Pediatric critical care medicine, volume 2 respiratory, cardiovascular and central nervous systems, 2e (2014)

Derek S. Wheeler
Hector R. Wong
Thomas P. Shanley
Editors

Pediatric Critical
Care Medicine
Volume 2:
Respiratory,
Cardiovascular and
Central Nervous
Systems
Second Edition

123


Pediatric Critical Care Medicine



Derek S. Wheeler • Hector R. Wong
Thomas P. Shanley
Editors

Pediatric Critical
Care Medicine
Volume 2: Respiratory, Cardiovascular
and Central Nervous Systems
Second Edition

Editors
Derek S. Wheeler, MD, MMM
Division of Critical Care Medicine
Cincinnati Children's Hospital Medical Center
University of Cincinnati College of Medicine
Cincinnati, OH
USA

Thomas P. Shanley, MD
University of Michigan Medical School
Ann Arbor, MI
USA

Hector R. Wong, MD
Division of Critical Care Medicine
Cincinnati Children's Hospital Medical Center
Cincinnati, OH
USA

ISBN 978-1-4471-6355-8
ISBN 978-1-4471-6356-5
DOI 10.1007/978-1-4471-6356-5
Springer London Heidelberg New York Dordrecht

(eBook)

Library of Congress Control Number: 2014939299
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For Cathy, Ryan, Katie, Maggie, and Molly
“You don’t choose your family. They are God’s gift to you…”
Desmond Tutu



Foreword to the First Edition

The practitioner of Pediatric Critical Care Medicine should be facile with a broad scope of
knowledge from human developmental biology, to pathophysiologic dysfunction of virtually
every organ system, and to complex organizational management. The practitioner should

select, synthesize and apply the information in a discriminative manner. And finally and most
importantly, the practitioner should constantly “listen” to the patient and the responses to interventions in order to understand the basis for the disturbances that create life-threatening or
severely debilitating conditions.
Whether learning the specialty as a trainee or growing as a practitioner, the pediatric intensivist must adopt the mantle of a perpetual student. Every professional colleague, specialist
and generalist alike, provides new knowledge or fresh insight on familiar subjects. Every
patient presents a new combination of challenges and a new volley of important questions to
the receptive and inquiring mind.
A textbook of pediatric critical care fills special niches for the discipline and the student of
the discipline. As an historical document, this compilation records the progress of the specialty. Future versions will undoubtedly show advances in the basic biology that are most
important to bedside care. However, the prevalence and manifestation of disease invariably
will shift, driven by epidemiologic forces, and genetic factors, improvements in care and,
hopefully, by successful prevention of disease. Whether the specialty will remain as broadly
comprehensive as is currently practiced is not clear, or whether sub-specialties such as cardiacand neurointensive care will warrant separate study and practice remains to be determined.
As a repository of and reference for current knowledge, textbooks face increasing and
imposing limitations compared with the dynamic and virtually limitless information gateway
available through the internet. Nonetheless, a central standard serves as a defining anchor from
which students and their teachers can begin with a common understanding and vocabulary and
thereby support their mutual professional advancement. Moreover, it permits perspective,
punctuation and guidance to be superimposed by a thoughtful expert who is familiar with the
expanding mass of medical information.
Pediatric intensivists owe Drs. Wheeler, Wong, and Shanley a great debt for their work in
authoring and editing this volume. Their effort was enormously ambitious, but matched to the
discipline itself in depth, breadth, and vigor. The scientific basis of critical care is integrally
woven with the details of bedside management throughout the work, providing both a satisfying rationale for current practice, as well as a clearer picture of where we can improve. The
coverage of specialized areas such as intensive care of trauma victims and patients following
congenital heart surgery make this a uniquely comprehensive text. The editors have assembled
an outstanding collection of expert authors for this work. The large number of international
contributors is striking, but speaks to the rapid growth of this specialty throughout the world.
We hope that this volume will achieve a wide readership, thereby enhancing the exchange
of current scientific and managerial knowledge for the care of critically ill children, and stimulating the student to seek answers to fill our obvious gaps in understanding.

Chicago, IL, USA
New Haven, CT, USA

Thomas P. Green
George Lister
vii



Preface to the Second Edition

The specialty of pediatric critical care medicine continues to grow and evolve! The modern
PICU of today is vastly different, even compared to as recently as 5 years ago. Technological
innovations in the way we approach the diagnosis and treatment of critically ill children have
seemingly changed overnight in some cases. Efforts at prevention and improvements in care of
patients prior to coming to the PICU have led to better outcomes from critical illness. The outcomes of conditions that were, even less than a decade ago, almost uniformly fatal have greatly
improved. Advances in molecular biology have led to the era of personalized medicine – we
can now individualize our treatment approach to the unique and specific needs of a patient.
We now routinely rely on a vast array of condition-specific biomarkers to initiate and titrate
therapy. Some of these advances in molecular biology have uncovered new diseases and conditions altogether! At the same time, pediatric critical care medicine has become more global.
We are sharing our knowledge with the world community. Through our collective efforts, we
are advancing the care of our patients. Pediatric critical care medicine will continue to grow
and evolve – more technological advancements and scientific achievements will surely come
in the future. We will become even more global in scope. However, the human element of what
pediatric critical care providers do will never change. “For all of the science inherent in the
specialty of pediatric critical care medicine, there is still art in providing comfort and solace
to our patients and their families. No technology will ever replace the compassion in the touch
of a hand or the soothing words of a calm and gentle voice [1].” I remain humbled by the gifts
that I have received in my life. And I still remember the promise I made to myself so many
years ago – the promise that I would dedicate the rest of my professional career to advancing

the field of pediatric critical care medicine as payment for these gifts. It is my sincere hope
that the second edition of this textbook will educate a whole new generation of critical care
professionals, and in so-doing help me continue my promise.
Cincinnati, OH, USA

Derek S. Wheeler, MD, MMM

Reference
1. Wheeler DS. Care of the critically ill pediatric patient. Pediatr Clin North Am 2013; 60:xv–xvi. Copied with
permission by Elsevier, Inc.

ix



Preface to the First Edition

Promises to Keep
The field of critical care medicine is growing at a tremendous pace, and tremendous advances
in the understanding of critical illness have been realized in the last decade. My family has
directly benefited from some of the technological and scientific advances made in the care of
critically ill children. My son Ryan was born during my third year of medical school. By some
peculiar happenstance, I was nearing completion of a 4-week rotation in the Newborn Intensive
Care Unit. The head of the Pediatrics clerkship was kind enough to let me have a few days off
around the time of the delivery – my wife Cathy was 2 weeks past her due date and had been
scheduled for elective induction. Ryan was delivered through thick meconium-stained amniotic fluid and developed breathing difficulty shortly after delivery. His breathing worsened
over the next few hours, so he was placed on the ventilator. I will never forget the feelings of
utter helplessness my wife and I felt as the NICU Transport Team wheeled Ryan away in the
transport isolette. The transport physician, one of my supervising 3rd year pediatrics residents
during my rotation the past month, told me that Ryan was more than likely going to require

ECMO. I knew enough about ECMO at that time to know that I should be scared! The next 4
days were some of the most difficult moments I have ever experienced as a parent, watching
the blood being pumped out of my tiny son’s body through the membrane oxygenator and
roller pump, slowly back into his body (Figs. 1 and 2). I remember the fear of each day when
we would be told of the results of his daily head ultrasound, looking for evidence of intracranial hemorrhage, and then the relief when we were told that there was no bleeding. I remember
the hope and excitement on the day Ryan came off ECMO, as well as the concern when he had
to be sent home on supplemental oxygen. Today, Ryan is happy, healthy, and strong. We are
thankful to all the doctors, nurses, respiratory therapists, and ECMO specialists who cared for
Ryan and made him well. We still keep in touch with many of them. Without the technological

Fig. 1
xi


xii

Preface to the First Edition

Fig. 2

advances and medical breakthroughs made in the fields of neonatal intensive care and pediatric
critical care medicine, things very well could have been much different. I made a promise to
myself long ago that I would dedicate the rest of my professional career to advancing the field
of pediatric critical care medicine as payment for the gifts that we, my wife and I, have been
truly blessed. It is my sincere hope that this textbook, which has truly been a labor of joy, will
educate a whole new generation of critical care professionals, and in so-doing help make that
first step towards keeping my promise.
Cincinnati, OH, USA

