Neonatal and Pediatric Respiratory Care

Front Cover
Inside Front Cover
Front matter
Neonatal and pediatric respiratory care
Copyright
Dedication
Preface
Audience
New to this edition
Learning AIDS
Evolve resources—http://evolve.elsevier.com/walsh/neonatal
For the instructor
For students
Acknowledgments
Contributors
Reviewers
Table of Contents
I Fetal Development, Assessment, and Delivery
1 Fetal lung development
Learning objectives
Key terms
Phases of lung development
Embryonal phase
Pseudoglandular phase
Canalicular phase
Saccular phase
Alveolar phase
Postnatal lung growth
Factors affecting prenatal and postnatal lung growth
Abnormal lung development
Pulmonary hypoplasia
Alveolar cell development and surfactant production
Fetal lung liquid
Key points
Assessment questions
References
2 Fetal gas exchange and circulation
Learning objectives
Key terms
Embryological overview
Fertilization to implantation
Maternal–fetal gas exchange
Cardiovascular development
Early development
Chamber development
Maturation
Fetal circulation and fetal shunts
Transition to extrauterine life
Key points
Assessment questions
References
3 Antenatal assessment and high-risk delivery
Learning objectives
Key terms
Maternal and perinatal disorders
Diabetes mellitus
Pregestational diabetes mellitus
Gestational diabetes mellitus
Infectious diseases
Group b streptococcus
Herpes simplex virus
Human immunodeficiency virus and hepatitis B virus
Human immunodeficiency virus.
Hepatitis B virus.
Toxic habits in pregnancy
Alcohol
Smoking
Cocaine
Opiates
Other substances
High-risk conditions
Hypertension and preeclampsia
Fetal membranes, umbilical cord, and placenta
Disorders of amniotic fluid volume
Preterm birth
Cervical insufficiency
Postterm pregnancy
Antenatal assessment
Ultrasound
Chorionic villus sampling
Amniocentesis
Nonstress test and contraction stress test
Fetal biophysical profile
Mode of delivery
Breech presentation
Assisted vaginal delivery
Cesarean delivery
Transient tachypnea of the newborn and type II respiratory distress syndrome
Intrapartum monitoring
Fetal transition to extrauterine life
Key points
Assessment questions
References
II Assessment and Monitoring of the Neonatal and Pediatric Patient
4 Examination and assessment of the neonatal and pediatric patient
Learning objectives
Key terms
Stabilizing the neonate
Drying and warming
Clearing the airway
Providing stimulation
Apgar score
Gestational age and size assessment
Physical examination of the neonate
Vital signs
General inspection
Respiratory function
Chest and cardiovascular system
Abdomen
Head and neck
Musculoskeletal system, spine, and extremities
Cry
Neurologic assessment
Pediatric patient history
Chief complaint
New patient history
Follow-up or established patient history
Pulmonary examination
Inspection
Palpation
Percussion
Auscultation
Nonpulmonary examination
Laboratory assessment
Key points
Assessment questions
References
5 Pulmonary function testing and bedside pulmonary mechanics
Learning objectives
Key terms
Definitions
Mechanics of breathing in newborns
Lung inflation and transpulmonary pressure
Neonatal pulmonary function testing in the laboratory
Plethysmography (baby box)
Measuring static compliance and airway resistance
Measuring maximal expiratory flow by the rapid thoracic compression technique
Thoracoabdominal motion analysis by respiratory inductance plethysmography
Pediatric pulmonary function testing in the laboratory
Pediatric testing
Spirometry
Flow–volume loop
Forced vital capacity, forced expiratory volume, and the ratio
Forced expiratory flow at 25% to 75% and at 50% of vital capacity
Reference values and relevant change
Spirometry values
Diffusing capacity
Lung volumes
Helium dilution method
Nitrogen washout method
Plethysmography
Airway resistance.
