Heart Syndrome (HLHS)
28.2.3.1 Pathophysiology
28.2.3.2 Main risk Factors for Postnatal Survival in HLHS Include
28.2.3.3 Clinical Signs
28.2.3.4 Pre-operative Management
28.3 Duct Dependent Pulmonary Lesions
28.3.1 Critical Pulmonary Stenosis
28.3.1.1 Pathophysiology and Clinical Signs
28.3.1.2 Pre-operative Management
28.3.2 Pulmonary Atresia with Intact Ventricular Septum
28.3.2.1 Pathophysiology and Clinical Signs
28.3.2.2 Pre-operative Management
28.3.3 Tetralogy of Fallot
28.3.3.1 Pathophysiology and Clinical Signs
28.3.3.2 Pre-operative Management
28.4 Common Mixing Lesion
28.4.1 Transposition of Great Arteries
28.4.1.1 Pathophysiology
28.4.1.2 Pre-operative Management
28.4.2 Total Anomalous Pulmonary Venous Connection
28.4.2.1 Pathophysiology and Clinical Signs
29. Principles of Postoperative Management in the Paediatric Cardiac Intensive Care: Low Cardiac Output State (LCOS) and Lesion-Specific Management
29.1 Introduction
29.2 Low Cardiac Output State (LCOS)
29.2.1 Definition
29.2.2 Pathophysiology and Aetiology
29.2.3 Diagnosis
29.2.4 Prevention
29.2.5 Treatment
29.2.5.1 Optimising Preload
29.2.5.2 Improving Myocardial Function
29.2.5.3 Manipulating Afterload
Vasodilators
SVR Reduction
PVR Reduction
29.2.6 Vasoconstrictors
29.2.6.1 The Role of Positive Pressure Ventilation (PPV)
29.2.6.2 The Role of Corticosteroids
29.2.6.3 Mechanical Circulatory Support (MCS)
29.3 Lesion-Specific Postoperative Management
30. ECMO in Children with Cardiac Failure
30.1 History of Cardiac ECMO
30.2 Cardiac ECMO: Description and Indications
30.3 Use and Strategy
30.4 Contraindications
30.5 Cannulation and ECMO Circuit
30.5.1 Cannulation Technique
30.5.2 Site of Cannulation
30.5.3 Additional Cannulas
30.5.4 Circuit
30.6 ECMO Run: Management, Monitoring and Complications
30.6.1 Goals and Principles of Cardiac ECMO
30.6.2 Myocardial Stun
30.6.3 Ventricular Decompression
30.6.4 Residual Lesions
30.6.5 Single Ventricle Physiology
30.7 Cardiovascular Management and Monitoring
30.7.1 Inotropes and Vasoactive Drugs
30.7.2 Respiratory Management and Monitoring
30.7.3 Anticoagulation
30.7.4 Bleeding Management
30.7.5 Blood Product Administration
30.7.6 Renal Function
30.7.7 Neurology and Sedation
30.7.8 Infection
30.8 Weaning and Decannulation
30.9 Outcomes
30.10 Future of Cardiac ECMO
31. Extracorporeal Cardiopulmonary Resuscitation in Pediatric Age
31.1 Introduction
31.2 Definition of ECPR, Objective, and Indications
31.3 Epidemiology of ECPR
31.4 Outcomes
31.4.1 Neurologic Outcomes
31.4.2 Medium and Long-Term Outcomes
31.5 ECPR Peculiarities in Specific Populations
31.5.1 ECPR in Children with Cardiac Disease
31.5.2 ECPR in Children with Noncardiac Disease
31.5.3 Out-of-Hospital ECPR and ECPR for Deep Hypothermia
31.6 Patient Selection and Factors Influencing EPCR Decision
31.7 Team and Algorithm
31.8 Cannulation Strategies and Equipment
31.9 Post-ECPR Care
32. Mechanical Circulatory Support in Paediatric Heart Failure
32.1 Introduction
32.2 Part 1: VAD Support
32.2.1 Choice of Support Strategy: ECMO versus VAD
32.2.2 Types of VAD
32.2.3 Selecting the Right Type of VAD
32.3 Part 2: Devices/Strategies LVAD, BiVAD and UVAD
32.3.1 Strategies and Applications
32.3.2 Right Ventricular Dysfunction
32.3.3 Single-Ventricle Anatomy
32.3.4 Recovery and Explant
32.3.5 Destination Therapy
32.4 Part 3: Anticoagulation
32.4.1 Detection of Thrombosis
32.5 Part 4: Patient Management and Outcomes
32.5.1 Thrombotic and Bleeding Complications
32.5.2 Optimising Haemodynamics
32.5.3 Nursing and Multi-professional Care
32.5.4 Outcomes
Case Studies
Case 1
Case 2
Case 3
Case 4
Summary
32.6 Part 5: Palliative and Holistic Care
32.6.1 Home Discharge
33. Cardiac Arrhythmias: Diagnosis and Management for the Paediatric Intensivist
33.1 Normal Cardiac Conduction
33.1.1 Electrical Anatomy of the Heart
33.1.2 ECG Recording in PICU
33.2 Mechanism of Cardiac Arrhythmias
33.3 Management
33.3.1 General Considerations
33.3.2 Antiarrhythmics
33.3.3 Cardioversion and Defibrillation
33.3.4 Temporary Cardiac Pacing
33.4 Individual Arrhythmias
33.4.1 Premature Atrial and Ventricular Complexes
33.4.2 Tachyarrhythmias
33.4.2.1 Junctional Ectopic Tachycardia (JET)
33.4.2.2 Atrial Ectopic Tachycardia (AET)
33.4.2.3 Supraventricular Tachycardia (SVT)
33.4.2.4 Atrial Flutter and Intra-atrial Re-entry Tachycardia (IART)
33.4.2.5 Ventricular Tachycardia (VT)
33.4.3 Bradyarrhythmias
33.4.3.1 Sinus Node Dysfunction
33.4.3.2 Atrioventricular (AV) Block
34. Outcomes of Paediatric Cardiac Intensive Care
34.1 Introduction
34.2 Outcome Measures
34.3 Outcome Evaluation
34.3.1 Registries and Multi-Institutional Collaborations
34.3.2 Relationship Between Case Mix Complexity and Outcomes
34.4 Solutions and Future Directions
IX: Neurocritical Care
35. Paediatric Major Trauma in Context for the PICU Clinician
35.1 What Is Major Trauma?
35.1.1 Paediatric Major Trauma Networks
35.2 Paediatric ‘Trauma Call’
35.2.1 Pre-alerts
35.2.2 Role of the PICU Doctor in a Trauma Call
35.2.3 Team Preparation and ‘Crowd Control’
35.2.4 Parents
35.2.5 Handover
35.3 Assessing the Paediatric Trauma Patient aka ‘The Primary Survey’
35.3.1 Catastrophic Haemorrhage
35.3.2 Airway Issues
35.3.3 Breathing (Thoracic Injury)
35.3.3.1 Blunt Injuries
35.3.4 Penetrating Injuries
35.3.4.1 Thoracotomy
35.3.5 Circulation (Haemorrhage)
35.3.5.1 Challenge of the Bleeding Child
35.3.5.2 ‘One on the Floor and Four More’
35.3.5.3 Blood Products or Crystalloid
35.3.5.4 ‘Code Red’ Care in Children
35.3.6 Disability (Traumatic Brain Injury and Spinal Injury)
35.3.6.1 Potential Spinal Injury and Immobilisation
35.3.6.2 Confirmed Spinal Injury
35.3.7 Exposure
35.4 Decision-Making After the Primary Survey
35.5 Burns and Blasts
35.5.1 Electric Burns
35.5.2 Blast Injuries
35.6 Traumatic Cardiac Arrest
35.6.1 Which Children Survive TCA?
35.6.2 Logistics of Running the Arrest
35.6.3 H: Addressing Hypovolaemia
35.6.4 O: Addressing Hypoxia
35.6.5 T: Addressing Tension Pathology
35.6.6 Non Accidental Injury or Suspected Physical Abuse
35.6.7 Rational Prioritisation
35.6.8 Recognition of Futility
35.6.9 Debrief
35.7 Traumatic Asphyxia—Hanging and Drowning
35.7.1 Hanging and Near Hanging
35.7.2 Drowning
35.8 Deterioration in PICU
36. Traumatic Brain Injury
36.1 Introduction
36.2 Basic Concepts
36.2.1 Cerebral Blood Flow, Perfusion Pressure, Autoregulation
36.2.1.1 ICP Waveforms
36.2.1.2 The Pressure-Time Burden
36.2.2 Concepts Behind Brain Injury
36.2.2.1 Primary Brain Injury
36.2.2.2 Secondary Injury
Ischaemia
Excitotoxicity and Inflammation
Oxidative Stress
Cortical Spreading Depolarisation
Impaired Glymphatic Drainage
Energy Failure
36.2.2.3 Herniation Syndromes
36.3 Management
36.3.1 Pre-Hospital Management
36.3.2 Emergency Room
36.3.3 PICU Management
36.3.3.1 ICP Monitoring
36.3.4 Post-TBI Neuroprotection Bundle
36.3.4.1 Managing CPP
36.3.5 Multimodal Neuromonitoring
36.3.5.1 Quantitative EEG
36.3.5.2 Near-Infrared Spectroscopy (NIRS)
36.3.5.3 PbtO2 (Brain Tissue Oxygen Monitoring)
36.3.5.4 Transcranial Doppler (TCD)
36.3.5.5 Pressure Reactivity Index (PRx)
36.3.5.6 ICP Treatment Thresholds
36.3.6 ICP Reduction Strategies
36.3.6.1 Hyperosmolar Therapy
36.3.6.2 CSF Drainage
36.3.6.3 Tier 2 Therapies
36.3.6.4 Hyperventilation
36.3.6.5 Hypothermia
36.3.6.6 Barbiturate Infusion
36.3.6.7 Decompressive Craniectomy
36.3.7 The Lund Concept
36.4 Rehabilitation and Outcomes
36.4.1 Step-Down from PICU
36.4.2 Outcomes and Prognostication
36.4.3 Biomarkers
36.4.4 Late Effects of Paediatric TBI
36.5 Clinical Trials in Paediatric TBI
37. Monitoring the Brain
37.1 Introduction
37.2 Neuromonitoring Techniques
37.2.1 EEG
37.2.2 Imaging
37.2.3 Increased Intracranial Pressure (ICP) and Advanced Cerebral Monitoring
37.2.4 Brain Oxygenation and Metabolism
37.2.5 Transcranial Doppler (TCD)
37.2.6 Key Points
38. Management of Seizures and Refractory Status Epilepticus in Critically Ill Children
38.1 Introduction
38.1.1 Definitions
38.1.2 Epidemiology: Incidence of Each Including Morbidity and Mortality
38.1.3 Aetiology
38.1.4 Pathophysiology
38.2 Investigations and Diagnosis
38.3 Treatment
38.3.1 Stabilization
38.3.2 First-Line Therapy
38.3.3 Second-Line Therapy
38.3.4 Anaesthetic Drugs: Refractory and Super Refractory SE
38.3.4.1 Midazolam
38.3.4.2 Thiopental/Pentobarbital
38.3.4.3 Propofol
38.3.4.4 Ketamine
38.3.5 Special Considerations for Seizures in Critically Ill Children with Acute Neurological Conditions
38.3.5.1 Post-traumatic Seizures and Status Epilepticus
38.3.5.2 Post-anoxic Seizures
38.3.6 Other Agents to Consider
38.3.6.1 Anti-Seizure Medications
38.3.6.2 Pyridoxine, Pyridoxal-5-Phosphate, Folinic Acid, and Biotin
38.3.6.3 Steroids and Immunotherapy
38.3.6.4 Ketogenic Diet
38.3.6.5 Epilepsy Surgery
X: Hematological Issues in PICU
39. Haemoglobinopathies and Haemostatic Disorders in the PICU
39.1 Introduction
39.2 Sickle Cell Disease
39.2.1 Multi-System Organ Failure
39.2.2 Acute Chest Syndrome
39.2.3 Stroke
39.2.4 Transfusions for Sickle Cell Disease
39.3 Haemophilia
39.3.1 Haemophilia A
39.3.2 Haemophilia B
39.4 Thalassaemia
39.5 Catastrophic Antiphospholipid Syndrome (CAPS)
39.6 Immune Thrombocytopenia
39.7 Thrombotic Thrombocytopenic Purpura
39.8 Disseminated Intravascular Coagulation
40. Transfusion Medicine in the Pediatric Intensive Care Unit
40.1 Introduction
40.2 Red Blood Cells
40.2.1 Anemia and O2 Delivery
40.2.2 When Should We Transfuse?
40.3 Plasma
40.3.1 When Should We Transfuse?
40.4 Platelets
40.4.1 When Should We Transfuse?
40.4.2 When Should We Not Transfuse?
40.5 Blood Product Modifications
40.5.1 Leukoreduction
40.5.2 Irradiated Blood Products
40.5.3 Pathogen Reduction
40.6 Transfusion Reactions and Complications
40.6.1 Early-Onset Reactions
40.6.2 Delayed Transfusion Reactions
40.6.3 Infectious Risks
XI: Specific Situations
41. Sepsis and Septic Shock
41.1 Introduction
41.2 Evolving Definitions of Sepsis
41.3 Aetiology
41.4 Identifying the Child with Sepsis
41.5 Pathophysiology
41.6 Antimicrobial Therapy
41.7 Vascular Access and Fluid Therapy
41.8 Vasoactive Agents
41.9 Corticosteroids
41.10 Respiratory Support
41.11 Monitoring the Child with Septic Shock
41.12 Electrolytes and Metabolites
41.13 Blood and Blood Product Transfusion
41.14 Refractory Septic Shock
41.15 Renal Replacement Therapy
41.16 Therapeutic Plasma Exchange/Plasmapheresis
41.17 Immunoglobulin Therapy
41.18 Extracorporeal Membrane Oxygenation (ECMO)
41.19 Conclusion
42. Hemorrhagic Shock in Children
42.1 Introduction
42.2 Diagnosis of Hemorrhagic Shock
42.3 Management of Hemorrhagic Shock in Children
42.3.1 Context of Damage Control Resuscitation in Children
42.3.2 Stop the Bleed
42.3.3 Rapid Rewarming
42.3.4 Permissive Hypotension in Children
42.3.5 Fluids and Drugs Administration
42.4 Damage Control Hemostatic
42.5 Damage Control Surgery (DCS)
42.6 Assessment of the Effectiveness of Treatment
43. Abdominal Trauma
43.1 Introduction
43.2 Spleen
43.2.1 Frequency
43.2.2 Trauma Mechanism
43.2.3 Diagnosis
