Pediatr Crit Care Me
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The objectives of this review are to discuss the clinical assessment, pathophysiology, and management of shock, with an emphasis on circulatory physiology, cardiopulmonary interactions, and pharmacologic strategies to optimize systemic oxygen delivery. These principles will then be applied to the clinical syndromes of heart failure and cardiogenic shock that are seen in children. ⋯ An understanding of essential circulatory physiology and the pathophysiology of shock are necessary for managing patients at risk for or in a state of shock. A timely and accurate assessment of cardiac function, cardiac output, and tissue oxygenation and the means by which to enhance the relationship between oxygen delivery and consumption are essential in order to optimize outcomes.
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The purpose of this review is to discuss current outcomes for patients with adult congenital heart disease, assess the level of knowledge regarding the impact of comorbidities, and discuss the various models of care with a view to establish the optimal environment for the care of these patients in the future. ⋯ There is an increasingly large population of adults with previously operated congenital heart disease. Consequently, there are increasing numbers of adults requiring intensive care support after re-do surgery, or as a consequence of medical complications of their underlying cardiac disease. There is relatively little data specific to this population to guide optimal disposition and care models.
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The objectives of this review are to discuss the global epidemiology of cardiovascular disease, emphasizing congenital heart disease; to discuss the concept of epidemiologic transition and its role in studying the evolving epidemiology of disease; and to assess and address the global burden of congenital heart disease including its prevention and treatment. ⋯ Despite impressive reductions in mortality from congenital and acquired cardiovascular disease in high-income countries, these reductions have not been observed on a global scale. It will be necessary to continue our attempts to extend rational programs of care to middle- and low-income countries based on community empowerment, economics, and population health. The specialist in pediatric cardiac critical care can be a central driver of these programs.
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Pediatr Crit Care Me · Aug 2016
ReviewFluid Management: Pharmacologic and Renal Replacement Therapies.
Focusing on critically ill children with cardiac disease, we will review common causes of fluid perturbations, clinical recognition, and strategies to minimize and treat fluid-related complications. ⋯ Meticulous fluid management is vital in critically ill children with cardiac disease. Fluid therapy is important to maintain adequate blood volume and perfusion pressure in order to support cardiac output, tissue perfusion, and oxygen delivery. However, fluid overload and acute kidney injury are common and are associated with increased morbidity and mortality. Understanding the etiologies for disturbances in volume status and the pathophysiology surrounding those conditions is crucial for providing optimal care.
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To review the clinical classification, diagnosis, and pathophysiology of pulmonary hypertension in children, emphasizing the role of right ventricular function, ventricular interaction, and congenital heart disease in the evolution and progression of disease, as well as management strategies and therapeutic options. ⋯ Critically ill children with pulmonary hypertension associated with congenital heart disease are a high-risk population. Congenital cardiac defects resulting in either increased pulmonary blood flow or impaired pulmonary venous drainage predispose patients to developing structural and functional aberrations of the pulmonary vasculature. Mortality from pulmonary hypertension is most directly related to right ventricular failure.