Impulse oscillometry
Bronchial provocation (challenge) testing
Cardiopulmonary exercise test
Exhaled nitric oxide
Measuring pulmonary mechanics at the bedside
Tidal volume
Respiratory frequency
Minute ventilation
Rapid shallow breathing index
Inspiratory and expiratory times
Lung compliance
Airway resistance
Time constants
Pressure, flow, and volume over time
Flow–volume loops
Pressure–volume loops
Lung overdistention
Work of breathing
Other bedside tests
Vital capacity
Peak expiratory flow rate
Maximal respiratory pressures
Complex bedside measurements
Key points
Assessment questions
References
6 Radiographic assessment
Learning objectives
Key terms
Radiographic imaging
Sonographic imaging
Normal chest anatomy
Positioning of lines and tubes
Airway obstruction
Respiratory distress in the newborn
Atelectasis
Pneumonia
Asthma
Cystic fibrosis
Acute respiratory distress syndrome
Chest trauma
Key points
Assessment questions
References
7 Pediatric flexible bronchoscopy
Learning objectives
Key terms
Indications
Diagnostic bronchoscopy
Stridor
Wheeze
Cough
Radiographic abnormalities
Foreign body aspiration
Hemoptysis
Hyperlucency
Inhalation injury
Endobronchial ultrasound
Therapeutic bronchoscopy
Flexible nasopharyngoscopy
Contraindications
Equipment
Flexible bronchoscope
Control handle
Flexible shaft and distal tip
Light source and image processors
Preparation
Equipment and supplies
Patient
Personnel
Procedure
Conscious sedation
Topical anesthesia
Patient monitoring
Technique
Postprocedural monitoring and complications
Equipment maintenance
Comparison with rigid bronchoscopy
Key points
Assessment questions
References
8 Invasive blood gas analysis and cardiovascular monitoring
Learning objectives
Key terms
Blood gas sampling
Pain control
Arterial sampling sites
Modified allen test
Arterial puncture
Procedure
Contraindications
Complications
Capillary blood gas samples
Puncture sites
Procedure
Contraindications
Complications
Arterial catheters
Umbilical artery catheterization
Peripheral artery catheterization
Procedure for sampling
Complications
Measurements
Central venous catheters
Monitoring sites
Procedure
Complications
Measurements
Noninvasive measurement of cardiac output and perfusion
Patient information
Frequency
Blood gas interpretation
Acid–base balance
Oxygenation
Abnormal hemoglobin
Key points
Assessment questions
References
9 Noninvasive monitoring in neonatal and pediatric care
Learning objectives
Key terms
Fundamental monitoring
Electrocardiography
Impedance respiratory rate
Noninvasive blood pressure
Pulse oximetry
Principles of operation
Application
Limitations
Capnography
Principles of operation
Limitations
Interpretation of capnogram
Detection of ventilation problems
Endotracheal tube in esophagus
Rebreathing
Obstructed airway
Paralyzed patients
Pneumothorax
Cardiogenic oscillations
Volumetric capnography (the carbon dioxide–volume plot)
Transcutaneous monitoring
Principles of operation
Application
Limitations
Calorimetry
Principles of operation
Limitations
Near-infrared spectroscopy
Principles of operation
Application
Limitations
Key points
Assessment questions
References
III Therapeutic Procedures for Treatment of Neonatal and Pediatric Disorders
10 Oxygen administration
Learning objectives
Key terms
Indications
Documented or suspected hypoxemia
Evidence of hypoxemia
Measurement of oxygen tension and saturation
Clinical signs and symptoms
Complications
Oxygen administration
Variable-performance oxygen delivery systems
Nasal cannula
Indications and contraindications.
Application.
Blenders and low-flow flow meters.
Inspired oxygen determination.
Hazards and complications.
Simple oxygen mask
Indications and contraindications.
Application.
Hazards and complications.
Reservoir masks
Partial-rebreathing mask.
Nonrebreathing mask.
Fixed-performance oxygen delivery systems
Air-entrainment mask
Indications and contraindications.
Application.
Hazards and complications.
Air-entrainment nebulizer
Indications and contraindications.
Application.
Hazards and complications.
High-flow nasal cannula
Washout of nasopharyngeal dead space
Indications and contraindication.
Application.
Hazards and complications.
Oxygen hood
Indications and contraindications.
Application.
Hazards and complications.
Key points
Assessment questions
References
11 Aerosols and administration of inhaled medications
Learning objectives
Key terms
Neonatal and pediatric medication delivery
Aerosol characteristics
Deposition of particles
Translocation of aerosols
Drug dose distribution
Aerosol delivery
Pneumatic jet nebulizers
Large-volume nebulizer
Small-particle aerosol generator
Ultrasonic nebulizers
Vibrating mesh nebulizers
Technique
Care and cleaning
Pressurized metered-dose inhalers
Technique
Accessory devices
Flow-triggered device.