43.2.3.1 Clinical
43.2.3.2 Imaging and Biology
43.2.3.3 Grade Classification
43.2.4 Treatment
43.2.4.1 Non-operative Management
43.2.4.2 Arterial Embolization
43.2.4.3 Surgery
43.2.5 Monitoring
43.2.6 Follow-Up
43.2.6.1 Complications
43.2.6.2 Control Imaging
43.2.6.3 Vaccination
43.3 Liver
43.3.1 Frequency
43.3.2 Trauma Mechanism
43.3.3 Diagnosis
43.3.3.1 Clinical
43.3.3.2 Imaging and Biology
43.3.3.3 Grade Classification
43.3.4 Treatment
43.3.4.1 Non-operative Management
43.3.4.2 Arterial Embolization
43.3.4.3 Surgery
43.3.5 Monitoring
43.3.6 Complications
43.3.6.1 Vascular Complications
43.3.6.2 Biliary Peritonitis
43.3.6.3 Bilioma
43.3.7 Follow-Up
43.3.7.1 Control Imaging
43.4 Kidney
43.4.1 Frequency
43.4.2 Trauma Mechanism
43.4.3 Diagnosis
43.4.3.1 Clinical
43.4.3.2 Biology and Radiology
43.4.4 Treatment
43.4.4.1 Non-operative Management
43.4.4.2 Surgical Treatment
43.4.5 Complications
43.5 Pancreas
43.5.1 Frequency
43.5.2 Trauma Mechanism
43.5.3 Diagnosis
43.5.3.1 Clinical
43.5.3.2 Radiological and Biological
43.5.4 Treatment
43.5.4.1 Non-operative Management
43.5.4.2 Surgery
43.5.5 Follow-Up
44. Immunosuppressed Patients
44.1 Introduction
44.2 Primary Immunodeficiency (PID)
44.3 Hemophagocytic Lymphohistiocytosis (HLH)
44.3.1 Clinical Diagnosis
44.3.2 Treatment
44.4 Hematopoietic Stem Cell Transplantation (HSCT)
44.4.1 General Considerations
Box 44.1: Key Information Upon Admission of a HSCT Patient on PICU
44.4.2 Approach to the HSCT Patient with Organ Failure
44.4.2.1 Respiratory Failure
44.4.2.2 Acute Kidney Injury (AKI)
44.4.2.3 Acute Encephalopathy
Box 44.2: Immune Reconstitution and Infections
Box 44.3: Early HSCT-Related Morbidity
Acute Graft-Versus-Host Disease (aGVHD)
Veno-Occlusive Disease (VOD)
Transplant-Associated Thrombotic MicroAngiopathy (TA-TMA)
45. Paediatric Onco-Critical Care
45.1 Introduction
45.2 Tumour Lysis Syndrome
45.2.1 Pathophysiology
45.2.2 Diagnosis
45.2.3 Treatment
45.3 Hyperleukocytosis
45.3.1 Pathophysiology
45.3.2 Diagnosis
45.3.3 Treatment
45.4 Mediastinal Tumours
45.4.1 Symptoms
45.4.2 Treatment
45.5 Posterior Reversible Encephalopathy Syndrome (PRES)
45.5.1 Pathophysiology
45.5.2 Diagnosis
45.5.3 Treatment
45.6 Intracranial Hypertension
45.6.1 Pathophysiology
45.6.2 Symptoms and Clinical Signs of Intracranial Hypertension
45.6.3 Diagnostics
45.6.4 Therapy
45.6.4.1 Conservative Treatment Strategies
45.6.4.2 Surgical Treatment Strategies
45.7 Sepsis and Non-infectious Inflammatory Conditions
45.7.1 Sepsis Definition
45.7.2 Micro-organisms and Antibiotics
45.7.3 Septic Shock Management and Organ Support
45.7.4 Special Circumstances
46. End-of-Life Nursing for Children and Families in ICU
46.1 Introduction
46.2 Experiences and Care Needs of Families in the PICU
46.3 When a Child Dies in the PICU
