IAP Textbook of PEDIATRIC ICU PROTOCOLS
IAP Textbook of PEDIATRIC ICU PROTOCOLS
THIRD EDITION
Founder Editor
Praveen Khilnani MD FAAP MCCM (USA)
Senior Consultant Pediatric Pulmonology and Critical Care Clinical Director Madhukar Rainbow Children's Hospital
New Delhi, India
Chief Academic Editor
Vinayak Patki MB DNB FCCP FIAP FCCM (USA) FICCM
Chief Consultant Advanced Pediatric Critical Care Unit Head, Department of Pediatrics Wanless Hospital Miraj,
Maharashtra, India
Editor-in-Chief
Santosh T Soans MD FIAP
President, IAP 2018 Professor and Head Pediatric Intensive Care Services Department of Pediatrics AJ Medical College and Hospital
Mangaluru, Karnataka, India
Executive Editor
Bakul Parekh MD
Chairperson IAP-Intensive Care Chapter 2019 Consultant Pediatric Intensivist
Mumbai, Maharashtra, India
Associate Editors
Kundan Mittal MD PGDMLS MBA FISCD FIAP FICCM FCCM (SCCM, USA) FNNF MAMS FIAMS
Senior Professor (Pediatrics) Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences
Rohtak, Haryana, India
Arun Bansal MD FCCM FRCPCH FICCM
Professor Division of Pediatric Critical Care Department of Pediatrics Advanced Pediatrics Center Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh, India
Mahesh Mohite MD
Medical Director Sai Children's Hospital Navi Mumbai Honorary Pediatric Intensivist Bai Jerbai Wadia Hospital for Children
Mumbai, Maharashtra, India
Rakshay Shetty MD FCCM (Toranto)
Head Pediatric Intensive Care Services Rainbow Children's Hospital
Bengaluru, Karnataka, India
Foreword
Digant D Shastri,
Remesh Kumar R,
Bakul Parekh
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© 2019, Indian Academy of Pediatrics
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IAP Textbook of Pediatric ICU Protocols
First Edition: 2006
Second Edition: 2013
Third Edition: 2019
9789352709694
Printed at
- Abhijit Choudhary MD DM (Pediatric Critical Care)
- Pediatric Intensivist
- Nelson Children's Hospital
- Nagpur, Maharashtra, India
- Abhijit Bagde MD FNB (Pediatric Critical Care)
- Pediatric Intensivist
- Apollo Hospitals
- Navi Mumbai, Maharashtra, India
- Abhishek Kulkarni MD PDCC
- Head
- Pediatric and Adolescent Endocrinology
- T2T Hormone Clinics
- Honorary Consultant
- PD Hinduja and Jaslok Hospital Mumbai, Maharashtra, India
- Afreen Banu MD
- Fellow
- Pediatric Intensive Care
- Rainbow Children's Hospital
- Bengaluru, Karnataka, India
- Akash Deep MD
- Director
- Pediatric Intensive Care Unit
- King's College Hospital
- London, UK
- Aliza Mittal MD DNB MNAMS PGDFM
- Assistant Professor
- Department of Pediatrics
- All India Institute of Medical Sciences (AIIMS)
- Jodhpur, Rajasthan, India
- Amit Shekharay MD
- Senior Resident
- Department of Pediatrics
- Pediatric Intensive Care Unit
- All India Institute of Medical Sciences Patna, Bihar, India
- Amita Kaul MD
- Consultant
- Pediatric Intensive Care Unit
- Surya Mother and Child Superspeciality Hospital
- Pune, Maharashtra, India
- Anand Bhutada MD IFPCCM
- Pediatric Intensivist
- Nelson Children's Hospital
- Nagpur, Maharashtra, India
- Anand M MBBS DNB
- Consultant Pediatrician and
- Pediatric Intensivist
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Anjankumar TK DNB
- Senior Resident
- Pediatric Intensive Care Unit
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Ankit Mehta MD DM (Pediatric Critical Care)
- Consultant
