Practical Approach to Pediatric Intensive Care Praveen Khilnani
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1Practical Approach to Pediatric Intensive Care
2Practical Approach to Pediatric Intensive Care
Second Edition
Editor Praveen Khilnani MD FAAP FCCM (USA) Senior Consultant and Incharge Pediatric Intensivist and Pulmonologist Max Hospitals, New Delhi, India Editorial Board Rajiv Uttam Vinay K Aggarwal Sandeep Chopra RK Mani Rajesh Chawla Yogesh Gautam Mritunjay Pao
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Practical Approach to Pediatric Intensive Care
© 2009, Praveen Khilnani
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editor will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2004
Second Edition: 2009
9788184486759
Typeset at JPBMP typesetting unit
Printed at
4To my mother
Late Smt Laxmi Devi Khilnani
Who left for heavenly abode on May 2001
She always knew I could do it whenever I thought I couldn't
She was the one who taught me to always be optimistic and hardworking
God will take care of the rest
5List of Contributors 8Foreword
Pediatric critical care is a relatively new subspecialty and has developed rapidly in many parts of the world. In India, it is still in infancy but over the last few years, it has made great strides. The standard of care for the critically ill or injured child is more or less at par with other countries. It is very gratifying to see that many institutions have excellent PICUs with current state of the art. The Indian Society of Critical Care Medicine and the Indian Academy of Pediatrics are to be commended for their lead and enormous input to disseminate the knowledge and skills to physicians, nurses and other health care personnel. With the explosion in current technology and monitoring techniques, many lives are being saved.
This book entitled Practical Approach to Pediatric Intensive Care edited by Dr Praveen Khilnani, Senior Consultant Pediatric Intensivist at Max Hospitals, New Delhi will be a valuable companion to all the medical and nursing personnel. Many areas and topics have been covered well by the author who is well experienced to conditions that prevail the world over.
A book like this cannot be exhaustive and complete. But, it contains practical guidance for the routine daily care of the sick child. I commend the editor for his efforts and venture.
N Janakiraman md faap fccm (usa)
Professor of Pediatrics and Critical Care
University of Illinois
Cookcounty Hospital
Chicago, Illinois, USA
9Preface to the Second Edition
As the field of pediatric critical care continues to grow, newer developments and guidelines have emerged. New resuscitation guidelines as well sepsis guidelines have been included, in addition to overall upgrading of latest information in the field of pediatric critical care. Practice oriented flow charts have been added to several chapters for common PICU problems.
It is hoped that this book will emerge as truly practical companion to any one taking care of a critically ill child.
Praveen Khilnani
10Preface to the First Edition
The field of pediatric critical care (pediatric intensive care) is rapidly advancing and new innovations and technologies are being frequently incorporated into the delivery of pediatric critical care. The role of the pediatric critical care specialist (pediatric intensivist) has become more defined as pediatrician who specializes in the field of diagnosis of critical pediatric illnesses and prompt management employing all—the principles of pediatric pathophysiology including hemodynamic disturbances, tissue oxygen delivery, septic process, trauma and surgical stress and systemic inflammatory response syndrome (SIRS). Treatment of critical illness involves a good grasp on ways to improve oxygen delivery for management of shock, respiratory failure and sepsis. Clinical reserve in a pediatric patient is far less compared to an adult patient, therefore, a timely detection of a clinically deteriorating patient as well as prompt institution of appropriate resuscitative efforts goes a long way. A pediatric intensivist must be well trained in emergency procedures such as central line placement, endotracheal intubation, bag mask ventilation, arterial line placement, sedation, ventilator management, chest tube placement, lumbar puncture, oxygen therapy, cardiopulmonary resuscitation, intraosseous line placement and above all the application of appropriate clinical judgement to use the above skills effectively and safely to improve patient outcome.
This book has been written and edited to emphasize practical aspects of pediatric intensive care contributed by various national and international authors involved in routine day-to-day management in the multidisciplinary pediatric intensive care unit with collaboration of a team of specialists including medical, surgical, nursing, and other important ancillary services. Ethical, legal, and nursing issues have also been included. I sincerely hope this book will be a resource to those practicing and training in the field of pediatric critical care medicine.
Effort has been taken to present currently accepted consensus on therapy rather than dogmatic opinions. I wish to thank all the contributors and my family members for their unconditional support.
Praveen Khilnani
11
Development of Pediatric Critical Care
1889
:
First infant respirator
Egon Braun, Vienna
1910
:
First positive pressure ventilator
1954
:
Extracorporal circulation described
1954
:
First PICU, Goteburg, Sweden
Closed chest defibrillation described
ECMO described
1957
:
Severinghaus electrode: led to blood gas analysis
1958
:
First physician-directed multidisciplinary adult ICU, Baltimore City Hospital
1963
:
First liver transplant
1964
:
Theodore Striker, MD, becomes first pediatric critical care fellow, Philadelphia
1967
:
First US physician-directed PICU, Philadelphia
:
Society of Critical Care Medicine (SCCM) established
1972
:
First US Textbook of Pediatric Critical Care Clement Smith (Editor)
1973
:
First edition, Critical Care Medicine (CCM)
1974
:
Pulse oximetry developed
1982
:
Pediatric Section of Society of Critical Care Medicine established
1983
:
First advanced pediatric life support PALS copywritten
:
Formation of section on critical care of AAP
1986
:
US Guidelines published for pediatric air and ground transport
1987
:
First Comprehensive Textbook for Pediatric Critical Care–MC Rogers
First pediatric critical care board examinations
1988
:
American College of Critical Care established
:
Prism score described by Murrey Pollack
1989
:
First pediatric critical care fellowship certified by American College of Graduate Medical Education (ACGME)
1993
:
US guidelines and levels of care for PICUs published
1993
:
Indian Society of Critical Care Medicine (ISCCM) established
1993
:
First Indian Academy of Pediatrics (IAP) intensive care conference, Delhi
:
Manual of pediatric intensive care published–K Chugh and Praveen Khilnani
1997
:
World congress and establishment of World Federation of Pediatric Intensive Care (WFPICC), Baltimore
1998
:
IAP intensive care chapter established
1998
:
1st national congress on pediatric intensive care, Nagpur
2000
:
ISCCM pediatric section formed
2001
:
IAP and ISCCM PICU guidelines and levels of care published
2002
:
First pediatric critical care fellowship started
2003
:
First pediatric critical care fellowship exam, Surat
2004
:
First comprehensive Indian Textbook on Pediatric Intensive Care: Praveen Khilnani
2007
:
DNB pediatric critical care started in India.