46.3.1 Family Experiences of End-of-Life Care in the PICU
46.3.2 Supporting Families When Their Child Is Dying: Some Practical Suggestions
46.4 After a Child Has Died in the ICU
46.4.1 Family Experiences of Post-death and Bereavement Care in the ICU
46.4.2 Supporting Families After a Child’s Death: Some Practical Suggestions
47. Paediatric Organ Donation
47.1 Introduction
47.1.1 Importance of Deceased Organ Donation
47.2 Paediatric Perspective
47.3 Ethics of Deceased Donation
47.3.1 What Makes Deceased Donation Ethical
47.3.1.1 Implicit or Presumed Consent
47.3.1.2 Explicit Consent
47.3.2 Ethical Framework
47.4 Understanding the Diagnosis of Death Using Circulatory and Neurological Criteria
47.4.1 All Human Death Is Death of the Brain
47.4.1.1 Somatic Criteria
47.4.1.2 Circulatory Criteria
47.4.1.3 Neurological Criteria
47.5 How to Diagnose Death Using Circulatory Criteria
47.6 How to Diagnose Death Using Neurological Criteria [13]
47.7 UK Procedure for Neurological Determination of Death [13]
47.7.1 Neurological Determination of Death in the Neonate
47.8 Donation Processes
47.8.1 UK Example
47.8.2 Donation After Circulatory (Cardiac) Death DCD
47.8.2.1 Warm Ischaemic Injury in DCD
47.8.3 Donation After Neurological Determination of Death DBD
47.8.4 Donor Identification and Referral
47.8.5 Organ Retrieval
47.9 International Perspectives
48. Toxicology in Pediatric ICU
48.1 Introduction
48.2 Clinical Presentation
48.3 Initial Management
48.4 Investigations
48.5 Criteria for PICU Admission
48.6 Specific Management
48.6.1 Whole Bowel Irrigation
48.6.2 Multi-dose Activated Charcoal
48.6.3 Urine Alkalinization
48.6.4 Extracorporeal Removal
48.6.5 Antidote Therapy
48.6.6 Lipid Emulsion Therapy
48.7 Ancillary Support and Prevention
Summary
Case Study
Presenting Complaints and History
Physical Examination
Initial Treatment
Details of Substance Ingested and Past Medical History
Diagnostic Testing
Hospital Course
Ancillary Tests
49. Burns in Children
49.1 Introduction
49.2 Resuscitation and Stabilization
49.2.1 Airway and Lower Respiratory Tract
49.2.2 Fluid Resuscitation After Thermal Injuries
49.2.3 Transport to a Burn Service
49.2.4 Ongoing Management: Surgical
49.2.5 Ongoing Management: Medical
49.2.5.1 Cardiovascular
49.2.5.2 Hypermetabolic Response
49.2.5.3 Nutritional Support and Gastro-Intestinal Support
49.2.5.4 Infection and Sepsis
49.2.5.5 Lines and Thromboprophylaxis
49.2.5.6 Sedation and Pain Management
49.3 Conclusion
Appendix
50. Surgical Neonates in PICU
50.1 Introduction
50.2 Preoperative Care of Surgical Neonates
50.3 Common Surgical Conditions
50.3.1 Tracheo-Oesophageal Fistula and Oesophageal Atresia
50.3.2 Congenital Diaphragmatic Hernia
50.3.3 Abdominal Wall Defects
50.3.3.1 Exomphalos