- Pediatric Critical Care
- Zydus Hospitals
- Ahmedabad, Gujarat, India
- Anupam Sehgal MD
- Consultant Pediatric Intensivist
- PD Hinduja Hospital
- Mumbai, Maharashtra, India
- Arun Bansal MD FCCM FRCPCH FICCM
- Professor
- Division of Pediatric Critical Care
- Department of Pediatrics
- Advanced Pediatrics Center
- Postgraduate Institute of Medical Education and Research (PGIMER)
- Chandigarh, India
- Arun Prasad MD
- Assistant Professor of Pediatrics (Trauma and Emergency)
- All India Institute of Medical Sciences Patna, Bihar, India
- Atul Jindal MD DM (Pediatric Critical Care)
- Associate Professor
- Department of Pediatrics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- B Ramachandran MD FCCM
- Head
- Pediatric Intensive Care Services
- Kanchi Kamakoti CHILDS Trust Hospital
- Chennai, Tamil Nadu, India
- Bakul Parekh MD
- Chairperson
- IAP-Intensive Care Chapter 2019
- Consultant Pediatric Intensivist
- Mumbai, Maharashtra, India
- Bal Mukund MD DNB MNAMA DM
- Assistant Professor
- Department of Pediatric Critical Care
- INHS Asvini Hospital
- Mumbai, Maharashtra, India
- Balakrishna Reddy Palnati MD
- Fellow
- Pediatric Intensive Care
- Rainbow Children's Hospital
- Bengaluru, Karnataka, India
- Chhitiz Anand MD
- Senior Resident
- Department of Pediatrics
- All India Institute of Medical Sciences Patna, Bihar, India
- D Manoj MD
- Fellow (Pediatric Critical Care)
- Indira Gandhi Institute of Child Bengaluru, Karnataka, India
- Ebor Jacob James MD
- Professor and Senior Consultant
- Pediatric Intensive Care Unit
- Christian Medical College and Hospital
- Vellore, Tamil Nadu, India
- Febna Rahiman MD
- Junior Consultant
- Pediatric Intensive Care Services
- Rainbow Children's Hospital
- Bengaluru, Karnataka, India
- Ganesh Sambandamoorthy MD MRCPCH
- Consultant Pediatric Cardiac Intensivist
- Narayana Institute of Cardiac Sciences
- Bengaluru, Karnataka, India
- Ganesh Shiwarkar MD
- Fellow
- Pediatric Intensive Care Unit
- Surya Mother and Child Superspeciality Hospital
- Pune, Maharashtra, India
- Gautam Kumar MD
- Senior Resident
- Department of Pediatrics
- All India Institute of Medical Sciences Patna, Bihar, India
- Govind Benakatti MD DM (Pediatric Critical Care)
- Specialist (PICU)
- NMC Royal Hospital
- Abu Dhabi, UAE
- Gurudutt MRCPCH CCT (UK)
- Lead PICU Consultant
- People Tree Hospitals
- Bengaluru, Karnataka, India
- GV Basavaraja MD DNB
- Associate Professor
- Pediatrics and Incharge (PICU)
- Indira Gandhi Institute of Child Health
- Bengaluru, Karnataka, India
- Harish Kumar MD (Ped) Fellowship in PICU (IAP-ISSCCM)
- Consultant Pediatric Intensivist
- Aster CMI Hospital
- Bengaluru, Karnataka, India
- Hemant Gangolia MD
- Medicolegal Expert
- Apollo Hospitals
- Navi Mumbai, Maharashtra, India
- Hemant Lahoti MS MCH
- Senior Pediatric Surgeon
- Bai Jerbai Wadia Hospital for Children
- Mumbai, Maharashtra, India
- Jyoti Chaturvedi Dip (Anesthesia)
- Consultant Anesthesiologist
- Mahavir Cancer Institute and
- Research Center
- Patna, Bihar, India
- KP Angadi MD Fellow (Pediatric and Adolescent Endocrinology)
- Consultant Pediatric and Adolescent Endocrinologist
- Basaveshwar Teaching and
- General Hospital
- Gulbarga, Karnataka, India
- Kasi Bandaru MD
- Pediatric Intensivist, Incharge PICU
- Care Hospital
- Visakhapatnam, Andhra Pradesh, India