Derek S. Wheeler, MD

Acknowledgements

With any such undertaking, there are people along the way who, save for their dedication,
inspiration, and assistance, a project such as this would never be completed. I am personally
indebted to Michael D. Sova, our Developmental Editor, who has been a true blessing. He has
kept this project going the entire way and has been an incredible help to me personally throughout the completion of this textbook. There were days when I thought that we would never finish – and he was always there to lift my spirits and keep me focused on the task at hand. I will
be forever grateful to him. I am also grateful for the continued assistance of Grant Weston at
Springer. Grant has been with me since the very beginning of the first edition of this textbook.
He has been a tremendous advocate for our specialty, as well as a great mentor and friend.
I would be remiss if I did not thank Brenda Robb for her clerical and administrative assistance
during the completion of this project. Juggling my schedule and keeping me on time during
this whole process was not easy! I have been extremely fortunate throughout my career to have
had incredible mentors, including Jim Lemons, Brad Poss, Hector Wong, and Tom Shanley.
All four are gifted and dedicated clinicians and remain passionate advocates for critically ill
children, the specialties of neonatology and pediatric critical care medicine, and me! I want to
personally thank both Hector and Tom for serving again as Associate Editors for the second
edition of this textbook. Their guidance and advice has been immeasurable. I have been truly
fortunate to work with an outstanding group of contributors. All of them are my colleagues and
many have been my friends for several years. It goes without saying that writing textbook
chapters is a difficult and arduous task that often comes without a lot of benefits. Their expertise and dedication to our specialty and to the care of critically ill children have made this
project possible. The textbook you now hold in your hands is truly their gift to the future of our
specialty. I would also like to acknowledge the spouses and families of our contributors –
participating in a project such as this takes a lot of time and energy (most of which occurs
outside of the hospital!). Last, but certainly not least, I would like to especially thank my family – my wife Cathy, who has been my best friend and companion, number one advocate, and
sounding board for the last 22 years, as well as my four children – Ryan, Katie, Maggie, and
Molly, to whom I dedicate this textbook and all that I do.

xiii

Contents

Part I

The Respiratory System in Critical Illness and Injury

1

Applied Respiratory Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
J. Grant McFadyen, Douglas R. Thompson, and Lynn D. Martin

3

2

Life-Threatening Diseases of the Upper Respiratory Tract. . . . . . . . . . . . . . . . .
Derek S. Wheeler

19

3

Congenital Airway Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Michael J. Rutter and Matthew J. Provenzano

41

4

Status Asthmaticus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Derek S. Wheeler and Riad Lutfi

49

5

Bronchiolitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kentigern Thorburn and Paul Stephen McNamara

75

6

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carrie I. Morgan and Samir S. Shah

87

7

Acute Lung Injury (ALI) and Acute Respiratory Distress
Syndrome (ARDS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Waseem Ostwani and Thomas P. Shanley

8

Mechanical Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Alik Kornecki and Derek S. Wheeler

9

Therapeutic Gases in the Pediatric ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Brian M. Varisco

10

High Frequency Oscillatory Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Kathleen M. Ventre and John H. Arnold

11

Surfactant Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Neal J. Thomas, Robert F. Tamburro Jr., Douglas F. Willson,
and Robert H. Notter

12

Extracorporeal Life Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Richard T. Fiser

13

Ventilator-Induced Lung Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Shinya Tsuchida and Brian P. Kavanagh

14

Neonatal Lung Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Thordur Thorkelsson and Gunnlaugur Sigfusson

15

Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Peter Oishi, Sanjeev A. Datar, and Jeffrey R. Fineman

16

Neuromuscular Respiratory Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
R. Paul Boesch and Hemant Sawnani
xv


xvi

Contents

Part II

The Cardiovascular System in Critical Illness and Injury

17

Applied Cardiovascular Physiology in the PICU . . . . . . . . . . . . . . . . . . . . . . . . . 303
Katja M. Gist, Neil Spenceley, Bennett J. Sheridan, Graeme MacLaren,
and Derek S. Wheeler

