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Management of critically ill child
- 1. By Dr Prabhakar, 1st year PG Dept of Pediatrics, Sri Venkateswara medical college, Tirupati.
- 2. Supportive care Nutrition Prevention of complications Overview
- 3. Eye care Oral hygiene Prevention and treatment of pressure sores Care of IV lines, central lines and chest tubes Prevention of stress ulcers Thromboembolic prophylaxis Glucose control Supportive care
- 4. Lubricating ointments Artificial tears Eye care
- 5. Ventilator associated pneumonia Chlorhexidine based oral care Oral hygiene
- 6. Pediatric hospital population – 7% ICU patients – 26% Most common sites Occipital region Nose Chin or neck Heel Sacral Pressure sores
- 7. Risk factors Mechanical ventilation Hypotension Malnutrition Sensory loss Dependent edema Central line access HFO ventilation >96 hrs stay
- 8. Pg.420 table 1
- 9. Regular checking and repositioning if necessary Use of pressure alternating mattress prevention
- 10. Ideal- once per shift for signs of infusion phlebitis Visual Infusion Phlebitis (VIP) scale Care of Intravenous lines
- 11.
- 12. Displacement Bleeding Patency Infection Hematoma formation Central lines
- 13. Movement of fluid column Amount of drainage and its nature Displacements Breath sounds Subcutaneous emphysema Chest drains
- 14. Risk factors Thrombocytopenia Coagulopathy Organ failure Mechanical ventilation and high pressure ventilator setting Higher severity of illness Shock Prolonged surgery Steroid administration Stress ulcers
- 15. Prophylaxis Ranitidine Sucralfate Proton- pump inhibitor Stress ulcers
- 16. Risk factors Central venous catheter Age <1yr and >14 yr Recent surgical procedure Complex medical conditions Prolonged hospitalization Inherited or acquired thrombophilia Thromboembolic prophylaxis Heparin Thrombolytic therapy
- 17. Intensive control (81-108 mg/dL) vs Conventional control(,180 mg/dL) Glucose control
- 18. Goal is safe and effective control of pain, anxiety and motion provide appropriate amnesia or decreased awareness . Sedation and analgesia
- 20. Sedation and analgesia for various procedures
- 21. Pg.431 table 3
- 22.
- 23. Causes of malnutrition in ICU Metabolic stress response Assessment of energy expenditure Nutrient delivery Nutrition
- 24. Peaks at 3rd or 4th day Subsides by 7th to 10th day
- 25. Assessment of nutritional status Medical history Diet history Weight, height, head circumference at admission Signs of malnutrition
- 26. Factors that may increase energy needs Factors that may decrease energy needs • Fever • Sepsis • Burns • Trauma • Cardiac or Pulmonary Disease. • Major surgery • Sedation • Pentobarbital Coma • Mechanical Ventilation • Starvation • Paralysis Factors affecting energy needs
- 27. Potential complications of Overfeeding Potential complications of Underfeeding • Hypercapnia and respiratory distress • Hepatic lipogenesis • Hyperglycemia • Electrolyte abnormalities • Impaired phagocytosis • Increased metabolic rate • Respiratory dysfunction • Poor wound healing • Increased infection risk • Poor prognosis Complications of underfeeding and overfeeding
- 28. Enteral vs parenteral nutrition
- 29.
- 30. Amino acid mixture, lipids, glucose and trace minerals and vitamins Central lines vs peripheral lines Total parenteral nutrition
- 31. Glucose infusion – started at 5-6 mg/kg/minute and increased gradually Amino acids – begun at 1 gm/kg/day, increased over 2-3 days to 2.5gm/kg/day. Lipids - 0.5 gm/kg/day on day 1, increased to 2-2.5 gm/kg/day over 4-5 days Trace elements and vitamin preparations are added.
- 33. Ventilator associated pneumonia Blood stream infections Urinary tract infections Prevention of complications
- 34. Hand washing Sterilization of medical devices Aseptic precautions Appropriate and rational use of antibiotics Surveillance of nosocomial infections General measures
- 35. Suctioning endotracheal tubes Endotracheal tube and intubations Oral care Ventilator circuit related issues Use of H2blockeres/proton pump inhibitors/sucralfate Elevation of Head of the bed Early extubation Prevention of VAP/HAP
- 36. Selection of vein Maximal aseptic technique Experienced personnel Avoid use of TPN catheters for infusions other than TPN Have adequate staff for management of central venous catheters Prevention of blood stream infections
- 37. Reduce inappropriate use of catheters Consider alternatives Catheter material Strict asepsis during insertion Closed drainage Removed at earliest possible Prevention of nosocomial urinary tract infections
- 38. FAST HUGS BID Feeding Analgesia Sedation Thromboembolic phenomenons Head end elevation Ulcer- stress ulcer prevention Glucose control Spontaneous breathing trial Bowel regimen Indwelling catheters De escalation of antibiotics
- 39. Holistic care Supportive care and sedation Nutrition Prevention of nosocomial infections Dictum of “DO NO HARM” Summary
- 40.