Spacers and holding chambers.
Wheezing infants
Care and cleaning
Dry powder inhalers
Technique
Care and cleaning
Device selection and compliance
Selecting an aerosol device for infants and toddlers (birth to 4 years)
Selecting an aerosol device for preschool children (4-5 years)
Selecting an aerosol device for young children (6-12 years)
Interface selection for aerosol drug delivery to infants and children
Aerosol administration in nonintubated infants and children
Emergency bronchodilator resuscitation
Intermittent versus continuous therapy
Undiluted bronchodilator
Aerosol drug delivery to children receiving noninvasive ventilation
Aerosol drug delivery to intubated infants and children
Factors affecting aerosol delivery during mechanical ventilation
Ventilator–patient interface
Breath configuration
Airway
Environment
Response assessment
Nebulizer placement
Inhaler adapters
Aerosol particle size
Endotracheal tube
Heating and humidification
Density of inhaled gas
Ventilator mode and settings
Technique of aerosol administration in critical care
Aerosol drug delivery during high-frequency oscillatory ventilation
Aerosol drug delivery to children with a tracheostomy
Deposition in intubated and nonintubated infants
Bronchodilator administration
Inhaler versus nebulizer
Care of accessory devices and nebulizers
Other medications for aerosol delivery
Antibiotics
Mucoactive agents
Surfactant
Hyperosmolar aerosols
Gene transfer therapy
Aerosols for systemic administration
Insulin
Home care and monitoring compliance
Key points
Assessment questions
References
12 Airway clearance techniques and hyperinflation therapy
Learning objectives
Key terms
References
13 Airway management
Learning objectives
Key term
References
14 Surfactant replacement therapy
Learning objectives
Key terms
References
15 Noninvasive mechanical ventilation and continuous positive pressure of the neonate
Learning objectives
Key terms
References
16 Noninvasive mechanical ventilation of the infant and child
Learning objectives
Key terms
References
17 Invasive mechanical ventilation of the neonate and pediatric patient
Learning objectives
References
18 Administration of gas mixtures
Learning objectives
Key terms
References
19 Extracorporeal membrane oxygenation
Learning objectives
Key terms
References
20 Pharmacology
Learning objectives
Key terms
References
21 Thoracic organ transplantation
Learning objectives
Key terms
References
IV Neonatal and Pediatric Disorders: Presentation, Diagnosis, and Treatment
22 Neonatal pulmonary disorders
Learning objectives
Key terms
References
23 Surgical disorders in childhood that affect respiratory care
Acronyms
Learning objectives
Key terms
References
24 Congenital cardiac defects
Learning objectives
Key terms
References
25 Pediatric sleep-disordered breathing
Learning objectives
Key terms
References
26 Pediatric airway disorders and parenchymal lung diseases
Learning objectives
Key terms
References
27 Asthma
Learning objectives
Key terms
References
28 Cystic fibrosis
Learning objectives
Key terms
References
29 Acute respiratory distress syndrome
Learning objectives
Key terms
References
30 Shock
Learning objectives
Key terms
References
31 Pediatric trauma
Learning objectives
Key terms
Epidemiology
Early evaluation and management
Prehospital care and transport
Primary survey
Airway
Breathing
Circulation
Disability
Exposure
Secondary survey
Imaging considerations
Thoracic trauma
Anatomic considerations
Penetrating versus blunt thoracic trauma
Indications for emergency department thoracotomy
Imaging considerations
Management considerations
Upper airway injuries or obstruction
Pneumothorax
Hemothorax
Pulmonary contusion
Rib fractures
Flail chest
Cardiac contusion
Great vessel injuries
Diaphragmatic injury
Esophageal injury
Abdominal trauma
Anatomic considerations
Penetrating versus blunt abdominal trauma
Indication for laparotomy
Imaging considerations
Management considerations
Solid organ injury
Hollow viscus organ injury
Abdominal compartment syndrome
Pelvic fractures
Genitourinary trauma
Head injuries
Anatomic considerations
Imaging considerations
Management considerations
Airway considerations
Acute brain injuries
Intracranial pressure monitoring and treatment
Skull injuries
Concussion
Neck and spine injuries
Anatomic considerations
Cervical spine protection and clearance
Imaging considerations
Management considerations
Neck injuries
Spine injuries
Special considerations
Birth injuries
Nerve injury
Chylothorax
Nonaccidental trauma
Bites
Burns
Inhalation injury
Electrical injuries
Drowning
Injury prevention
Key points
Assessment questions
References
32 Disorders of the pleura
Learning objectives
Key terms
Pleural effusions
Pneumothorax
Thoracostomy drainage
Pneumomediastinum
Surgery in the pleural space
Key points
Assessment questions
References
33 Neurologic and neuromuscular disorders
Learning objectives
Key terms
Neuromuscular control of respiration
Central nervous system
Peripheral nervous system
Respiratory muscles
Respiratory control system
Bulbar muscles
Neuromuscular diseases affecting the respiratory system
Central nervous system
Disorders of the brain
Disorders affecting the spinal cord
Trauma.
