8th Edition of PICU Protocols of AIIMS-2022
Contents
“Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedure, equipment, and the use of drugs become necessary. The authors, editors, contributors, and publishers have, as far as possible taken care to ensure that the information given in this text is accurate and up to date. However, readers are strongly advised to confirm that the information, especially with regard to drugs, doses/usage, complies with current legislation and standards of practice. Please consult full prescribing information before issuing a prescription for any product mentioned in this publication.”
One of the most remarkable advances in the care of children in India has been the introduction of intensive care. Emergency rooms existed in all pediatric units where immediate care was provided to sick infants and children. However, it was realized that full-time in-ICU staffing and patient care will result in improved outcomes for critically ill pediatric patients. The first unit to be set up in this frontier area in India was at the All India Institute of Medical Sciences in Delhi in the 1980s. Initially, the pediatric staff had to learn intubation from the anesthesiologists, but the practice soon made them even more skillful in resuscitation procedures than their mentors. A review of the functioning of this intensive care unit a few months later effectively demonstrated that many more lives were saved which would otherwise have been lost.
Experts abroad have argued that countries with under-5 mortality rates above 40 or so should spend more money on primary care to reduce infant and child mortality rather than establish intensive care units which admittedly are costly. I have always believed this argument to be fallacious, simply because every child who is ill deserves the best care that can be provided according to the local resources. Moreover, in the cities in India, the infant mortality and under-5 mortality rates are sufficiently low that it is desirable to establish intensive care units.
It is well recognized that a protocol-based approach is of great help in improving the care of an acutely ill child. We at the Indian Journal of Pediatrics felt that it would be advantageous to present the protocols that had evolved through years of experience and research at the AIIMS. Professor Kabra and his colleagues have succeeded admirably in putting together the protocols used in Indian pediatric intensive care units. These have been designed to be used both as a source of readily accessible information and as a concise yet comprehensive summary of current knowledge and practice in intensive care. It is hoped that they will assist clinicians in their daily practice. The editors have made every effort to ensure that the protocols are clinically focused and evidence-based. We deeply appreciate their extraordinary efforts, their dedication, and their commitment to excellence. It is hoped that the readers would find these protocols useful. We would appreciate feedback from them so that future editions can be improved upon.
Protocol Based Treatment in Pediatric Intensive Care Units
Rakesh Lodha and S.K. Kabra 1–3
Comatose Child: A Practical Approach
Shruthi N.M., Rahul Sinha and Sheffali Gulati 4–27
Approach to Convulsive Status Epilepticus in Children
Priyanka Madaan, Juhi Gupta and Sheffali Gulati 28–51
Management of Raised Intracranial Pressure
Vishal Sondhi and Sheffali Gulati 52–75
Arrhythmias in Children
Kana Ram Jat, Rakesh Lodha and S.K. Kabra 76–89
Myocarditis
Krishna Mohan Gulla, S.K. Kabra and Rakesh Lodha 90–99
Management of Acute Heart Failure
Krishna Mohan Gulla, S.K. Kabra and Rakesh Lodha 100–112
Cardiopulmonary Resuscitation
Kana Ram Jat, Rakesh Lodha and S.K. Kabra 113–120
Management of Acute Severe Asthma in Children
Arpita Chattopadhyay, Rakesh Lodha and S.K. Kabra 121–140
Management of Acute Respiratory Distress Syndrome
Arpita Chattopadhyay, S.K. Kabra and Rakesh Lodha 141–167
Diagnosis and Management of Upper Gastrointestinal Bleeding in Children
Rohan Malik 168–186
Intensive Care Management of Pediatric Acute Liver Failure
Rohan Malik 187–213
Hypertensive Emergencies in Children
Pankaj Hari and Aditi Sinha 214–229
Management of Acute Kidney Injury
Menka Yadav and Arvind Bagga 230–250
Management of Common Oncologic Emergencies
Rachna Seth and Prasanth Srinivasan 251–277
Hematological Emergencies in PICU
Samriti Gupta, Jhuma Sankar and Rakesh Lodha 278–299
Shock in Children
Jhuma Sankar and Rakesh Lodha 300–322
Management of Septic Shock
Jhuma Sankar, S.K. Kabra and Rakesh Lodha 323–349
Severe Dengue Infection and Management
Vijaya Kumar, Rakesh Lodha and S.K. Kabra 350–371
Severe Malaria
Samriti Gupta, Rakesh Lodha and S.K. Kabra 372–391
Invasive Fungal Infection in Critically Ill Children
Jagat Jeevan Ghimire and Kana Ram Jat 392–406
Management of Diabetic Ketoacidosis
Meenakshi Bothra Gupta and Vandana Jain 407–428
Other Endocrine Emergencies
Rajni Sharma and Smriti Rohatgi 429–449
Hyperferritinemia in the PICU
Mohsin Raj Mantoo and Jhuma Sankar 450–461
Acute Management of Sick Infants with Suspected Inborn Errors of Metabolism
Neerja Gupta and Madhulika Kabra 462–476
Approach to Poisoning in a Child
Ramesh P. Menon 477–499
Management of Snake Bite
Jhuma Sankar 500–512
Scorpion Envenomation
Jhuma Sankar, Rakesh Lodha and S.K. Kabra 513–529
Supportive Care of a Critically Ill Child
Nitin Dhochak, Rakesh Lodha and S.K. Kabra 530–544
Sedation, Analgesia and Paralysis in Children in Critical Care Unit
Krishna Mohan Gulla and Rakesh Lodha 545–555
Nutrition in Critically Ill Children
Vijaya Kumar and Rakesh Lodha 556–579
Therapeutics in Critically Ill Children
Nitin Dhochak and Rakesh Lodha 580–600
Transfusion of Blood and Components in Critically Ill Children
Banothu Kiran Kumar, Rakesh Lodha and S.K. Kabra 601–613
Ultrasonography and Echocardiography in Critically Ill Children
Arpita Chattopadhyay, Jagat Jeevan Ghimire and 614–652
Rakesh Lodha
Arterial Blood Gas Analysis and Interpretation
Samriti Gupta, S.K. Kabra and Rakesh Lodha 653–669
Acid-Base Disorders
Samriti Gupta, S.K. Kabra and Rakesh Lodha 670–682
Fluid and Electrolyte Disturbances
Krishna Mohan Gulla and Rakesh Lodha 683–709
Mechanical Ventilation
Nitin Dhochak, S.K. Kabra and Rakesh Lodha 710–757
High Frequency Ventilation
Arpita Chattopadhyay and Rakesh Lodha 758–781
Non-Invasive Ventilation for Acute Respiratory Failure in Children
Krishna Mohan Gulla, S.K. Kabra and Rakesh Lodha 782–792
Home Respiratory Support
Arvind Kumar and Rakesh Lodha 793–811
Health Care Associated Infections in Pediatric Intensive Care Unit
Jhuma Sankar and Rakesh Lodha 812–850
Ventilator-Associated Pneumonia
Jhuma Sankar and Rakesh Lodha 851–864
Care of a Cardiac Baby
Ramesh P. Menon, Sandeep Chauhan and Ratnesh Kumar 865–895
Communicating with Families of Critically Ill Children
Lesa Dawman, Anju Unnikrishnan and Rakesh Lodha 896–905
Follow-up Care of Pediatric Intensive Care Unit Survivors
Arpita Chattopadhyay 906–917
Severe COVID-19 and Multisystem Inflammatory Syndrome in Children
Hardeep Kaur, Rakesh Lodha and S.K. Kabra 918–932
Subject Index 933–936
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