Critical care after surgery for congenital cardiac disease
Pearls • The neonatal myocardium is less compliant than that of the older child, less tolerant of increases in afterload, and less responsive to increases in preload. A predictable decrease…
Shock states
The clinical syndrome of shock is one of the most dramatic, dynamic, and life-threatening problems faced by the physician in the critical care setting. Although untreated shock is universally lethal,…
Disorders of cardiac rhythm
Pearls • Arrhythmias may result from ongoing therapies; ask, “What’s the DEAL?” ( d rugs and drips, e lectrolytes, a irway and acid-base, l ines). • Appropriate diagnosis is key….
Cardiopulmonary interactions
Pearls • Positive-pressure ventilation (PPV) alters ventricular loading conditions and compliance. • In patients who are hypovolemic, the effects of positive airway pressure on the right heart predominate, whereas in…
Echocardiographic imaging
Pearls • The intensive care unit is a unique environment for performing an echocardiogram; the intensivist, sonographer, and pediatric cardiologist must work together to obtain the needed information with minimal…
Pharmacology of the cardiovascular system
Pearls • Clinical acumen and knowledge of physiology is needed to distinguish between the need for an inotropic agent, which is used to increase cardiac contractility, and the need for…
Diagnostic and therapeutic cardiac catheterization
Pearls • The cardiac catheterization laboratory can play an important diagnostic and/or therapeutic role in the management of children in the pediatric intensive care unit. • For patients with cardiac…
Cardiac failure and ventricular assist devices
Pearls • Advances in medical management, surgical techniques, and mechanical circulatory support (MCS) for pediatric patients with congestive heart failure continue to improve patient outcomes. • Indications for the use…
Assessment of cardiovascular function
Pearls • Cardiovascular assessment and monitoring in the pediatric intensive care unit require careful integration of physical findings, laboratory studies, and electronic data to make appropriate therapeutic decisions. • Noninvasive…
Principles of invasive cardiovascular monitoring
Pearls • Hemodynamic monitoring refers to measurement of the functional characteristics of the heart and circulatory system that affect the perfusion of tissues with oxygenated blood. • Hemodynamic monitoring can…