- Kaushtubh Trikande DNB
- Fellow
- Pediatric Critical Care
- Nelson Children's Hospital
- Nagpur, Maharashtra, India
- Keshavamurthy ML MD FPCC DM (Pediatric Critcal Care)
- Pediatric Intensivist
- Assistant Professor
- Department of Pediatrics
- Indira Gandhi Institute of Child Health
- Bengaluru, Karnataka, India
- KG Ravikumar MD MRCPCH CCST (UK)
- Pediatric Intensivist
- Kanchi Kamakoti CHILDS Trust Hospital
- Chennai, Tamil Nadu, India
- Kundan Mittal MD PGDMLS MBA FISCD FIAP FICCM FCCM (SCCM, USA) FNNF MAMS FIAMS
- Senior Professor (Pediatrics)
- Pandit Bhagwat Dayal Sharma
- Post Graduate Institute of
- Medical Sciences
- Rohtak, Haryana, India
- Lait Takia MD
- Senior Resident
- Division of Pediatric Critical Care
- Department of Pediatrics
- Advanced Pediatrics Center
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Lakshmi Shobhavat MD
- Consultant Pediatric Intensivist
- BJ Wadia Children's Hospital
- Mumbai, Maharashtra, India
- Lalitha AV MD DNB FNB (Pediatric Critical Care)
- Professor
- Head (PICU and Pediatric Emergency)
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Lokesh Tiwari DNB (Pediatrics) PDF (Pediatric Critical Care)
- Associate Professor and Head
- In-charge, PICU
- Pediatric Intensive Care Unit Department of Pediatrics
- All India Institute of Medical Sciences Patna, Bihar, India
- Maaz Ahmed MD DNB
- Assistant Professor
- Department of Pediatrics
- Indira Gandhi Institute of Child Health
- Bengaluru, Karnataka, India
- Madhusudan Samprati MD
- Senior Resident
- Division of Pediatric Critical Care
- Department of Pediatrics
- Advanced Pediatrics Center
- Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India
- Mahesh Kamate MD DM (Pediatric Neurology)
- Consultant Pediatric Neurologist and Professor
- Department of Pediatrics
- JN Medical College and
- Dr Prabhakar Kore Hospital
- Belagavi, Karnataka, India
- Mahesh Mohite MD
- Medical Director
- Sai Children's Hospital
- Navi Mumbai
- Honorary Pediatric Intensivist
- Bai Jerbai Wadia Hospital for Children
- Mumbai, Maharashtra, India
- Maninder Singh Dhaliwal MD
- Associate Director
- Pediatric Intensive Care Unit
- Medanta—The Medicity
- Gurugram, Haryana, India
- Manish Kumar MD
- Assistant Professor (Pediatrics)
- All India Institute of
- Medical Sciences
- Rishikesh, Uttarakhand, India
- Manoj MC
- Chief Pediatric and Neonatal Perfusionist and
- ECMO Co-ordinator
- Kokilaben Dhirubhai Ambani Hospital and Medical Reasearch Center
- Mumbai, Maharashtra, India
- Milind Jambagi DCH DNB Fellow IDPCCM
- Rainbow Children's Hospital, Bengaluru, Karnataka, India
- Mounika Reddy MD DM (Pediatric Critical Care)
- Assistant Professor
- Pediatric Intensive Care Unit
- Department of Pediatrics
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Mullai Baalaaji AR MD DM (Pediatric Critical Care)
- Consultant
- Pediatric Critical Care
- Kovai Medical Center and Hospital
- Coimbatore, Tamil Nadu, India
- Namitha Ravi Kumar MD
- Senior Resident
- Division of Pediatric Critical Care Department of Pediatrics
- Advanced Pediatrics Center Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India
- Nanditha Rathnam MD
- Associate Consultant
- Pediatric Intensivist
- People Tree Hospitals
- Bengaluru, Karnataka, India
- Neelam Mohan MD
- Director
- Pediatric Gastroenterology and Hepatology
- Medanta—The Medicity
