Contents xxvii
19. Meconium Aspiration Syndrome and Persistent Pulmonary Hypertension in Neonate ............................. 267
Naveen Gupta, Siddarth Nayyar, Anil Batra, Manish Malik, Praveen Khilnani
• Meconium Aspiration Syndrome 267 • Persistent Pulmonary Hypertension of Newborn 270
20. Acute Respiratory Distress and Failure ............................................................................................................ 276
Vibin K Vasudevan, Praveen Khilnani
• Epidemiology 276 • Definition 276 • Pathogenesis and Pathophysiology 276
• Clinical Evaluation of a Child with Respiratory Distress and Failure 279 • Clinical Assessment of Diagnosis 281
• Management 283 • Disease or Etiology-specific Management 284
21. Pediatric Tracheostomy..................................................................................................................................... 289
Bala Ramachandran
• History 289 • Indications 289 • Airway Obstruction 289 • Dead Space/Pulmonary Toilet 289
• Ventilation 289 • Types of Tracheostomy Tubes 290 • Specific Indications for a Tracheostomy 290
• Tracheostomy Tubes Available in India 290 • Choice of a Tube 291 • Technique 291 • Postoperative Care 292
• Routine Care 292 • Speech and Swallowing Assessment 294 • Parent Teaching and Home Care 294
• Decannulation 295 • Complications 295
22. Acute Severe Asthma Management in Pediatric Intensive Care Unit............................................................ 297
Ankur Ohri, Arun Kumar, Abhishek Gupta, Chandra Sekhar Singha, Praveen Khilnani
• Admission to the Pediatric Intensive Care Unit 297 • Preparation for Intubation 298
• Endotracheal Intubation 298 • Mechanical Ventilation 298 • Noninvasive Ventilation and Status Asthmaticus 301
23. Viral Pneumonias: Common Pneumonias and Recent Advances .................................................................. 304
Sibabratta Patnaik
• Influenza 304 • Parainfluenza Virus 305 • Respiratory Syncytial Virus 305 • Human Metapneumovirus 306
• Rhinovirus 306 • Adenovirus 306 • Measles Virus 306 • Cytomegalovirus 306 • Epstein–Barr Virus 306
• Varicella 306 • Bronchiolitis 307 • COVID-19 Pneumonia 308
24. Recurrent and Persistent Pneumonia .............................................................................................................. 312
Karthik Narayan R, Praveen Khilnani
• Epidemiology of Recurrent Pneumonias 312 • Mimics for Recurrent Pneumonia 312
• Radiology in Persistent/Recurrent Pneumonias 312 • Etiology of Recurrent or Persistent Pneumonia 312
• Approach to Recurrent/Persistent Pneumonia 313 • Investigative Approach 314
25. Advances in Rapid Diagnosis of Respiratory Tract Infection in Children ...................................................... 316
Chandra Sekhar Singha, Aparna Chakravarty
• Viral Infection 316 • Bacterial Infection 317
26. Human Immunodeficiency Virus Disease and Respiratory Infection in Children ........................................ 319
Praveen Khilnani
• Incidence of Childhood Human Immunodeficiency Virus Infection 319 • Diagnosis of HIV Infection in Infancy 320
• Causes and Management of Respiratory Infections 320 • Pulmonary Tuberculosis 322
• Other Causes of Respiratory Disease 323
27. Pediatric Acute Respiratory Distress Syndrome ............................................................................................. 327
Sajith Kesavan, Srinivas Rekapalli, Prabhat Maheshwari, Praveen Khilnani
• Causes of Acute Respiratory Distress Syndrome 327 • Pathophysiology 327
• Physiological Derangements in Acute Respiratory Distress Syndrome 328 • Incidence 329
• Clinical Course 329 • Diagnostic Evaluation 329 • Management of Acute Respiratory Distress Syndrome 329
28. Empyema Thoracis in Children ......................................................................................................................... 337
Pradeep Sharma, Bhaskar Saikia, Rachna Sharma, Prashant Jain, Zahid Hussain, Praveen Khilnani
• Pathophysiology 337 • Biomarkers and Diagnostic Biochemical Tests 337 • Imaging of Pleural Infection 338
• Bacterial Tests and Bacteriology of Pleural Fluid 338 • Management 339
• Indications for Pleural Cavity Drainage 340 • Treatment Failure and Complications 343
• Discharge and Follow-up 343
29. Air Leak Syndromes ........................................................................................................................................... 346
Utkarsh Kohli, Rakesh Lodha
• Pneumothorax 346 • Pulmonary Interstitial Emphysema 347 • Pneumomediastinum 348
• Pneumopericardium 348

Contentsxxviii
30. Cystic Fibrosis: Clinical Manifestations and Treatment .................................................................................. 351
Shushil Kabra, Madhulika Kabra, Rakesh Lodha
• Molecular Genetics of Cystic Fibrosis 351 • Clinical Manifestations 351 • Diagnosis 351
• Management 352 • Nutritional Management of Cystic Fibrosis 354
• Management of Other Gastrointestinal Manifestations of Cystic Fibrosis 356 • Emerging Therapies 356
• Prenatal Diagnosis 358 • Prognosis 358
31. Neonatal Congenital Lung Lesions .................................................................................................................. 360
