Journal of Pediatric Intensive Care - Volume 2, issue 4

Authors: Levin, Daniel L. | Downes, John J. | Todres, I. David

Article Type: Review Article

Abstract: OBJECTIVES: to review and cite important individuals and events in the development of pediatric critical care medicine (PCCM). DATA SOURCES: A MEDLINE search was performed looking for citations of the history of PCCM. This yielded 85 citations of which 46 were obtained. Thirty nine of the 85 were rejected as inappropriate either by title (e.g., pediatric emergency medicine) or because they were in a foreign language only. After review of the 46, 21 were included in this review and the others rejected as inappropriate. Textbooks of PCCM were reviewed for chapters on the history of PCCM and …four were included. Forty-eight personal communications were made to individuals and four to organizations to elicit and verify information. One speech is referenced and from these sources, a total of 37 additional textbooks, monographs and chapters and 47 journal manuscripts and reference sites were found and included. SELECTION AND EXTRACTION: Materials pertinent to the specific disciplines, individuals and events in the development of CCM(Critical care medicine) and PCCM were included in this review. CONCLUSIONS: PCCM owes a great debt to the expertise in anesthesiology, neonatology, pediatric cardiology, pediatric general and cardiovascular surgery and nursing for its evolution. The modern PCCM unit and service is more the result of the need to treat and organize care for critically ill and injured patients than to any developments in technology. Show more

Keywords: history, pediatrics, critical care, pediatric critical care, ventilation, poliomyelitis

DOI: 10.3233/PIC-13068

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 147-167, 2013

Authors: Turkel, Susan | Hanft, Alan | Epstein, David | Jacobson, Julienne

Article Type: Review Article

Abstract: Delirium is an acute neuropsychiatric syndrome reflecting serious cerebral dysfunction. The characteristic core symptoms of delirium include the inability to direct, focus, sustain, and shift attention; abnormalities of the sleep-wake cycle; impaired consciousness and awareness; disturbance of thought processes; and behavioral dyscontrol. Delirium is particularly prevalent in critically ill and post-operative patients in the intensive care unit, and may result from hypoxia or infection. It is most likely in the most severely ill, and length of stay is prolonged, and morbidity and mortality and higher with delirium. A variety of clinical instruments have been developed to facilitate the diagnosis …of delirium. The Delirium Rating Scale, and its 1998 revision (DRS and DRS-R98) are for psychiatrists to use and are based on DSM criteria. The Pediatric Confusion Assessment Method, adapted for pediatric patients in the ICU (pCAM-ICU), is designed for non-psychiatrists and nurses in the intensive care unit. The Pediatric Anesthesia Emergence Delirium scale (PAED) is the basis for the Cornell Assessment of Pediatric Delirium (CAP-D), and both are for nurses and doctors in the pediatric ICU to use to identify delirium in their patients. Delirium is typically multifactorial and its pathogenesis reflects neurotransmitter changes associated with metabolic and inflammatory processes. Benzodiazepines and anticholinergic drugs, including opioids and antihistamines, are widely used in the pediatric ICU and may precipitate or exacerbate delirium. Benzodiazepines especially are best used sparingly, in the lowest dose possible, if at all. The treatment of delirium is predicated on detecting and addressing its underlying cause, which usually results in its rapid resolution. Environmental interventions may ameliorate the risk for delirium, and drugs which may precipitate or worsen delirium should be avoided. Antipsychotics can provide benefit in managing agitation, perceptual disturbances, sleep-wake cycle abnormalities, and behavioral dyscontrol. Atypical antipsychotics, including olanzapine, risperidone, and quetiapine, have largely replaced haloperidol in newer approaches to management because of lower risk for adverse side effects. The risk for delirium may be mitigated by vigilance, and awareness of its presentation, pathogenesis, and management. Its prevention will be of significant benefit in reducing morbidity, improving outcome, and providing comfort to these very ill and fragile children. Show more

Keywords: Delirium, management, antipsychotic, pediatric, intensive care

DOI: 10.3233/PIC-13070

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 169-176, 2013

Authors: Kopač, Matjaž

Article Type: Other

Abstract: To perform proper and optimal catheterization, a urinary catheter of appropriate size has to be selected as the success of a procedure is often dependent on it. Catheterization of the urinary bladder is a common procedure in pediatric practice which is used for numerous diagnostic and therapeutic purposes. There are very few recommendations on how to choose the optimal size of a catheter on the basis of a child’s age or weight. Based on a few published relationships between a child’s age, body weight and urinary catheter size, as well as personal experience, the author has developed a formula for …estimating urinary catheter size according to a child’s weight that reads as follows: $\textit{Urin.Catheter}(F) = \frac{\textit{Weight}(kg)}{3} + 4$ . Presented formula may prove useful in everyday clinical practice and especially in emergency settings. Show more

Keywords: Urinary catheter, bladder, body weight, age, child

DOI: 10.3233/PIC-13069

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 177-180, 2013

Authors: Pantaleoni, Julie | Parsapour, Kourosh | Kon, Alexander A.

Article Type: Other

Abstract: Pulmonary arteriovenous malformations may result in intrapulmonary shunting and hypoxemia, and often are treated by embolization or surgical resection. Previous reports have demonstrated effective treatment of hypoxia with inhaled nitric oxide in the acute setting. In this report, we describe a child with severe hypoxemia secondary to an inoperable pulmonary arteriovenous malformation that was initially managed with the use of nitric oxide followed by long term management with the phosphodiesterase-5 inhibitor, sildenafil.

Keywords: Arteriovenous malformations, nitric oxide, phosphodiesterase-5 inhibitors

DOI: 10.3233/PIC-13065

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 181-185, 2013

Authors: Firdouse, Mohammed | Garwal, Arnav | Almeida, Claudia Lace De | Mondal, Tapas

Article Type: Other

Abstract: Takotsubo cardiomyopathy is characterized by the acute onset of a reversible left ventricular wall motion abnormality that extends beyond a single coronary artery’s distribution, following a period of emotional or physical stress. We present a 4 yr 11 mo old boy who was admitted to the pediatric intensive care unit a few days following tonsillectomy and adenoidectomy. The patient presented with mild cyanosis, shortness of breath and decreased levels of consciousness. Initial investigations revealed significant hypokinesia and dilatation of the mid and apical segments of the left ventricle along with preserved function of the basal segment. The patient was given …inotropes and diuretics for hemodynamic management. The patient made a complete recovery with normalization of cardiac function within 3-4 wk. Upon follow up, the patient had normal sinus rhythm, improved ejection fraction and no ventricular wall motion abnormalities. The authors believe the myocarditis, rhabdomyolysis, and sepsis following tonsillectomy and adenoidectomy to be the stressors in this case. The rarity of cases that phenotypically mimic classical Takotsubo cardiomyopathy in children makes this case of special interest to pediatricians and cardiologists. Show more

Keywords: Takotsubo cardiomyopathy, broken heart syndrome, transient left apical ballooning, stress cardiomyopathy, myocardial stunning

DOI: 10.3233/PIC-13067

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 187-192, 2013

Authors: Derin, Hatice | Yıldırım, Gökçen | Çaksen, Hüseyin

Article Type: Other

DOI: 10.3233/PIC-13066

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 193-194, 2013

Article Type: Other

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 195-197, 2013

Article Type: Other

Citation: Journal of Pediatric Intensive Care, vol. 2, no. 4, pp. 199-200, 2013