- Gurugram, Haryana, India
- Neil Castellino MD FNB (Ped. Critical Care)
- Consultant Pediatric Intensivist
- Surya Children's
- Medicare Pvt. Ltd.,
- Mumbai, Maharashtra, India
- Nilesh Darvhekar MD
- Senior Consultant
- Nelson Children's Hospital
- Nagpur, Maharashtra, India
- Pradeep Kumar MD
- Assistant Professor (Pediatrics)
- All India Institute of Medical Sciences Patna, Bihar, India
- Pragathesh P MD
- Fellow
- Pediatric Intensive Care Unit
- Christian Medical College and Hospital
- Vellore, Tamil Nadu, India
- Praveen Khilnani MD FAAP MCCM (USA)
- Senior Consultant
- Pediatric Pulmonology and
- Critical Care
- Clinical Director
- Madhukar Rainbow Children's Hospital
- New Delhi, India
- Preetha Joshi DNB
- Pediatric Intensivist
- Kokilaben Dhirubhai Ambani Hospital and Medical Reasearch Center
- Mumbai, Maharashtra, India
- Rachna Sharma MD
- Consultant Pediatric Intensivist
- BLK Superspecialty Hospital
- New Delhi, India
- Raghavendra Vanaki MD IDPCCM
- Pediatric Intensivist
- Associate Professor
- Department of Pediatrics
- SN Medical College and HSK Hospital
- Bagalkot, Karnataka, India
- Rajalakshmi Iyer MD
- Senior Resident
- Division of Pediatric Critical Care
- Department of Pediatrics
- Advanced Pediatrics Center Postgraduate Institute of Medical Education and Research (PGIMER)
- Chandigarh, India
- Rajesh Hegde MD
- Senior Consultant Pediatric Cardiac Intensivist
- Narayana Institute of
- Cardiac Sciences
- Bengaluru, Karnataka, India
- Rakshay Shetty MD FCCM (Toranto)
- Head
- Pediatric Intensive Care Services
- Rainbow Children's Hospital
- Bengaluru, Karnataka, India
- Ramanuj Sharma MD
- Senior Resident
- Department of Pediatrics
- Pediatric Intensive Care Unit
- All India Institute of Medical Sciences Patna, Bihar, India
- Rekha Soloman MD
- Pediatric Intensivist
- Bai Jerbai Wadia Hospital for Children
- Mumbai, Maharashtra, India
- Riyan Shetty MD (Anesthesia)
- PICU Fellow
- Consultant Pediatric Cardiac Intensivist
- Head, Extracorporeal Life Support
- Narayana Institute of
- Cardiac Sciences
- Bengaluru, Karnataka, India
- Romit Saxena MD
- Consultant Pediatric Intensivist
- Max Super Speciality Hospital
- New Delhi, India
- Rupesh Raina MD FAAP FACP FASN FNK
- Consultant Nephrologist
- Adult-Pediatric Kidney Disease/Hypertension
- Department of Nephrology
- Cleveland Clinic, Akron General and Staff at Akron Children's Hospital, Akron, Ohio, USA
- S Senthil Kumar MD
- Pediatric Intensivist
- Columbia Asia Hospital
- Bengaluru, Karnataka, India
- Sachin Shah MD DM (Neo)
- Medical Director
- Head
- Pedaitric and
- Neonatal Intesive Care
- Surya Mother and Child Superspeciality Hospital
- Pune, Maharashtra, India
- Sagar Hiremath MD
- Consultant Pediatric Intensivist Narayana Health City
- Bengaluru, Karnataka, India
- Sagar Lad DNB DCH
- Consultant Pediatrc Intensivist
- Jehangir Hospital
- Pune, Maharashtra, India
- Sandeep Karanam MD FPCC
- Pediatric Intensivist
- Assistant Professor
- Kamineni Medical College and Research Center
- Hyderabad, Telangana, India
- Sanjeev Aggarwal
- Advocate
- Punjab and Haryana High Court
- Chandigarh, India
- Santosh T Soans MD FIAP
- Professor and Head
- Neonatal and
- Pediatric Intensive Care Unit
- AJ Medical College
- Mangaluru, Karnataka, India
- Sarfaraz Rahiman MD DNB IDPCCM FCICM
- Pediatric Intensivist