Deepika Singhal, Meera Luthra, Praveen Khilnani
• Congenital Diaphragmatic Hernia 360 • Pulmonary Sequestration 361 • Congenital Lobar Emphysema 363
• Bronchogenic Cysts 365 • Congenital Cystic Adenomatoid Malformation 365
• Esophageal Atresia and Tracheoesophageal Fistula 367
32. Bronchodilator Therapy in Mechanically-ventilated Children ...................................................................... 372
Ankur Chawla, Rajesh Chawla, Praveen Khilnani
• Target Sites and Mechanism of Drug Delivery 372 • Jet Nebulizer 373 • Electric Vibrating Mesh Nebulizer 373
• Ultrasound Nebulizers 373 • Pressurized Metered-dose Inhaler 373
• Aerosol Delivery During Heated, Humidified, High-flow Nasal Cannula 374
• Aerosol Delivery During NIV, Using Single Limb and Dual Limb Circuits 375
• Delivering Aerosol During Mechanical Ventilation 376 • Aerosol Delivery Through a Tracheostomy 378
• Future of Aerosol Delivery and Recent Advances 378 • Limitations of Aerosol Therapy in Intensive Care Unit 379
33. Basics of Mechanical Ventilation ...................................................................................................................... 380
Praveen Khilnani, Mritunjay Pao, Deepika Singhal, Shekhar T Venkataraman
• Basic Mechanics of Ventilation 380 • Modes of Ventilation 382 • Initial Ventilator Settings 384
• Adjustments after Initiation 384
34. How to Choose a Ventilator .............................................................................................................................. 387
Praveen Khilnani, Kumar Ankur, Naresh Lal, Ramesh S
• Technical Specifications of a Ventilator 387 • Commonly Available Ventilators 389 • Technical Specifications 392
35. Disease-specific Mechanical Ventilation ......................................................................................................... 397
Praveen Khilnani, Bhaskar Saikia, Ankur Ohri
• Mechanical Ventilation Strategies 397
36. Advanced Mechanical Ventilation.................................................................................................................... 407
Ankur Chawla, Praveen Khilnani
• Advanced Modes and Modalities of Ventilation 407 • Principles of Gas Exchange 416
37. Ventilator Graphics and Clinical Applications................................................................................................. 427
Rachna Sharma, Praveen Khilnani
• Principle 427 • Advantages 427 • Disadvantages 427 • Scalars/Waveforms 427
• Identifying the Type of Breath 429 • Plateau Pressure 430 • Graphics in other Common Modes of Ventilation 431
• Loops 432 • Troubleshooting by Scalars and Loops 435 • Identify Signs of Asynchrony 436
38. Care of the Patient on Ventilator ...................................................................................................................... 442
VSV Prasad, Praveen Khilnani, Meera Ramakrishnan
• Major Issues and Factors in the Care of Ventilated Children 442 • Role of the Ventilator Circuit in Ventilator-associated
Pneumonia 445
39. Weaning from Ventilator................................................................................................................................... 447
Kumar Ankur, Sanjay wazir, Sankaran Krishnan, Praveen Khilnani
• Weaning Strategies: Neonate 447 • Protocolized Approach to Weaning a Neonate from Ventilator 449
40. Complications of Mechanical Ventilation ........................................................................................................ 453
Madhumati Otiv, Praveen Khilnani
• Ventilator-induced Lung Injury 453 • Vali versus Vili 454
• Complications Related to Cardiovascular Effects of Mechanical Ventilation 458
• Extrathoracic Complications 459 • Complications Related to Mechanical Equipment 459
• Miscellaneous Complications 459

Contents xxix
41. Noninvasive Ventilation .................................................................................................................................... 461
Rajiv Uttam, Shipra Gulati
• Pathophysiology and Mechanism of Action 461 • Advantages of Noninvasive Ventilation 461
• Noninvasive Ventilation Techniques and Equipment 461 • Applications of Noninvasive Ventilation 463
• Central Hypoventilation Syndrome 463 • Contraindications to Noninvasive Ventilation 463
• Signs of Effective Response to Noninvasive Ventilation 463 • Reasons to Discontinue Noninvasive Ventilation 463
• Acute Noninvasive Ventilation: Monitoring 463
42. High-frequency Ventilation in Neonates ......................................................................................................... 465
Kumar Ankur
• Principles of Gas Exchange 465
43. Inhaled Nitric Oxide........................................................................................................................................... 469
Saumen Meur, Monideepa Dutta, Reeta Singh, Praveen Khilnani
• History 469 • Nitric Oxide Biochemistry and Mechanism of Action 469
• Inhaled Nitric Oxide in Neonatal Hypoxemic Respiratory Failure 469
• Unresponsiveness to Inhaled Nitric Oxide Therapy in Persistent Pulmonary Hypertension of the Newborn 471