50.3.3.2 Gastroschisis
50.3.4 Intestinal Obstruction
50.3.5 Necrotising Enterocolitis
50.4 Postoperative Care of Surgical Neonates
51. Transport of the Critically Ill Child
51.1 Introduction
51.2 Referral to a PCCT
Box 51.1: Suggested Structure for the Initial Referral Call
51.3 The Transport Process
51.3.1 Staffing and Equipment
51.3.2 Handover at Referring Centre
51.3.3 Patient Stabilisation
Box 51.2: Suggested Emergency Equipment and Drugs for Transport
51.3.3.1 Airway
51.3.3.2 Breathing
51.3.3.3 Circulation
51.3.3.4 Disability
51.3.3.5 Exposure
51.3.4 Packaging for Transport
Box 51.3: Oxygen Cylinder Capacities for Commonly Used Cylinder Types [14]
51.3.5 The Transport Phase
51.3.6 Handover at Receiving Centre
51.4 Time-Critical Transfers
51.5 Air Transport
51.6 Safety and Clinical Governance
52. Analgosedation in the Pediatric Intensive Care Unit
52.1 Introduction
52.2 Two Basic Concepts: Pain and Distress
52.2.1 Definition of Pain
52.2.2 Developmental Aspects of Pain
52.2.3 The Conceptual Model of Pain
52.2.4 Incidence of Pain
52.3 Pain Assessment
52.4 Treatment Interventions
52.4.1 Non-pharmacological Interventions
52.4.2 Pharmacological Interventions
52.5 Conclusion
Supplementary Data
Specific Pharmacology Data
Analgesic Drugs
Opioids
Non-opioids
Sedative Drugs
Benzodiazepines
Alfa (α-2)-Adrenergic Agonists
Barbiturates
Volatile Anesthetics
Local Anesthetics
XII: Vital Support
53. Clinical Pharmacology in the Paediatric Intensive Care Unit
53.1 Introduction
53.2 General Aspects of Clinical Pharmacology
53.2.1 PK Processes: Its Language and Parameters
53.2.2 Dose and Dosing Interval
53.2.3 Targeted Pharmacotherapy
53.2.4 Pharmacokinetic Models
53.2.5 General Factors
53.3 Specific Aspects of Clinical Pharmacology
53.3.1 Maturational Factors
53.3.2 Non-maturational Factors
53.4 Evidence-based Pharmacotherapy
53.4.1 Rational Use of Drugs
53.4.2 Therapeutic Drug Monitoring
53.4.3 Specific Drugs
53.5 Conclusion
Appendix
54. Continuous Kidney Replacement Therapy in Children
54.1 Introduction
54.2 Early Development
54.3 Mechanisms of Solute Removal in KRT
54.4 Modalities of KRT
54.5 Indications of KRT
54.6 Timing of Initiation of KRT
54.7 CKRT Devices–CKRT Devices
54.8 CKRT Prescription (◘ Table 54.3)
54.9 Future Directions
54.10 Conclusions
55. Role of Dietitian and Nutrition in Paediatric Critical Care
55.1 Introduction
55.2 Organising Nutrition Care
55.3 Anthropometry (A)
55.3.1 Quality Assurance Framework for the Measurement of Anthropometry
55.4 Biochemistry (B)
55.4.1 Refeeding Syndrome
55.5 Clinical (C)
55.6 Dietary (D)
55.7 Evaluation (E)
56. Psychology
56.1 Introduction
56.2 Psychological Care of the Child
Box 56.1. Post-traumatic Stress Disorder (ICD-11 Code 6B40)
56.3 Supporting Parents
Box 56.2. Psychological First Aid [18]