- Lady Cilento Children's Hospital Brisbane, Australia
- Sasidaran K MD DM (Pediatric Critical Care)
- Consultant Pediatric Intensivist
- Dr Mehta's Children's Hospital
- Chennai, Tamil Nadu, India
- Satish Devpujari MD
- Chairman
- Nelson Academic Counsel
- Nagpur, Maharashtra, India
- Shivakumar Shamarao DNB DCh IDPCCM Fellow Pediatric Critical Care (GOSH London)
- Consultant
- Pediatric Intensive Care and
- Pediatric Emergency
- Manipal Hospital
- Bengaluru, Karnataka, India
- Sidharth Kumar Sethi MD FASN FIAP
- Senior Consultant
- Pediatric Nephrology and Pediatric Kidney Transplantation
- Medanta—The Medicity
- Gurugram, Haryana, India
- Soonu Udani MD DCH
- Medical Director
- SRCC Children's Hospital
- Mumbai, Maharashtra, India
- Subhash Chettri MD DNB FNB (Pediatric Intensive Care)
- Senior Resident
- Pediatric Intensive Care Unit
- St John's Medical College and
- Hospital
- Bengaluru, Karnataka, India
- Suchita Khadse MD
- Senior Consultant
- Nelson Children's Hospital
- Nagpur, Maharashtra, India
- Suhas BS MD
- Fellow (Pediatric Critical Care)
- Indira Gandhi Institute of
- Child Health
- Bengaluru, Karnataka, India
- Sujith Kumar Tummala MD FPCC
- Pediatric Intensivist
- Assistant Professor
- NRI Medical College
- Vijayawada, Andhra Pradesh, India
- Sumithra S DCH DNB IDPCCM
- Assistant Professor
- St John's Medical College and
- Hospital
- Bengaluru, Karnataka, India
- Supraja Chandrasekar MRCPCH
- Consultant Pediatric Intensivist
- Chief Pediatrics
- People Tree Hospitals
- Bengaluru, Karnataka, India
- Suvasini Sharma MD DM (Pediatric Neurology)
- Associate Professor
- Neurology Division
- Department of Pediatrics
- Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
- Teena Bansal MD
- Associate Professor
- Anesthesia and Critical Care
- Pt BD Sharma, PGIMS
- Rohtak, Haryana, India
- Uday Shankar Surabhi MD FPCC DAA
- Pediatric Intensivist
- Omni RK Superspeciality Hospital
- Visakhapatnam, Andhra Pradesh, India
- Veena Raghunathan MD
- Senior Consultant
- Pediatric Intensive Care Unit
- Medanta—The Medicity
- Gurugram, Haryana, India
- Vijai Williams MD
- Senior Resident
- Division of Pediatric Critical Care
- Department of Pediatrics
- Advanced Pediatrics Center
- Postgraduate Institute of Medical Education and Research (PGIMER)
- Chandigarh, India
- Vinay Joshi MD DM (Neo)
- Pediatric Intensivist
- Kokilaben Dhirubhai Ambani Hospital and Medical Reasearch Center
- Mumbai, Maharashtra, India
- Vinay Munikoty MD (Ped) DM (Ped Hem Onc)
- Assistant Professor
- St John's Medical College and
- Hospital
- Bengaluru, Karnataka, India
- Vinayak Patki MB DNB FCCP FIAP FCCM (USA) FICCM
- Chief Consultant
- Advanced Pediatric Critical Care Unit
- Head
- Department of Pediatrics
- Wanless Hospital
- Miraj, Maharashtra, India
- Vishram Buche MD
- Vice Chairman
- Nelson Academic Counsel
- Nagpur, Maharashtra, India
- Vivek Manchanda MD
- Senior Consultant Pediatric Surgeon
- Max Superspeciality Hospital
- New Delhi, India
Dear Readers,
We are very happy to launch the third edition of IAP Textbook of Pediatric ICU Protocol. First edition of this book was released in 2006 and later second edition in 2013. It was strong need and request from fellow Pediatricians and Postgraduates to have updated version of this protocol book as many changes in the management guidelines have occurred in last five to six years.