• Bronchopulmonary Dysplasia 471 • Inhaled Nitric Oxide in Pediatric Acute Respiratory Distress Syndrome 471
• Inhaled Nitric Oxide in Cardiology and Cardiac Surgery 471 • Miscellaneous Uses 472
• Nitric Oxide Delivery Systems 473
44. Mechanical Ventilation in a Neonate ............................................................................................................... 478
Kumar Ankur, Naveen Gupta, Anil Batra, Anjali Inamdar Kulkarni
• Initiation of Invasive Ventilation 478 • Intubation and Mechanical Ventilation 478
• Neonatal Patient-triggered Ventilation 478 • Signal Detection: Flow Sensor 479
• Selecting Mode of Endotracheal Ventilation 481 • Optimizing “Ventilatory Settings” 481
• Neonatal Ventilation Settings 481 • Permissive Hypercapnia 482 • Pulmonary Graphics 482
• Pressure–volume Loop 483 • Overdistension: Bird Beak Appearance 483 • Flow–volume Loop 483
45. Surfactant Therapy in Newborn ....................................................................................................................... 486
Vidya Gupta
• Surfactant Composition 486 • Surfactant Synthesis and Function 487 • Types of Surfactants 487
• Evidence for Surfactant 488 • Methods of Administration of Surfactant 488
• Surfactant Therapy in Meconium Aspiration Syndrome 490
46. Extracorporeal Membrane Oxygenation: Role in Neonates and Pediatrics ................................................. 492
Shubhadeep Das, Praveen Khilnani, Debasis Das, Pranay Oza, Suneel Pooboni
• Indications of ECMO 493 • Technique of ECMO 494 • Management of ECMO 494
• Patient Management 499 • Weaning ECMO Flows and Decannulation 500 • ECMO Management Summary 501
• Complications of ECMO 502 • Outcomes 502 • Setting up an ECMO Program 503
• Indian Scenario and Future of ECMO 504
47. Pediatric Heart and Lung Transplantation ...................................................................................................... 507
Shekhar T Venkataraman
• Heart Transplantation 507 • Lung and Heart–Lung Transplantation 510
• Physiology of the Transplanted Heart 510 • Physiology of the Transplanted Lung 511
• Chronic Rejection and Problems after Transplantation 516 • Problems Specific to Each Organ Transplant 517
• Psychosocial Issues before and after Transplantation 519
CIRCULATORY SYSTEM ISSUESSECTION 3
48. Shock: Management in Pediatric Intensive Care Unit .................................................................................... 525
Vasanth Kumar S, Gude Anupama, Suchitra Ranjit, Praveen Khilnani
• Pathophysiology 525 • Phases of Shock 525 • Types of Shock 526
• Assessment and Recognition of Shock 526 • Rapid Assessment of Shock 527 • Management of Shock 527
• Vasoactive Agents 528 • Role of Point-of-care Ultrasound 529 • Supportive Therapy in Shock 530 • Pitfalls 531
49. Inotropes and Vasopressors in Pediatric Intensive Care Unit ........................................................................ 532
Agni Sekhar Saha, Bichitrovanu Sarkar
• Physiological Considerations 532 • Pharmacology of Individual Agents 533
• Choice of Inotropes in Different Clinical Situations 535 • Newer Inotropes 541

Contentsxxx
50. Cardiogenic Shock ............................................................................................................................................ 546
Nameet Jerath
• Pathophysiology 546 • Symptoms 547 • Causes 547 • Investigations 547 • Management 547
• Cardiogenic Shock in a Newborn 549
51. Pediatric Septic Shock: 2020 Guidelines and Future Direction ..................................................................... 551
Yogesh Kumar Arya, Mullai Baalaaji, Kavitha Joseph, Vikram Gagneja, Praveen Khilnani, Leticia Castillo
• Pathogenesis 551 • Screening, Diagnosis, and Systematic Management of Sepsis 552
• Urgent Care (Airway, Breathing, and Circulation) 553 • Some Newer Concepts and Newer Therapies 558
52. Multiorgan Failure in Critically Ill Children ..................................................................................................... 566
Naresh Lal, Rachna Sharma, Praveen Khilnani, Rajiv Uttam
• Definition of Multiple Organ Dysfunction Syndrome 566 • Historical Perspective 566
• Epidemiology 567 • Assessment of Multiple Organ Dysfunction Syndrome Severity (Scoring Systems) 568
• Pathophysiology of Multiple Organ Dysfunction Syndrome 570
• Individual Organ Injury in Multiple Organ Dysfunction Syndrome 575
• Current Therapy: Multiorgan Support is the Key 577
• Promising Extracorporeal Therapies for Multiple Organ Dysfunction Syndrome 580
53. Dengue Virus Infection and Other Viral Hemorrhagic Fevers ....................................................................... 585
Shivkumar Shamarao, Archana M, Indumathy Santhanam, Thangavelu S
• Pathophysiology of Dengue Infection 585 • Clinical Manifestation 586
• Diagnostic Tests Available According to the Phase of Illness 587 • Management of Dengue Infection in Children 588
• Viral Hemorrhagic Fevers other than Dengue 594
PEDIATRIC CARDIAC INTENSIVE CARE ISSUESSECTION 4
54. Role of Echocardiography in Pediatric Intensive Care Unit ........................................................................... 601