18

Cardiopulmonary Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Ronald A. Bronicki

19

The Classification and Nomenclature of Congenital Heart Disease . . . . . . . . . . 335
Ali Dodge-Khatami

20

Shunt Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Ganga Krishnamurthy, Eva W. Cheung, and William E. Hellenbrand

21

Cyanotic CHD Lesions with Decreased Pulmonary Blood Flow. . . . . . . . . . . . . 359
John M. Costello and Peter C. Laussen

22

Cyanotic Lesions with Increased Pulmonary Blood Flow . . . . . . . . . . . . . . . . . . 377
Nazima Pathan and Duncan J. Macrae

23

Congenital Heart Disease: Left Ventricular Outflow Tract Obstruction . . . . . . 387
John R. Charpie, Dennis C. Crowley, and Ranjit Aiyagari

24

Single Ventricle Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Katja M. Gist, Steven M. Schwartz, Catherine D. Krawczeski,
David P. Nelson, and Derek S. Wheeler

25

Long-Term Outcomes in Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . . 417
Haleh C. Heydarian, Nicolas L. Madsen, and Bradley S. Marino

26

Ventricular Assist Device Support in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
Sanjiv K. Gandhi and Deirdre J. Epstein

27

Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
David S. Cooper and Timothy K. Knilans

28

Inflammatory Diseases of the Heart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Mary E. McBride and Paul A. Checchia

29

Cardiomyopathies in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Angela Lorts, Thomas D. Ryan, and John Lynn Jefferies

30

Acute Decompensated Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
Shilpa Vellore, Jennifer L. York, and Avihu Z. Gazit

31

Diseases of the Pericardium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
Katja M. Gist and Derek S. Wheeler

32

Hypertensive Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
Amanda B. Hassinger and Denise M. Goodman

Part III

The Central Nervous System in Critical Illness and Injury

33

Molecular Biology of Brain Injury: 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Michael J. Whalen, Phoebe Yager, Eng H. Lo, Josephine Lok, Heda Dapul,
Sarah Murphy, and Natan Noviski

34

Tumors of the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Robert F. Tamburro Jr., Raymond Barfield, and Amar Gajjar

Contents

xvii

35

Intracranial Hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
Andrew C. Argent and Anthony Figaji

36

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589
Brandon A. Zielinski and Denise Morita

37

Inflammatory Brain Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601
Marinka Twilt, Dragos A. Nita, and Susanne M. Benseler

38

Abusive Head Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617
Rachel P. Berger and Michael J. Bell

39

Toxic Metabolic Encephalopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
Jorge S. Sasbón and Hugo Arroyo

40

CNS Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 643
Simon Nadel and Mehrengise Cooper

41

Status Epilepticus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675
Robert C. Tasker and Ryan Wilkes

42

Diseases of the Peripheral Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
Matthew Pitt

43

Movement Disorders in the ICU. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
Dragos A. Nita and Teesta B. Soman

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 721



Contributors

Ranjit Aiyagari, MD Department of Pediatrics, C.S. Mott Children’s Hospital,
University of Michigan, Ann Arbor, MI, USA
Andrew C. Argent, MBBCh, MD(Paediatrics), FCPaeds(SA), FRCPCH(UK)
Paediatric Intensive Care, School of Child and Adolescent Health, Red Cross War

Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
John H. Arnold, MD Division of Critical Care Medicine, Children’s Hospital,
Boston, MA, USA
Hugo Arroyo, MD Department of Neurology, Hospital de Pediatria “Dr. J. P. Garrahan”,
Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
Raymond Barfield, MD, PhD Department of Pediatric Hematology/Oncology,
Duke University, Durham, NC, USA
Michael J. Bell, MD Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Susanne M. Benseler, MD, MSCE, PhD Division of Pediatric Rheumatology,
Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
Rachel P. Berger, MD, MPH Department of Pediatrics, Children’s Hospital
of Pittsburgh of UPMC, Pittsburgh, PA, USA
R. Paul Boesch, DO, MS Department of Pediatrics and Adolescent Medicine,
Pediatric Pulmonology, Mayo Clinic, Rochester, MN, USA
Ronald A. Bronicki, MD Department of Pediatrics, Baylor College of Medicine,
Houston, TX, USA
Cardiovascular Intensive Care Unit, Texas Children’s Hospital, Houston, TX, USA
John R. Charpie, MD, PhD Department of Pediatrics and Communicable Diseases,
C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Paul A. Checchia, MD Department of Pediatrics, Texas Children’s Hospital,
Houston, TX, USA
Eva W. Cheung, MD Department of Pediatric Cardiology, Children’s Hospital
of New York Presbyterian, Columbia University College of Physicians and Surgeons,
New York, NY, USA
David S. Cooper, MD, MPH Cardiovascular Intensive Care Unit,
Heart Institute, Division of Cardiology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH, USA
Department of Pediatrics, University of Cincinnati College of Medicine,
Cincinnati, OH, USA

xix


xx

Mehrengise Cooper, MRCPCH Pediatric Intensive Care Unit,
St. Mary’s Hospital, London, UK
John M. Costello, MD, MPH Division of Cardiology, Ann and Robert H. Lurie
Children’s Hospital of Chicago, Chicago, IL, USA
Dennis C. Crowley, MD Department of Pediatrics, C.S. Mott Children’s Hospital,
Ann Arbor, MI, USA
Heda Dapul, MD Pediatric Critical Care Medicine and Neuroscience Center,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Sanjeev A. Datar, MD, PhD Department of Pediatrics, University of California
San Francisco, Benioff Children’s Hospital, San Francisco, CA, USA
Ali Dodge-Khatami, MD, PhD Department of Cardiovascular Surgery,
University of Mississippi Medical Center, University of Mississippi Children’s
Heart Center, Batson Children’s Hospital, Jackson, MS, USA
Deirdre J. Epstein, BSN Division of Cardiothoracic Surgery,
St. Louis Children’s Hospital, Washington University School of Medicine,
St. Louis, MO, USA
Anthony Figaji, MBChB, MMed, FCS (Neurosurgery), PhD Department
of Neurosurgery, University of Cape Town, Red Cross War Memorial Children’s Hospital,
Cape Town, South Africa
Jeffrey R. Fineman, MD Department of Pediatrics, University of California
San Francisco, Benioff Children’s Hospital, San Francisco, CA, USA
Richard T. Fiser, MD Department of Pediatrics, University of Arkansas
for Medical Science, Little Rock, AR, USA
Amar Gajjar, MD Department of Oncology, St. Jude Children’s Research Hospital,
Memphis, TN, USA

Sanjiv K. Gandhi, MD Department of Pediatric Cardiothoracic Surgery,
British Columbia Children’s Hospital, Vancouver, BC, Canada
Avihu Z. Gazit, MD Department of Pediatrics, Saint Louis Children’s Hospital,
St. Louis, MO, USA
Katja M. Gist, DO, MA, MSCS Department of Pediatrics,
Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA
Denise M. Goodman, MD, MS Department of Pediatrics,
Children’s Memorial Hospital, Chicago, Chicago, IL, USA
Amanda B. Hassinger, MD Department of Pediatrics, Women’s and Children’s
Hospital of Buffalo, Buffalo, NY, USA
William E. Hellenbrand, MD Department of Pediatrics, Yale New Haven Children’s
Hospital/Yale University’s School of Medicine, New Haven, CT, USA
Haleh C. Heydarian, MD Department of Pediatrics – Division of Cardiology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
John Lynn Jefferies, MD, MPH Department of Cardiology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

Contributors


Contributors

xxi

Brian P. Kavanagh, MB, FRCPC, FFARCSI (hon) Critical Care Medicine – Physiology
and Experimental Medicine, Hospital for Sick Children, Dr Geoffrey Barker Chair
in Critical Care Medicine, Toronto, ON, Canada
Department of Anesthesia, University of Toronto, Toronto, ON, Canada
Timothy K. Knilans, MD Heart Institute/Department of Pediatrics,