Pediatric critical care is the most dynamic subspecialty of Pediatrics, not only in terms of disease process and management but also in terms of updating of knowledge. We feel that so many new things are happening in the arena of Pediatric Critical Care that sometimes it is difficult to keep pace with updating those. Better understanding of disease process, newer drugs, novel biomedical engineering and multicentric research, have translated the treatment of critically ill children into systematically approached, evidenced based management. So, we have decided to bring this 3rd edition of Pediatric ICU (PICU) Protocol book with updated knowledge, under the auspices of Indian Academy of Pediatrics (IAP).
The IAP specialty series books serve the purpose of providing evidence based, authentic and updated information to IAP members, other pediatricians, and both under and postgraduate students of Pediatrics in this country. Guidelines and protocols on disease management will not only be helpful for their everyday practice but will also bring uniformity in their management.
Renowned pediatric intensivist across the country, mixture of young and enthusiastic consultants and experienced and senior national faculties has written this book. Almost 30 new chapters have added in this edition. Recently published international and national guidelines pertaining to that disease entity has been adopted in brief and summarized manner. Protocols are grouped under small sub-sections in a systematic manner to find out the topics easily and to read associated topic to that system. Evidence based and practice-oriented protocols have been used in an easy to read format with flow diagram after every chapter as much as feasible.
Creating a book is not an easy task. Right from conception to delivery, there is long and complex process. It is very labor intensive and time-consuming work that involves considerable precious time of authors and editors. We congratulate Dr Santosh T Soans, Editor in Chief and Dr Vinayak Patki, Chief Academic Editor for their untiring hard work of conceptualizing, conveying and coordinating chapters with authors, editors and publishers.
We also appreciate the contribution by associate editors and section editors, towards this book. Despite their busy schedule, they have completed their editorial work in timely manner. It goes without saying that efforts put by all authors’ needs special mention, as they created the foundation of each chapter. We thank whole team of authors and all editors for their valuation contribution towards this book. We thank M/s Jaypee Brothers Medical Publishers for publishing this book.
It is our sincere hope that this “IAP Textbook of Pediatric ICU protocol” would be available in all emergency room and Pediatric Intensive Care Units as well as medical colleges, and would be used to improve the outcome of critically ill children
Digant D Shastri
President, IAP 2019
Remesh Kumar R
Hon. Secretary General, IAP 2018–19
Bakul Parekh
President Elect 2019
Preface to the Third Edition
It gives us immense pleasure to present this new edition of IAP Textbook of Pediatric ICU Protocols to you. The book will be officially released during PEDICON 2019 at Mumbai. It was almost six years ago that the 2nd edition of this book was published. From A-B-C to C-A-B in advanced life support and resuscitation, from dopamine to adrenalin as first choice of inotropes in septic shock management, from aminophylline to magnesium sulfate as second line drug in status asthmaticus and from 60 mL rapid bolus to repeated 20 mL slow boluses in graded manner for fluid resuscitation of shock, pediatric critical care has seen substantial changes in the management protocols in recent years. So, we have decided to bring out this 3rd edition with updated knowledge, under the auspices of Indian Academy of Pediatrics (IAP).
This protocol book will update your knowledge with respect to published national and international guidelines published for different category of diseases in the pediatric intensive care unit (PICU). Most of the protocols are based upon recent published data or best practice strategies of reputed institutes. The aim of the book is to make the management of the sick child with uniformity, across the hospitals in India. This uniformity will not only improve the standard of quality practice in various hospitals but also will give an edge in facing medicolegal issues when conflict develops, as these protocols will set a standard of care for Indian context.