Arvind Balaji, Jhuma Sankar, Praveen Khilnani
• Utility of Echocardiography in the Intensive Care Unit 601
55. Interventional Pediatric Cardiology: An Overview ......................................................................................... 609
Thomas Albrecht G, Praveen Khilnani
• Vascular Angioplasties 609 • Dilation of Valvular Lesions 610
• Closure of Extracardiac and Intracardiac Communications 611 • Procedures 612 • Complications 613
56. Myocarditis in Children ..................................................................................................................................... 615
Vinay Joshi, Preetha Joshi
• Incidence 615 • Etiology 615 • Pathogenesis 616 • Clinical Presentation 616
• Natural History of Myocarditis 616 • Diagnosis 616 • Management 617 • Prognosis 619
57. Cardiac Arrhythmias in Pediatric Intensive Care Unit .................................................................................... 621
Vinay Kukreti, Mosharraf Shamim, Praveen Khilnani
• Approach to Arrhythmia in PICU 621 • Classification of Arrhythmias 621
58. Hypertension and Hypertensive Emergencies in Children ............................................................................ 628
Lalitha AV, Yashaswini K, Prashant Pruthi, Prasanna C Tellis, Praveen Khilnani
• Blood Pressure Measurement 628 • Etiology 628 • Clinical Presentation 628 • Physical Examination 629
• Investigations 630 • Management 630 • Posterior Reversible Encephalopathy Syndrome 633
59. Common Congenital Heart Defects and Perioperative Issues ....................................................................... 634
Jesal Sheth, Praveen Khilnani
• Ventricular Septal Defect 634 • Atrial Septal Defect 635 • Patent Ductus Arteriosus 636
• Aortic Stenosis 636 • Some Common Issues in Preoperative Care 637
60. Postoperative Care of Cardiac Patients after Open Heart Surgery ............................................................... 639
Ravi R Thiagarajan
• Postoperative Care of Children Undergoing Congenital Surgery 639
61. Perioperative Management of Transposition of Great Arteries .................................................................... 644
Ajay Kumar Gupta, Vishal K Singh, Rajesh Sharma, Amit Varma
• Incidence and Epidemiology 644 • Definition and Anatomic Features 644 • Pathophysiology 645
• Clinical Manifestations 645 • Diagnosis 645 • Management 645
• Postoperative Critical Care Management 647

Contents xxxi
62. Perioperative Management of Total Anomalous Pulmonary Venous Drainage........................................... 653
Vishal K Singh, Rajesh Sharma, Amit Varma
• Types of Total Anomalous Pulmonary Venous Drainage 653 • Presentation 654
• Guidelines to Postoperative Management 658 • Management of Pulmonary Hypertensive Crisis 659
63. Perioperative Management Strategy of Univentricular Heart ...................................................................... 662
Vishal K Singh, Amit Varma, Rajesh Sharma
• Obstruction to Systemic Outflow 662 • Obstruction to Pulmonary Outflow 662
• Obstruction to Systemic and Pulmonary Venous Return or Ventricular Inflows 663 • Clinical Features 663
• Diagnostic Evaluation 663 • Management 664 • Preoperative Stabilization and Postoperative Management 666
• Complications and Natural History of Fontan Circulation 668
64. Cardiac Pacing in Pediatric Intensive Care Unit .............................................................................................. 672
Neeraj Gupta, Anil Sachdev, Dhiren Gupta
• Normal Cardiac Electrical Activity 672 • Normal Echocardiography 672 • Types of Cardiac Pacing 672
65. Pediatric Mechanical Circulatory Support....................................................................................................... 678
Michael A Maymi, Dipankar Gupta, Wendy E Barnes
• Indications 678 • Contraindications 678 • Complications 679
• Short-term Mechanical Circulatory Support 679 • Long-term Mechanical Circulatory Support: Berlin Heart 680
66. Heart Transplantation in Children.................................................................................................................... 684
Dipankar Gupta, Frederick Jay Fricker, Mark S Bleiweis, Jai P Udassi, Praveen Khilnani
• Indications for Heart Transplantation 684 • Organ Allocation and Matching 687
• Donor Management 687 • Evaluation and Management of the Patient Awaiting Heart Transplantation 688
• Postoperative Management 690 • Follow-up 692 • Survival 692
• Long-term Complications 692 • Neurodevelopmental Outcomes and Functional Status 697
67. Pediatric Pacemaker and Implantable Cardioverter-defibrillator Therapy .................................................. 701
Frank Zimmerman, Madelyn Kahana, Praveen Khilnani
• Indications 701 • Pacemaker Basics 702 • Common Pacing Scenarios in the Pediatric Intensive Care Unit 706
• Implantable Cardioverter-defibrillator 707
METABOLIC AND ENDOCRINE ISSUESSECTION 5
68. Genetic Disorders and Inborn Errors of Metabolism ...................................................................................... 713
Seema Thakur, Vinay K Aggarwal, Kanika Singh, Nitesh Singhal, Verma IC
