The care of the critically ill or injured child begins with timely, prompt, and aggressive res- citation and stabilization. Ideally, stabilization should occur before the onset of organ failure in order to achieve the best possible outcomes. In the following pages, an international panel of experts provides an in-depth discussion of the early recognition, resuscitation, and stabilization of the critically ill or injured child. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley V Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU). The head of the pediatrics clerkship was kind enough to let me have a few days off around the time of the delivery-my wife, Cathy, was 2 weeks past her due date and had been scheduled for elective induction.

The ? eld of critical care medicine is in the midst of a dramatic change. Technological and s- enti? c advances during the last decade have resulted in a fundamental change in the way we view disease processes, such as sepsis, shock, acute lung injury, and traumatic brain injury. Pediatric intensivists have been both witness to and active participants in bringing about these changes. As the understanding of the pathogenesis of these diseases reaches the cellular and molecular levels, the gap between critical care medicine and molecular biology will disappear. It is imperative that all physicians caring for critically ill children in this new era have a th- ough understanding of the applicability of molecular biology to the care of these patients at the bedside in order to keep up with the rapidly evolving ? eld of critical care medicine. To the same extent, the practice of critical care medicine is in the midst of fundamental change. In keeping with the Institute of Medicine's report "Crossing the Quality Chasm," the care of critically ill and injured children needs to be safe, evidence-based, equitable, ef? cient, timely, and fami- centered [1,2]. In the following pages, these changes in our specialty are discussed in greater scope and detail, offering the reader fresh insight into not only where we came from, but also where we are going as a specialty.

The development of pediatric cardiac surgical programs has had a profound effect on the s- cialty of pediatric critical care medicine, and as a result, the ? eld of pediatric cardiac intensive care is rapidly emerging as a separate subspecialty of pediatric critical care medicine. The ability to provide care for the critically ill child with congenital heart disease clearly separates pediatric intensivists from our adult colleagues. A thorough understanding and knowledge of the unique physiology of the child with congenital heart disease are therefore absolutely crucial for anyone working in the pediatric intensive care unit. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pe- atric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley v Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU).

The principal role of the respiratory system is to permit ef? cient exchange of respiratory gases (O and CO ) with the environment. The respiratory system is unique in that it is constantly 2 2 exposed to a barrage of foreign substances from both the internal environment (at any one point in time, approximately one-half of the cardiac output is received by the lungs) and the external environment (with each breath, the respiratory tract is exposed to pollens, viruses, bacteria, smoke, etc). According to the Centers for Disease Control and Prevention, diseases of the res- ratory system were the seventh and eighth leading causes of deaths in children aged 1 to 19 years in 2003 [1]. Dr. George A. Gregory, one of the founding fathers of pediatric critical care me- cine, once estimated that acute respiratory failure accounts for nearly 50% of all admissions to the pediatric intensive care unit (PICU) [2]. Just as important are the many diseases that affect the respiratory system that are not associated with acute respiratory failure, but nevertheless constitute a major portion of the practice of pediatric critical care medicine, some of which account for signi? cant morbidity and mortality [3]. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P.

The second edition of Pediatric Critical Care Medicine spans four volumes, with major sections dedicated to specific organ systems. Each major section consists of separate chapters dedicated to reviewing the specific disease processes affecting each organ system. Each chapter concludes with a comprehensive list of references, with brief, concise remarks denoting references of 'special interest' and 'of interest'. Consequently, the books are unique in their comprehensive coverage of pediatric critical care and their ease of use and will be of value to those studying towards pediatric critical care examinations and those who are already qualified.

This second edition spans four volumes, with major sections dedicated to specific organ systems. Each major section consists of separate chapters dedicated to reviewing the specific disease processes affecting each organ system. Each chapter concludes with a comprehensive list of references, with brief, concise remarks denoting references of 'special interest' and 'of interest'. Consequently, the books are unique in their comprehensive coverage of pediatric critical care and their ease of use and will be of value to those studying towards pediatric critical care examinations and those who are already qualified.

Neurologic emergencies are a common reason for admission to the pediatric intensive care unit (PICU). A thorough understanding of the diseases and disorders affecting the pediatric central nervous system is vital for any physician or healthcare provider working in the PICU. In the following pages, an international panel of experts provides an in-depth discussion on the res- citation, stabilization, and ongoing care of the critically ill or injured child with central nervous system dysfunction. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley v Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU).