Management of postoperative cardiovascular, pulmonary and renal functions is discussed in addition to management of hemostasis, bleeding, blood coagulation, and other organ systems which influence the immediate outcome of a surgical procedure.
Patients who undergo complex congenital cardiac procedures and or patients whose stay in the intensive care unit is prolonged due to critical illness, disciplines such as prolonged ventilatory support, infection, wound management, nutrition, fluid and electrolyte balance, altered endocrine function assume importance for adequate patient management and these systems are dealt comprehensively, discussing basic sciences and clinical issues relevant in management of the patient.
This manual has also dealt with issues of poor postoperative ventricular function and principles of mechanical ventricular support systems that are designed to improve patient outcomes after complex cardiac procedures. A brief postoperative management of heart and heart-lung transplant recipients with peri-operative immunosupression is also discussed.
Algorithms are provided for appropriate management of cardiac emergencies, together with instructions and or calculations provided for mixing of inotropic drug solutions in emergencies. These would enable physicians and nurse practitioners to deliver expeditious care in such situations. Drug formulary provided here has dealt with several drugs that are commonly used in the intensive care. Several other drugs, including inotropes, antimicrobials, and cardiac drugs which are often used in the perioperative care of infants, and children are discussed comprehensively.
| The Full Book PDF |
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| Front Matter |
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| Chapter 1 Transport and Stabilization in ICU |
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1.1 Patient Transport
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1.2 Patient Stabilization
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| Chapter 2 Fluid, Electrolytes, and Acid-Base Balance |
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A. Guidelines for Fluid and Electrolyte Therapy
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2.1 Maintenance Fluids
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2.2 Specific Fluid and Electrolyte Orders
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B. Diagnosis of Common Electrolyte Disorders and Management
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2.3 Sodium Abnormalities
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2.4 Potassium Homeostasis and Serum Potassium Abnormalities
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2.5 Calcium Homeostasis and Calcium Abnormalities
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2.6 Phosphate Homeostasis and Phosphate Abnormalities
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2.7 Magnesium Abnormalities and Magnesium Homeostasis
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C. Acid Base Disorders and Management
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2.8 Physiology of Normal Acid-Base Balance
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2.9 Metabolic Alkalosis (MAk)
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2.10 Respiratory Acidosis (RA)
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2.11 Metabolic Acidosis (MA)
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2.12 Respiratory Alkalosis (RAK)
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| Chapter 3 Hemostasis and Blood Component Therapy |
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A. Bleeding and Hemostasis
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3.1 Postoperative Monitoring of Hemostasis and Chest Tube Drainage
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3.2 Assessment of Moderate to Significant Postoperative Bleeding
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3.3 Blood Coagulation
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3.4 Tests of Coagulation
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3.5 Interpretation of Coagulation Tests and Diagnosis of Bleeding Disorder
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3.6 Cardiopulmonary Bypass (CPB) Hemorrhage
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3.7 Von Willebrand’s Disease and Hemorrhage
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3.8 Disseminated Intravascular Coagulation (DIC)
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B. Blood Component Therapy
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3.9 Blood Components
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3.10 Complications of Blood Component Therapy
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| Chapter 4 Cardiovascular Monitoring and Therapy |
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4.1 Immediate Postoperative Care and Monitoring
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4.2 Postoperative Cardiac Output and Cardiovascular Function
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4.3 Low Cardiac Output, Determinants, and Treatment
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4.4 Right Ventricular (RV) Dysfunction and Inhaled Nitric Oxide (NO)
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4.5 Heart Rate, Rhythm, and Conduction Disturbances
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| Chapter 5 Respiratory Management and Ventilators |
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5.1 Initial Ventilator Orders
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5.2 Controls in Mechanical (Positive Pressure) Ventilation
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5.3 Cardiovascular Effects of Mechanical Ventilation (MV)
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5.4 Evaluation of Gas Exchange
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5.5 Management of Acute Respiratory Decompensation and Evaluation of Hypoxia / Hypercarbia
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5.6 Principles of Use of Conventional Ventilators and Settings
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5.7 High Frequency Jet Ventilation (HFJV)
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5.8 Weanining from Conventional Mechanical Ventilation (MV)
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5.9 Chest Physiotherapy (CP), Re-intubation, and Oxygen Delivery
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| Chapter 6 Renal Function and Renal Failure |
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6.1 Clinical Assessment of Renal Function
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6.2 Differential Diagnosis of Oliguria