• Pathophysiology 713 • Laboratory Investigations 714
• Diagnosis of Inborn Errors of Metabolism in Genomic Era 715 • Treatment 715
69. Diabetic Ketoacidosis ........................................................................................................................................ 718
Asrar Rashid, Sanjay Perkar, Praveen Khilnani, Sarah Ehtisham, Sukhmeet Singh
• Diabetic Ketoacidosis 718
70. Endocrine Emergencies in Critically Ill Children ............................................................................................. 726
Indira Jayakumar
• Hyperglycemia 726 • Hypoglycemia 726 • Adrenal Insufficiency 727
• Adrenocorticotropic Hormone Stimulation 728 • Nonthyroidal Illness Syndrome (Sick Euthyroid Syndrome) 728
• Thyrotoxic Crisis 730 • Pheochromocytoma (Hypercatecholamine Crisis) 730
• Hypocalcemia (Levels <1.8 Mmol/L or 7.5 mg/dL) 731
• Hypocalcemia in Critical Illness (1 Mmol/L of Calcium = 4 mg/dL) 731
• Hypercalcemia (Levels >3 Mmol/L Or 12 mg/dL) 732 • Salt/Water Syndromes 732 • Diabetes Insipidus 733
FLUIDS, ELECTROLYTES, AND RENAL ISSUESSECTION 6
71. Fluid and Electrolyte Abnormalities in the Critically Ill Children .................................................................. 737
Preetha Joshi, Vinay Joshi
• Body Water Distribution in Children 737 • Understanding “Fluid” Concepts 738
• Crystalloids versus Colloids in Critically Ill Children 740 • Electrolyte Disorders 740

Contentsxxxii
72. Acute Kidney Injury in Children and Renal Replacement Therapy ................................................................ 746
Kanav Anand, Pruthi PK
• Incidence 746 • Criteria for Defining Acute Kidney Injury 746 • Etiology 747
• Assessment and Investigations 747 • Management 749 • Treatment of the Underlying Disease 750
• Peritoneal Dialysis 751 • Intermittent Hemodialysis 753 • Outcome 754
• Follow-up of Acute Kidney Injury 755 • Prevention 755
73. Pediatric Renal Transplantation ....................................................................................................................... 756
Kanav Anand, Pruthi PK
• Immediate Preoperative Period 756 • Surgery 756 • Postoperative Period 757
• Complications 758 • Immunosuppression 759 • Monitoring 759 • Other Medications 760 • Survival 760
GASTROINTESTINAL, HEPATIC, AND NUTRITIONAL ISSUESSECTION 7
74. Gastrointestinal Bleeding: Diagnosis and Management ............................................................................... 763
Mridul Chandra Das, Arti Pawaria, Ted A Williams, Praveen Khilnani
• Assessment of the Severity of Bleeding 763 • Establishing the Origin of Gastrointestinal Bleed 763
• Clinical Presentation 763 • Specific Causes of Gastrointestinal Bleeding 764
• Upper Gastrointestinal Bleed 764 • Lower Gastrointestinal Bleed 765 • Obscure Gastrointestinal Bleed 766
• Management 767
75. Acute Liver Failure ............................................................................................................................................. 772
Nameet Jerath, Anita S Bakshi
• Etiology 772 • Pathogenesis 773 • Management 773 • Management of Hepatic Encephalopathy 775
76. Liver Transplantation ........................................................................................................................................ 777
John M Downey, Madelyn Kahana, Praveen Khilnani
• Indications 777 • Preoperative Evaluation 778 • Orthotopic Liver Transplant 778
• Extrahepatic Complications 782
77. Liver Transplantation in Children: Indian Scenario ........................................................................................ 785
Smita Malhotra, Nameet Jerath, Anupam Sibal, Vidyut Bhatia, Akshay Kapoor
• Indications 785 • Assessment 787 • Preparation for Liver Transplantation 787
• Critical Care Issues in Postliver Transplantation Management 788 • Indian Scenario 790
78. Nutrition in Pediatric Intensive Care Unit........................................................................................................ 792
Nidhi Rawal, Reeta Singh, Praveen Khilnani
• Pathophysiology of Malnutrition in Critically Ill Children 792 • Modes of Nutritional Repletion 793
• Determination of Nutritional Needs in Pediatric Intensive Care Unit 793 • Nutritional Support 794
• Nutrition in Special Circumstances 795 • Nutritional Supplements 796
79. Parenteral Nutrition for Critically Ill Child ....................................................................................................... 799
Rachel Leung, Pankaj Vohra
• Contents of Parenteral Nutrition 799 • What to do before Starting Parenteral Nutrition? 799
• Contraindications to Parenteral Nutrition 800 • Caloric Needs of a Child 800 • How to Get Started? 800
• How to Administer the Parenteral Nutrition? 800 • What to Monitor when a Child is on Parenteral Nutrition? 801
• At what Rate can Protein and Lipids be Increased? 801 • When to Consider Decreasing Parenteral Nutrition? 801
• Complications of Parenteral Nutrition 802
HEMATOLOGY, IMMUNOLOGY, AND ONCOLOGY ISSUESSECTION 8
80. Blood Transfusion in Neonatal and Pediatric Intensive Care ......................................................................... 809