Division of Cardiology, Cincinnati Children’s Hospital Medical Center/University
of Cincinnati College of Medicine, Cincinnati, OH, USA
Alik Kornecki, MD Department of Pediatric Critical Care,
London Health Sciences Centre, Children’s Hospital, London, ON, Canada
Catherine D. Krawczeski, MD Department of Critical Care Medicine,
Stanford University School of Medicine, Palo Alto, CA, USA
Ganga Krishnamurthy, MBBS Department of Pediatrics, Children’s Hospital
of New York Presbyterian, Columbia University Medical Center, New York, NY, USA
Peter C. Laussen, MBBS Department of Critical Care Medicine,
The Hospital for Sick Children, Toronto, Canada
Eng H. Lo, PhD Neuroscience Center, Massachusetts General Hospital,
Harvard Medical School, Charlestown, MA, USA
Josephine Lok, MD Pediatric Critical Care Medicine and Neuroscience Center,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Angela Lorts, MD The Heart Institute, Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA
Riad Lutfi, MD Division of Critical Care Medicine, Riley Hospital for Children,
Indianapolis, IN, USA
Graeme MacLaren, MBBS, DipEcho, FCICM, FCCM Paediatric ICU,
National University Health System, Singapore, Singapore
Paediatric ICU, Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia
Duncan J. Macrae, MB ChB, FRCH, FRCPCH Department of Pediatric Intensive Care,
Royal Brompton and Harefield NHS Foundation Trust, London, UK
Nicolas L. Madsen, MD, MPH Department of Pediatrics – Division of Cardiology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Bradley S. Marino, MD, MPP, MSCE Department of Pediatrics,
Divisions of Cardiology and Critical Care Medicine, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH, USA
Lynn D. Martin, MD, MBA Department of Anesthesiology and Pain Medicine,
Seattle Children’s Hospital, Seattle, WA, USA

Mary E. McBride, MD Department of Pediatrics, Ann and Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL, USA
J. Grant McFadyen, MBChB, FRCA Department of Anesthesiology and Pain Medicine,
Seattle Children’s Hospital, Seattle, WA, USA
Paul Stephen McNamara, MBBS, MRCPCH, PhD Institute of Translational
Medicine (Child Health), The University of Liverpool, Liverpool, Merseyside, UK
Paediatric Respiratory Medicine, Alder Hey Children’s Hospital, Liverpool, Merseyside, UK


xxii

Carrie I. Morgan, MD Department of Pediatrics, Division of Critical Care Medicine,
Blair E. Batson Children’s Hospital, Jackson, MS, USA
Denise Morita, MD Division of Pediatric Neurology, Primary Children’s Medical Center,
University of Utah, Salt Lake City, UT, USA
Sarah Murphy, MD Pediatric Critical Care Medicine and Neuroscience Center,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Simon Nadel, FRCP Pediatric Intensive Care Unit, St. Mary’s Hospital, London, UK
David P. Nelson, BS, PhD, MD Department of Cardiology, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH, USA
Dragos A. Nita, MD, PhD, FRCPC Division of Neurology, Department of Pediatrics,
The Hospital for Sick Children, Toronto, ON, Canada
Robert H. Notter, MD Department of Pediatrics, University of Rochester,
Rochester, NY, USA
Natan Noviski, MD Pediatric Critical Care Medicine, Massachusetts General Hospital,
Harvard medical School, Boston, MA, USA
Peter Oishi, MD Department of Pediatrics, University of California San Francisco,
Benioff Children’s Hospital, San Francisco, CA, USA
Waseem Ostwani, MD Pediatric Critical Care Medicine, Department of Pediatric
and Communicable Diseases, C. S. Mott Children’s Hospital, Ann Arbor, MI, USA