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6.3 Management of Acute (Parenchymal) Renal Failure (ARF)
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6.4 Acute Renal Failure and Renal Replacement Therapy (RRT)
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| Chapter 7 Neurological Monitoring and Management |
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7.1 Risk Factors for Neurological Injury
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7.2 Neuroprotective Strategies
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7.3 Neurological Monitoring
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7.4 Neurological Injury / Complications
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7.5 Treatment of Neurological Complictions
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| Chapter 8 Nutritional Support in Pediatric Patients |
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8.1 Protocol for Nutritional Support in Infants and Children
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8.2 Total Parenteral Nutrition (TPN) in the PICU Patient
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8.3 Enteral Nutrition in Pediatric Critical Illness
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| Chapter 9 Endocrine and Metabolic Management in Critically Ill |
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9.1 Adrenal Cortex and Acute Adrenal Insufficiency
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9.2 Sodium and Water Metabolism, Juxtaglomerular Apparatus, and Posterior Pitutary Function
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9.3 Thyroid Functional Abnormalities
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9.4 Insulin and Blood Glucose Control
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| Chapter 10 Wound and Postoperative Infections and Management |
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10.1 Wound Infections
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10.2 Sternal (Mediastinal) Infection
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10.3 Pneumonias in the Intensive Care Unit
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10.4 Invasive Fungal Infection (Candidiasis)
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10.5 Bacterial Sepsis and Therapy
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10.6 Antimicrobial Prophylaxis
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| Chapter 11 Mechanical Circulatory Support, Heart Transplantation, and Heart and Lung Transplantation |
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A. Mechanical Circulatory Support Systems
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11.1 Intraaortic Balloon Pump (IABP)
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11.2 Extracorporeal Membrane Oxygenation (ECMO)
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11.3 Ventricular Assist Devices (VADs)
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B. Heart Transplantation
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11.4 Care of a Heart Transplant Patient
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C. Heart-Lung Transplantation
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11.5 Postoperative Management of a Heart and Lung Transplant
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11.6 Immunosuppressant Therapy of a Heart-Lung Transplant
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11.7 Clinical Surveillance of a Heart-Lung Transplant
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11.8 Management of Rejection of Heart-Lung Transplant
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| Chapter 12 Miscellaneous Considerations |
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12.1 Pleural Effusions
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12.2 Chylothorax
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12.3 Necrotizing Enterocolitis (NEC)
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| Chapter 13 Pediatric Advance Life Support Algorithms |
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13.1 Pulseless Arrest Algorithm
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13.2 PALS Bradycardia Algorithm
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13.3 Tachycardia Algorithm and Inadequate Perfusion
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13.4 Tachycardia Algorithm with adequate Perfusion
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| Chapter 14 CPR Pediatric Drugs and Doses |
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| Chapter 15 Pediatric Drip Calculations in Emergency |
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15.1 Routine Drug Preparation
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15.2 Concentrated Drug Preparation at Standardized Concentration
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15.3 Alternate Drip Calculations
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| Chapter 16 Drug Formulary |
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A. Intensive Care Sedation and Analgesia
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B. Diuretics of Common Usage
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C. Electrolytes and Minerals
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D. Antiarrhythmic Drugs
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E. Cardiac Inotropic Drugs
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F. Afterload (Vascular Resistance) Modulators and Hypotensive Agents
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G. Gastrointestinal and Antisecretory Drugs
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H. Miscellaneous Drugs
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I. Antimicrobials and Antifungal Agents
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| Chapter 17 Normal Laboratory Values, Equations and Formulae |
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17.1 Normal Laboratory Values
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17.2 Respiratory System Equations
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17.3 Cardiovascular System:
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17.4 Fluid and Electrolytes
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| Back Matter |
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Sirivella Srikrishna
MD, FRCSEd, MNAMAS, BRS Hospitals, MADRAS, Sri Venkateswara Institute of Medical Sciences, Tirupati.
Cardiac surgery and cardiovascular disease specialists include anesthesiologists, intensive care specialists as well as trainees, the pediatricians and medical students. The audience also includes all the nurses and physicians and other specialists involved in the care of the pediatric cardiac surgical patients.