Chiari malformations.
Other conditions.
Peripheral nervous system
Disorders of the motor nerves
Spinal muscular atrophy.
Poliomyelitis.
Guillain-barré syndrome.
Disorders of the neuromuscular junction
Infantile botulism.
Myasthenia gravis.
Other conditions affecting the neuromuscular junction.
Myopathies
Duchenne and becker muscular dystrophy
Myotonic dystrophies
Glycogen storage diseases
Electrolyte abnormalities
Respiratory evaluation of children with neuromuscular disease
Pulmonary function testing
Sleep studies
Respiratory care of children with neuromuscular disease
General considerations
Airway clearance mechanisms
Facilitating clearance of mucus
Assisted coughing
Glossopharyngeal breathing
Mechanical ventilatory support
Noninvasive ventilation
Nocturnal ventilation
Diurnal ventilation
Tracheostomy
Nonrespiratory care
Transition to adulthood
Key points
Assessment questions
References
V Neonatal and Pediatric Transient and Ambulatory Care
34 Transport of infants and children
Learning objectives
Key terms
Team composition
Staffing
Training
Simulation-based medical education
Modes of transportation
Ground transport
Air transport
Rotor wing
Fixed-wing aircraft
Equipment
Communications
Medical
Monitoring equipment
Ventilator
Transport incubator
Infusion pumps
Point-of-care testing
Medications
Medical gas supply
Supplies
Patient assessment and stabilization
Advanced transport
High-altitude physiology
Nitric oxide
Safety of transport
Accreditation
Key points
Assessment questions
References
35 Home care
Learning objectives
Key terms
Discharge planning: The decision to go home
Patient and family assessment
Identification and education of in-home caregivers
Financial resources
Home assessment
Durable medical equipment and supply
Home care personnel and community resources
Communication with the discharge planning team
Barriers that delay discharge
Oxygen therapy at home
Liquid oxygen system
Oxygen concentrators
Oxygen cylinders
Apnea–bradycardia monitors
Monitor placement
Caregiver education
Pulse oximeters
A child with a tracheostomy
Airway suctioning
Decannulation and tube changes
Humidification systems
Communication and speaking valves
Activities of daily living
Mechanical ventilation in the home
Family preparation
Selection of the ventilator and durable medical equipment provider
Common delays to discharge home
Home at last
A successful transition home
Key points
Assessment questions
References
36 Quality and safety
Learning objectives
Key terms
What is quality in health care?
Health care quality evolution
Teamwork
Leadership
Just culture
Measuring quality improvement
Benchmarking—internal/external
Reliability
High-reliability organizations
Simplifying work processes
Daily check-ins
Executive rounds
Safety huddles
Performance management
Evidence-based practice
Practitioner skills
Agency for healthcare research and quality
Reduction of health care–associated infections
Central line–associated bloodstream infections
Reduction of serious adverse events
Respiratory failure
Preventable and premature mortality rates
Thirty-day mortality rates
Information technology
Designing safe process
Six sigma
Lean production
Root cause analysis
Failure modes and effects analysis
Plan-do-study-act
Tools for process evaluation
Handoff communication
Culture of safety
Safety behaviors for error prevention
Key points
Assessment questions
References
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