Nazima Pathan, FRCPCH, PhD Department of Paediatrics, University of Cambridge,
Cambridge, UK
Matthew Pitt, MD, FRCP Department of Clinical Neurophysiology,
Great Ormond Street Hospital for Children NHS Foundation Trust, London, Middlesex, UK
Matthew J. Provenzano, MD Division of Pediatric Otolaryngology –
Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA
Michael J. Rutter, FRACS Division of Pediatric Otolaryngology – Head and Neck Surgery,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Thomas D. Ryan, MD, PhD The Heart Institute, Cincinnati Children’s Hospital Medical
Center, Cincinnati, OH, USA
Jorge S. Sasbón, MD Pediatric Intensive Care, Hospital de Pediatria “Dr. J. P. Garrahan”,
Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
Hemant Sawnani, MBBS, MD Division of Pulmonary Medicine,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Steven M. Schwartz, MD, MS, FRCPC Department of Critical Care Medicine,
The Hospital for Sick Children, Toronto, ON, Canada
Samir S. Shah, MD, MSCE Department of Pediatrics, Cincinnati Children’s Hospital
Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
Thomas P. Shanley, MD MICHR, University of Michigan Medical School,
Ann Arbor, MI, USA
Bennett J. Sheridan, MBBS, FRACP, FCICM The Royal Children’s Hospital,
Melbourne, VIC, Australia
Gunnlaugur Sigfusson, MD Department of Pediatrics, Children’s Hospital Iceland,
Reykjavik, Iceland

Contributors


Contributors

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Teesta B. Soman, MBBS, FAAP, DIPL, ABPN, MBA Department of Pediatrics,
Division of Neurology, The Hospital for Sick Children, Neurology, Toronto, ON, Canada
Neil Spenceley, MB ChB, MRCPCH Department of Pediatric Critical Care,
Yorkhill Children’s Hospital, Glasgow, Scotland, UK
Robert F. Tamburro Jr. , MD, MSc Department of Pediatrics,
Penn State Hershey Children’s Hospital, Hershey, PA, USA
Robert C. Tasker, MBBS, MD, FRCP Departments of Neurology
and Anaesthesia (Pediatrics), Boston Children’s Hospital, Boston, MA, USA
Neal J. Thomas, MD, MSc Penn State CHILD Research, Division of Pediatric
Critical Care Medicine, Penn State Children’s Hospital, Pennsylvania State University
College of Medicine, Hershey, PA, USA
Douglas R. Thompson, MD Department of Anesthesiology and Pain Medicine,
University of Washington, Seattle Children’s Hospital, Seattle, WA, USA
Kentigern Thorburn, MBChB, MMed, MD, FCPaed, FRCPCH, MRCP,
DCH Pediatric Intensive Care, Alder Hey Children’s Hospital and Department of Clinical
Infection, Microbiology and Immunology, The University of Liverpool,
Alder Hey Children’s Hospital, Liverpool, Merseyside, UK
Thordur Thorkelsson, MD, MS Department of Neonatology,
Children’s Hospital Iceland, Reykjavik, Iceland
Shinya Tsuchida, MD Department of Pediatrics, The University of Tokyo,
Tokyo University Hospital, Tokyo, Japan
Marinka Twilt, MD, MSCE, PhD Department of Pediatric Rheumatology,
Aarhus University Hospital, Aarhus, Denmark
Brian M. Varisco, MD Department of Pediatrics, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH, USA
Shilpa Vellore, MD Department of Pediatrics, Saint Louis Children’s Hospital,
Saint Louis, MO, USA

Kathleen M. Ventre, MD Department of Pediatrics, Children’s Hospital
Colorado/University of Colorado, Aurora, CO, USA
Michael J. Whalen, MD Department of Pediatrics, Massachusetts General Hospital,
Charlestown, MA, USA
Derek S. Wheeler, MD, MMM Division of Critical Care Medicine,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, OH, USA
Ryan Wilkes, MD Department of Cardiology, Children’s Hospitals of Atlanta,
Atlanta, GA, USA
Douglas F. Willson, MD Department of Pediatrics, Medical College of Virginia,
Richmond, VA, USA
Phoebe Yager, MD Pediatric Critical Care Medicine and Neuroscience Center,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Jennifer L. York, MD Department of Pediatrics, Saint Louis Children’s Hospital,
Saint Louis, MO, USA
Brandon A. Zielinski, MD, PhD Division of Pediatric Neurology,
Primary Children’s Medical Center, University of Utah, Salt Lake City, UT, USA


Part I
The Respiratory System
in Critical Illness and Injury