In this edition you will find system-based protocols divided in almost 20 sub-sections. Each section has been written by esteemed faculty with substantial authority on that subject, many are either fellows of pediatric subspecialty or having vast experience in that field and edited by renowned Pediatric Intensivists. All the aspects of basic and advanced life support as per recent Pediatric Advanced Life Support (PALS) guidelines are incorporated. In basic mechanical ventilation, protocols on trouble shooting, ventilation, weaning, extubation, prone positioning, recruitment maneuvers and tracheotomy are added. Shock has been revised and new American College of Critical Care Medicine (ACCM) guidelines for septic shock are included. Many centers in India are now using inhaled nitric oxide and extracorporeal membrane oxygenation (ECMO); hence protocols on these advanced therapies are added. Tropical infections are still a major contributor for admissions in our ICUs and healthcare-associated infections are increasing in India too, hence protocols on these infections are added with chapters on antibiotics and antifungals in PICU.
Special chapter on fluids in different situations in PICU has been added. Chapters on DIC, transfusion of blood and blood products, transfusion reactions and oncological emergencies are added in hematology section. Gastroenterology section is added with protocols on acute pancreatitis and surgical abdomen. Protocols on renal replacement therapy are also newly added. There is a new addition on common respiratory problems like severe pneumonia, bronchiolitis, acute croup, empyema, acute respiratory distress syndrome (ARDS) and air leak syndrome. In environmental injuries section we have included management issues about heat stroke, burns, electrical injury, poly trauma and drowning. New sections on quality care in PICU and medicolegal issues in PICU are specially incorporated to address the special needs of the present era.
We sincerely thank our associate editors Dr Kundan Mittal, Dr Mahesh Mohite, Dr Arun Bansal and Dr Rakshay Shetty for critically evaluating all the protocols and editing those to best possible way. We are also thankful to all section editors and authors for completing the work in stipulated time, despite their busy schedule.
We hope this book will help the postgraduates, fellows, consultants and pediatric intensivists for better management of critically ill children and improving their outcome and should be a standard book available always in any PICU.
Santosh T Soans
Vinayak Patki
Preface to the Second Edition
This book entitled IAP Textbook of Pediatric ICU Protocols is intended to be a practical current state of the art resource for pediatric residents, pediatricians and physicians involved in care of neonatal and pediatric emergency, and intensive care patients commonly seen in the Indian scenario.
A practice-oriented protocol-based approach to common conditions such as acute pneumonia, severe asthma, acute respiratory distress syndrome (ARDS), cardiorespiratory failure, shock, sepsis, coma, raised intracranial pressure, status epilepticus protocol, cardiac failure, rhythm abnormalities, including postoperative cardiac surgery in critically ill children has been discussed. It has been the effort to include as much evidence-based protocols as feasible.
Basic mechanical ventilation details have been emphasized including airway management, rapid sequence intubation, initial ventilator settings, maintenance, monitoring and ongoing adjustment of mechanical ventilation, arterial blood gas analysis and weaning from the ventilator.
Besides a discussion of basic conventional ventilation, advanced ventilation modes, high frequency oscillatory ventilation (HFOV) and noninvasive ventilation protocols have also been included. Wherever feasible, practical case scenarios of commonly seen neonatal and pediatric conditions involving acute renal failure, fulminant hepatic failure, inborn errors of metabolism, acid-base, and fluid and electrolyte disturbances have also been included.
Finally, a brief description of commonly seen poisonings, multiple trauma, standard basic life support (BLS), pediatric advanced life support (PALS) protocols, sedation protocols, pediatric intensive care unit (PICU) drug dosages as well as PICU procedures have been covered with a view of having that information readily available to the reader.
Hope this protocol book finds important place in emergency rooms and PICUs at various institutions facilitating delivery of appropriate and timely emergency and intensive care at right time by all residents, fellows and consultant pediatricians.
Praveen Khilnani