Practical Approach to Pediatric Intensive Care Praveen Khilnani, Rajiv Uttam
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1Practical Approach to PEDIATRIC INTENSIVE CARE2
3Practical Approach to PEDIATRIC INTENSIVE CARE
Third Edition
Chief Editor Praveen Khilnani MD FICCM FAAP FCCM (USA) Diplomate American Board of Pediatric Critical Care Medicine Chair Guidelines Committee 2001 (for IAP and ISCCM ) Senior Consultant and Head Pediatric Critical Care and Pulmonology BLK Super Speciality Hospital New Delhi, India Associate Editor Rajiv Uttam MRCP (UK) Editorial Board Mritunjay Pao MD Nitesh Singhal MD Rachna Sharma MD Nameet Jerath MD Maninder S Dhaliwal MD Prabhat Maheshwari MRCP (UK) Mritunjay Pao MD Foreword Janakiraman N
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Practical Approach to Pediatric Intensive Care
First Edition: 2004
Second Edition: 2009
Third Edition: 2015
9789351527398
Printed at
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Dedicated to 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 could not
She was the one who taught me to always be optimistic and hardworking
God will take care of the rest
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Contributors Foreword
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 pediatric intensive care units 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 healthcare 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 and Head, Pediatric Critical Care and Pulmonology, BLK Super Speciality Hospitals, New Delhi, India, 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.
Janakiraman N MD FAAP FCCM (USA)
Professor
Pediatrics and Critical Care
University of Illinois
Cook County Health and Hospitals System
Chicago, Illinois, USA
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Preface to the Third Edition
Since the publication of the first edition in 2004, the field of pediatric critical care has grown by leaps and bounds, newer developments and guidelines have emerged. New resuscitation guidelines (AHA PALS, 2010) as well as International Surviving Sepsis Guidelines (2012) have been included, in addition to overall upgrading of latest information and technology in the field of pediatric critical care. Pediatric intensive care delivery is cost intensive and can be a limiting factor in resource-limited countries, such as India. Resource limitations have been particularly kept in mind, while discussing various treatment and investigative modalities. Practice-oriented flowcharts have been updated in several chapters for giving a quick overview of management of common pediatric intensive care unit problems.
I hope that this book Practical Approach to Pediatric Intensive Care will emerge as truly practical companion to doctors and nurses at various levels of training, consultants in teaching programs, and also in corporate practice of pediatric critical care in saving lives of critically ill children.
Praveen Khilnani20
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Preface 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 the 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 a 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 judgment 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.
The effort has been made 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
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35Development of Pediatric Critical Care
1889 : First infant respirator, Egon Braun, Vienna
1910 : First positive pressure ventilator
1954 : Extracorporeal circulation described
1954 : First PICU, Gothenburg, 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 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), William Shoemaker
1974 : Pulse oximetry developed
1982 : Pediatric Section of Society of Critical Care Medicine established
1983 : First pediatric advanced life support (PALS) copy written
Formation of Section on Critical Care of AAP
1986 : US Guidelines published for pediatric air and ground transport
1987 : First comprehensive Textbook of Pediatric Critical Care, MC Rogers
First Pediatric Critical Care Board examinations
1988 : American College of Critical Care Medicine (ACCM) established
Prism score described by Murray 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, Mumbai
1993 : First Indian Academy of Pediatrics (IAP) Intensive Care Conference, New 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 by Krishan Chugh
1998 : First National Congress on Pediatric Intensive Care, Nagpur
2000 : ISCCM Pediatric Section formed, Founder Chair Praveen Khilnani
2001 : IAP and ISCCM PICU Guidelines and Levels of Care published
2002 : First Pediatric Critical Care Fellowship started
2003 : First Pediatric Critical Care Fellowship examination, Surat, Gujarat
2004 : First comprehensive Indian textbook on Pediatric Intensive Care, Praveen Khilnani
2007 : DNB Training In Pediatric Critical Care started in India
2009 : Basic Pediatric Intensive Care Course (BPICC) developed by IAP (Intensive Care Chapter) and ISCCM Pediatric Section
2010 : DM training in Pediatric Critical Care Medicine started at PGIMER, Sunit Singhi, Chandigarh
2014 : IAP Intensive Care Journal started, Journal of Pediatric Critical Care (JPCC), Editor-in-Chief Praveen Khilnani
2014 : Formation of College of Pediatric Critical Care, India
2015 : Advanced Pediatric Intensive Care Course (APICC) by College of Pediatric critical care, India