Abhishek Gupta, Makroo RN, Praveen Khilnani
• Good Practice Recommendations 809 • Physiological Principles 810 • Anemia in Intensive Care Unit 811
• Leukocyte Reduction of Blood Components 819
Appendix
• Massive Transfusion Protocol 822

Contents xxxiii
81. Disseminated Intravascular Coagulation ........................................................................................................ 826
Mehak Bansal, Rajesh Mehta, Prashant Pruthi
• Pathophysiology of Disseminated Intravascular Coagulation 826
• Etiology of Disseminated Intravascular Coagulation 827 • Clinical Features 828
• Diagnosis 828 • Treatment 830 • Prognosis 831
82. Immunotherapy in Critically Ill Children ......................................................................................................... 833
Gunjan Baweja, Sunil Gomber
• Cytokines and Chemokines 833 • Extracorporeal Therapies 836 • Neutropenic Patient 836
• Transplant Patient 836 • Immunonutrition 836 • Immunomodulation in Coronavirus Disease-19 836
83. Malaria................................................................................................................................................................ 838
Santosh T Soans, Mallikarjun RP
• Life Cycle 839 • Clinical Disease and Epidemiology 839 • Diagnosis 840
• Definition of Uncomplicated Malaria 840 • Severe Plasmodium falciparum Malaria 840
• Mixed Malaria Infections 843 • Severe Malarial Anemia 843 • Cerebral Malaria 843
84. Immunocompromised Child in Pediatric Intensive Care Unit ........................................................................ 845
Amieleena Chhabra, Priyanka Sharma, Mukesh Desai, Amita Mahajan
• Balance of Inflammation and Anti-inflammation 845 • Primary Immunodeficiencies 845
• Secondary Immunodeficiencies 846 • Immunology in Sepsis 847 • Immunodeficiency in Critical Care Setting 847
• Infectious Complications in the Immunocompromised Child 849 • Immunoglobulin 851
• Care in the Pediatric Intensive Care Unit 851
85. Pediatric Human Immunodeficiency Virus Infections .................................................................................... 853
Deepika Singhal, Shiv Kumar Rajdev, Praveen Khilnani
• Identification of Perinatal Human Immunodeficiency Virus Exposure 853
• Diagnosis of Human Immunodeficiency Virus Infection in Infants 853
• Monitoring Pediatric Human Immunodeficiency Virus Infection 855
• Opportunistic Infections and other Clinical Manifestations of HIV Disease in Children 855
• Currently Available Antiretroviral Agents 857 • General Features of Antiretroviral Agents 858
• HIV Counseling 858 • Prognosis 859 • Protease Inhibitors 867 • Fusion Inhibitors 873
86. Bone Marrow Transplantation in Children ...................................................................................................... 874
Gaurav Kharya, Sanjeev Sharma, Rachna Sharma, Praveen Khilnani
• Autologous Hematopoietic Stem Cell Transplantation 874 • Allogeneic Hematopoietic Stem Cell Transplantation 874
• Histocompatibility 874 • Indications of Hematopoietic Stem Cell Transplantation 876
• Prognosis and Outcomes 879 • Complications in Hematopoietic Stem Cell Transplantation 879
• Indian Scenario 882
INFECTION MANAGEMENT ISSUESSECTION 9
87. Antibiotic Therapy in Pediatric Intensive Care Unit ........................................................................................ 887
Chandra Sekhar Singha, Praveen Khilnani, Aparna Chakravarty
• Infections and Empirical Therapy 887 • Criteria for Selection of Antibiotics 888 • History and Clinical Setting 888
• Pharmacology 888 • Pharmacokinetics and Pharmacodynamics 888
• Strategy in Case of Clinical Deterioration 889 • Empirical Initial Antimicrobial Therapy in the Pediatric Intensive Care
Unit 889 • Empirical Antibiotic Therapy in Renal Failure 891 • Carbapenem 892 • Linezolid 894
• Teicoplanin 896 • Tigecycline 897 • Colistin 897
• Empirical Use of Antifungal Agents in Severe Sepsis or Septic Shock 897
88. Nosocomial Infections and Management........................................................................................................ 901
Ebor Jacob, Kala Ebnezar
• Infection Control 901 • Surveillance 905 • Infection Rates/1,000 Patient Days 905
• Device-associated Infection Rates Reported/1,000 Device Days 905 • Risk Index 905
• Bloodstream Infections 905 • Ventilator-associated Pneumonia 906 • Urinary Tract Infections 908
• Organization of Infection Control Program 908

Contentsxxxiv
TRAUMA AND PEDIATRIC SURGICAL ISSUESSECTION 10
89. Management of Pediatric Trauma .................................................................................................................... 913
Aparna Pande, Kapil Dev Soni, Jashua Caresky, Meera Luthra, Chhabi Ranu Gupta, Praveen Khilnani
• Variations in Pediatric Anatomy 913 • Variations in Pediatric Physiology 914
• Classification of Pediatric Trauma 914 • Management of the Injured Child 916
• Pediatric Intensive Care Unit Management Protocol 920
• Pediatric Intensive Care Unit Monitoring of a Trauma Patient 922
90. Child Abuse and Shake Injuries ........................................................................................................................ 925
