Marc Anders is a paediatric intensivist.

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Inotropes and vasodilators

Vasodilators: Decreasing the pressures against which the heart works (systemic and pulmonary afterload); decreasing the work of the heart hence myocardial O2 demand. Usual indications for vasodilator therapy are: systemic vasodilation (LV afterload reduction), pulmonary vasodilatation (RV afterload reduction), systemic hypertension, improving coronary blood flow. Beware that infants, in response to low CO, increase afterload…

Haemofiltration and dialysis

Indications: Correction of water overload To remove larger quantities of water from the body than the kidney is able to achieve in order to enable the administration of therapeutic fluids such as parenteral nutrition To remove excess electrolytes Correction of disorders of acid/base homeostasis, including inborn errors of metabolism, particularly metabolic acidosis Liver failure (but…

Renal Failure

Definition: acute kidney injury (AKI) is failure of the kidneys to regulate electrolyte, acid-base and fluid homeostasis adequately with concomitant reduction in glomerular filtration rate (GFR). pRIFLE (paediatric Risk, Injury, Failure, Loss, End-Stage Criteria). Chronic renal failure: hyperfiltration, estimated creatinine clearance <75 ml/min/1.73m2 , hypertension, microalbuminuria.

Open chest

Negative impact on haemodynamics and respiratory parameters after median sternotomy was first described in 1975, with emphasis on “compression of the heart and producing a cardiac tamponade”. Indications for delayed sterna closure and open chest: ‘Large’ heart syndrome Haemodynamic instability after temporal sternal approximation Low cardiac output post CPB ECMO or VAD cannulation Severe arrhythmia…

Nutrition

Facts: 1. Nutritional support for children in PICU is important to prevent deficiency and remain in a positive or neutral neutrogen balance 2. Overfeeding is associated with adverse effects 3. There is no clear evidence supporting PN over TPN 4. If the bowel works, use it ! 5. Always slowly introduce lipids ! 5. Cautiously…