Box 56.3. Useful Online Resources
57. Ethics in Paediatric and Neonatal ICU
57.1 Introduction
57.2 Traditional Moral Theories
57.3 Ethics in Modern PICU
57.4 Death
57.5 Moral Injury
57.6 Pandemics
57.7 Consent
57.8 Research
57.9 Second Opinions
57.10 Ethics Support
58. Chaplains and Faith Support
58.1 Introduction
58.2 The Taxonomy
58.3 Setting
58.3.1 Intended Effect
58.3.2 Method
58.3.3 Intervention
58.4 Who Carries Out This Work?
58.5 How Does the Work Happen?
58.6 What Are the Processes?
58.7 Distinctions
58.8 Themes
58.9 Outcomes
58.10 Resourcing and Training
58.11 Conclusion
XIII: Looking After People
59. Caring and Listening to Families in the ICU
59.1 Introduction
59.2 Family-Centred Care
59.2.1 The Parental Impact of Paediatric Intensive Care
59.2.2 Paediatric Intensive Care and Its Effect on Siblings
59.3 PIC Survivorship: Morbidity
59.4 Supporting the Parental Role
59.4.1 Visiting
59.4.2 Delivering Care
59.4.3 Ward Rounds, Decision-Making and Communication
59.4.4 Transitions
59.5 The Multidisciplinary Team
59.5.1 Family Liaison Service
59.5.2 Psychology
59.5.3 Religious and Spiritual Support
59.5.4 Play Specialists
59.6 Care of the Family at the End of Life
59.7 When Death is Expected or Imminent
59.8 Resuscitation
59.9 After Death
59.10 Bereavement Services
59.11 Mediation, Feedback and Liaison
59.12 Peer Support Services
59.13 Practical Matters
Summary
60. Care of the Critical Care Team
60.1 Introduction
60.2 Burnout
60.3 Post-Traumatic Stress
60.4 Moral Distress
60.5 Special Situations
60.6 Self-Care and Organisational Level Interventions
Box 60.1. Burnout
Box 60.2. Post-traumatic Stress Disorder (ICD-11 code 6B40)
Box 60.3. Moral Distress
Box 60.4. Useful Online Resources
61. Management of Older Children in the ICU
61.1 Introduction
61.2 Definitions
Box 61.1 Definitions Pertinent to Adolescent Medicine
61.3 Diagnostic Spectrum
Box 61.2 The 6 Ps
61.4 Practical Issues
61.4.1 Physical Differences
61.4.2 Experiences on ICU
61.5 Privacy
61.6 Personal Life
Box 61.3 HEADSSS Risk Assessment
61.7 Puberty
61.8 Prophylaxis
Box 61.4 Risk Factors for VTE
61.9 Permission
61.9.1 Communication
61.9.2 Consent
61.9.3 Confidentiality
XIV: Where Do Critically Ill Children Go?
62. Outcomes in PICU
62.1 Introduction
62.2 Case Reports
62.3 Physical Outcomes After Pediatric Critical Illness
62.4 Psychological Outcomes After Pediatric Critical Illness
62.4.1 The “New Normal”
62.4.2 Quality of Life
62.5 Post-traumatic Stress
62.6 Neurocognitive Outcome
62.7 Predictors: What Affects Outcome After a PICU Admission?
62.8 Challenges and Future Directions for Follow-Up
XV: Research Needed in the ICU
63. What Do We Need to Find Out?
63.1 Introduction
63.2 So, What Do We Need to Find Out?
Case Study
63.2.1 Consider Now: How Much of the Therapies, Practices, and Policies Above Do We Have Clear Evidence For?
63.2.1.1 Why We Need to Question the Evidence for Our Routine and Historical Practices
XVI: Education
64. Online Education
64.1 Introduction
64.2 What Qualifies as “Online Education”?
64.3 Implementing Online Education: A Pragmatic Approach
64.3.1 Problem Identification
64.3.2 Needs Assessment
64.3.3 Describing Goals and Objectives
64.3.4 Selecting Educational Strategies
64.3.5 Implementation of the Intervention
64.3.6 Evaluation and Feedback
64.4 Evidence for Online Medical Education
64.5 Educational Features (◘ Table 64.2)
65. Simulation in Pediatric Critical Care
65.1 Introduction
65.1.1 Challenges in Pediatric Critical Care Education
65.2 Evolution of Paediatric Resuscitation Training
65.2.1 History of CPR Training
65.2.2 Quality CPR Training in Pediatrics
65.2.3 Basic Concept of Role-Play Simulated Scenarios
65.2.4 Importance of Simulation and Debriefing in CPR Training
65.3 Crisis Resource Management in Pediatric Resuscitation Teams
65.3.1 Leadership and Followership
65.3.2 Communication
65.3.3 Use of Resources
65.3.4 Situational Awareness
65.4 Future Perspectives
65.4.1 Rapid Cycle Deliberate Practice and Repeated Encounters
65.4.2 Gaming
65.4.3 Boot Camp
65.4.4 Coaching, Codes and Mock Codes
65.4.5 Telesimulation