Praveen Khilnani
• Definition and Etiology 925 • Diagnosis 925 • Examination 925 • Shake Injuries 926
• Treatment 927 • Laboratory and Diagnostic Imaging Studies 928 • Management 929
• Legal Implications 929
91. Perioperative Anesthetic and Surgical Issues ................................................................................................. 930
Col Rakhee Goyal, Shandip Sinha, Ramesh S, Meera Luthra, Praveen Khilnani
• Preoperative 930 • Intraoperative Period 931 • Postoperative Period 932
ENVIRONMENTAL AND TOXICOLOGY ISSUESSECTION 11
92. Poisoning and Bites ........................................................................................................................................... 937
Pradeep Sharma, Praveen Khilnani, Suchita Khadse
• Evaluation of Children with Suspected Toxin Ingestion 937 • Management 938 • Envenomation 941
• Scorpion Sting 947
93. Thermal Burns and Inhalation Injury ............................................................................................................... 954
Sidra Ishaq, Qalab Abbaas, Seth RK, Praveen Khilnani
• Pathophysiology of Burn Wounds in Pediatric Patients 954 • Types and Extent of Injury 955
• Classification and Diagnosis 955 • Management 957 • Morbidity 960 • Rehabilitation of Burn Patients 961
94. Heat Disorders ................................................................................................................................................... 962
Purnima Dhar
• Thermoregulation 962 • Environmental Hyperthermia 963 • Minor Heat Illnesses 963
• Heat Stroke 963 • Malignant Hyperthermia 964 • Sudden Unexpected Cardiac Arrest in Children 965
95. Electrical Shock .................................................................................................................................................. 967
Soonu Udani
• Mechanism of Electrical Injury 967
96. Near-drowning .................................................................................................................................................. 969
Bala Ramachandran
• Definition 969 • Epidemiology 969 • Pathophysiology 969 • Hypothermia and the Diving Reflex 970
• Assessment and Management 971 • Hypothermia 972 • Outcome 974 • Prognosis 974
NEUROLOGICAL ISSUESSECTION 12
97. Coma: Encephalitis and Cerebral Malaria ........................................................................................................ 979
Suresh Kumar Angurana, Arun Bansal, Praveen Khilnani, Krishan Chugh, Dhiren Gupta
• Definitions 979 • Etiology 979 • Pathophysiology 980 • Evaluation of a Child in Coma 980
• Laboratory Evaluation 982 • Treatment 983 • Prognosis 984
• Management of Some Common Specific Causes 985
98. Bacterial, Viral, Fungal, and Tubercular Meningitis ........................................................................................ 988
Suresh Kumar Angurana, Renu Suthar, Arun Bansal, Jose Irazzuzta, Deepika Singhal, Praveen Khilnani
• Bacterial Meningitis 988 • Fungal Meningitis 993 • Herpes Simplex Encephalitis 994
• Tubercular Meningitis 996

Contents xxxv
99. Hydrocephalus ................................................................................................................................................... 999
Praveen Khilnani, Sandeep Chopra, Manish Vaish
• Cerebrospinal Fluid Production and Physiology 999 • Cerebrospinal Fluid Hydrodynamics 999
• Hydrocephalus 999 • Options for CSF Drainage Procedure 1001
100. Status Epilepticus in Children......................................................................................................................... 1003
Mehak Bansal, Kamal Preet, Gurpreet Kochar, Gnanam R, Mritunjay Pao, Praveen Khilnani
• Definition 1003 • Types 1003 • Systemic Manifestations 1004 • Management 1004
• Pharmacological Intervention 1005 • Prognosis 1008
101. Pediatric Head Injury....................................................................................................................................... 1009
Bhaskar Saikia, Sandeep Chopra, Praveen Khilnani
• Monro-Kellie Doctrine 1009 • Pathogenesis of Brain Injury 1009
• Clinical Evaluation and Management in Emergency 1010 • Intracranial Hematoma 1011
• Diffuse Brain Injury 1012 • Neurosurgical Management 1012 • Nonsurgical Management 1012
• Complications and Sequelae of Head Injury 1015 • Revised Recommendations 1017
102. Pediatric Brain Death Guidelines ................................................................................................................... 1020
Bala Ramachandran
• Definition 1020 • Clinical Examination 1020 • Demonstration of Apnea 1021 • Ancillary Tests 1022
• Tests to Assess Intracranial Blood Flow 1022 • Time Course of Tests for Brain Death 1022
• Pediatric Brain Death Guidelines Group 2011 1022
103. Sedation, Analgesia, and Neuromuscular Blockade..................................................................................... 1024
Romit Saxena, Muthiah Periyakaruppam, Jyotinder Kaur, Praveen Khilnani
• Basics and Definitions 1024 • Sedation 1024 • How to Monitor Sedation 1029
• What to Sedate with Individual Sedatives Used in Pediatric Practice? 1032 • Analgesia 1039
• What to Provide Pain Relief with? 1040 • Analgesia in Special Situations 1043
• Iatrogenic Withdrawal Syndrome 1045 • Muscle Relaxants 1047 • Individual Muscle Relaxants 1048
Appendix 1
• Alternative Routes for Administration of Sedoanalgesia: Rectal Medications for Sedoanalgesia 1060
Appendix 2
• Intranasal Medications for Sedoanalgesia 1060
104. Intensive Care Unit-acquired Weakness ........................................................................................................ 1063
Vinay Kukreti, Mosharraf Shamim, Praveen Khilnani
• Incidence 1063 • Risk Factors 1063 • Clinical Features 1064 • Pathogenesis 1064 • Diagnosis 1066
• Electrophysiological and Histological Features 1066 • Differential Diagnosis 1066 • Management 1067
• Prognosis 1067
END-OF-LIFE, ETHICAL, AND MEDICOLEGAL ISSUESSECTION 13
105. Care of Terminally Ill Children ........................................................................................................................ 1073
Praveen Khilnani
• Common Sources of Stress for Parents of a Hospitalized Child 1073
• Factors Relating to a Sick Child Admitted to PICU 1073 • A Child’s Reaction to Illness and Hospitalization 1074
• Stress in PICU Team Members 1074
• Issues Related to a Critically Ill Child Dying (Or Likely to Die) in PICU and End-of-life Care 1074
• End-stage Palliative Care 1076 • Bereavement and Grief 1076 • Interventions 1078
106. Psychosocial Issues in Pediatric Intensive Care Unit .................................................................................... 1082
Pooja Verma, Praveen Khilnani
• Child’s Reaction to Hospitalization 1082 • Effects of Hospitalization on the Family of the Child 1083
• Sources of Stress in a Hospital Setting 1084
• Role of Nurse in Helping Child and Family in Coping with Stress of Hospitalization and Illness 1085
107. Ethical Issues Related to End-of-life ............................................................................................................... 1086
Mani RK, Praveen Khilnani
• Definitions of Categories 1086 • Standards of Practice 1086 • Quality of Care 1087
• Cost Reduction 1087 • Ethical and Legal Issues Related to Life-support Limitation 1088 • Autonomy 1088

Contentsxxxvi
• Concept of Futility 1088 • Legal Aspects of Palliative Care 1088 • Physician-assisted Suicide and Euthanasia 1089
• Drawbacks in the Current Strategies 1089 • Indian Scenario 1089
108. Medicolegal Issues in Intensive Care ............................................................................................................. 1092
Uttara Babbar, Sidharth Luthra
• Medical Negligence 1092 • Balancing of Risks 1092 • Criminal Negligence 1092
• Consumer Protection Act and the Medical Profession 1094
PEDIATRIC INTENSIVE CARE UNIT TRAINING,
RESEARCH, AND QUALITY ISSUES
SECTION 14
109. Training in Pediatric Critical Care Medicine .................................................................................................. 1099
Utpal Bhalala, Praveen Khilnani
• Components of Training 1099 • Clinical Skills Acquired in PICU 1099
• Legal Aspects of Pediatric Critical Care 1099 • Death Certification 1099 • Planning Clinical Research 1100
• Leadership 1100 • Develop Treatment Protocols 1100
Appendix
• Skills 1100 • Syllabus 1100
110. Simulation-based Training in Pediatric Intensive Care ................................................................................ 1102
Rakshay Shetty, Sujatha Thyagarajan, Praveen Khilnani
• Simulation-based Training or Learning 1102 • Procedure to Apply Simulation in Pediatric Intensive Care Unit 1104
111. Basics of Clinical Research and Statistics in Pediatric Critical Care ............................................................. 1107
Sasidharan Kandasamy, Suresh Kumar Angurana, Renu Suthar, Praveen Khilnani
• Evidence-based Medicine 1107 • Statistics 1107 • Types of Studies 1107 • Population and Sample 1108
• Summarizing the Results 1108 • Common Statistical Tests 1110 • Publishing in Critical Care Literature 1111
• Evaluation of Research or Scientific Paper 1112 • How to Get Published: Some Helpful Hints 1112
112. Concept of Quality and Safety in Pediatric Intensive Care Unit................................................................... 1114
Vinayak K Patki
• Quality in Critical Care: An Overview 1114
DRUG INDEX, USEFUL EQUATIONS AND FORMULAE
FOR PEDIATRIC INTENSIVE CARE UNIT
SECTION 15
113. Drugs Used in Pediatric Intensive Care Unit .................................................................................................. 1129
Sagar Lad, Suman Bisht, Vinayak K Patki, Praveen Khilnani
• Commonly Used Drugs 1129 • Antibiotics 1129 • Antimalarials 1131 • Antiviral Agents 1131
• Cardiovascular 1134 • Central Nervous System 1137 • Intubation 1140 • Gastrointestinal 1141
• Respiratory 1141 • Miscellaneous 1142
Appendix
• Useful Information and Equations in the Pediatric Intensive Care Unit 1147
Index .......................................................................................................................................................................................................................1149