Pediatric Critical Care Medicine

Derek S. Wheeler • Hector R. Wong Thomas P. Shanley Editors

Volume 4: Peri-operative Care of the Critically Ill or Injured Child

Second Edition Editors Derek S. Wheeler, MD, MMM Thomas P. Shanley, MD Division of Critical Care Medicine Michigan Institute for Clinical and Health Research Cincinnati Children’s Hospital Medical Center University of Michigan Medical School University of Cincinnati College of Medicine Ann Arbor, MI Cincinnati, OH USA USA

Hector R. Wong, MD Division of Critical Care Medicine Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati, OH USA

ISBN 978-1-4471-6358-9 ISBN 978-1-4471-6359-6 (eBook) DOI 10.1007/978-1-4471-6359-6 Springer London Heidelberg New York Dordrecht

Library of Congress Control Number: 2014938035

© Springer-Verlag London 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com) For Cathy, Ryan, Katie, Maggie, and Molly

“You don’t choose your family. They are God’s gift to you…” Desmond Tutu

Foreword to the First Edition

The practitioner of Pediatric Critical Care Medicine should be facile with a broad scope of knowledge from human developmental biology, to pathophysiologic dysfunction of virtually every organ system, and to complex organizational management. The practitioner should select, synthesize and apply the information in a discriminative manner. And fi nally and most importantly, the practitioner should constantly “listen” to the patient and the responses to interventions in order to understand the basis for the disturbances that create life-threatening or severely debilitating conditions. Whether learning the specialty as a trainee or growing as a practitioner, the pediatric inten- sivist must adopt the mantle of a perpetual student. Every professional colleague, specialist and generalist alike, provides new knowledge or fresh insight on familiar subjects. Every patient presents a new combination of challenges and a new volley of important questions to the receptive and inquiring mind. A textbook of pediatric critical care fi lls special niches for the discipline and the student of the discipline. As an historical document, this compilation records the progress of the specialty. Future versions will undoubtedly show advances in the basic biology that are most important to bedside care. However, the prevalence and manifestation of disease invariably will shift, driven by epidemiologic forces, and genetic factors, improvements in care and, hopefully, by successful prevention of disease. Whether the specialty will remain as broadly comprehensive as is currently practiced is not clear, or whether sub-specialties such as cardiac- and neurointensive care will warrant separate study and practice remains to be determined. As a repository of and reference for current knowledge, textbooks face increasing and imposing limitations compared with the dynamic and virtually limitless information gateway available through the internet. Nonetheless, a central standard serves as a defi ning anchor from which students and their teachers can begin with a common understanding and vocabulary and thereby support their mutual professional advancement. Moreover, it permits perspective, punctuation and guidance to be superimposed by a thoughtful expert who is familiar with the expanding mass of medical information. Pediatric intensivists owe Drs. Wheeler, Wong, and Shanley a great debt for their work in authoring and editing this volume. Their effort was enormously ambitious, but matched to the discipline itself in depth, breadth, and vigor. The scientifi c basis of critical care is integrally woven with the details of bedside management throughout the work, providing both a satisfy- ing rationale for current practice, as well as a clearer picture of where we can improve. The coverage of specialized areas such as intensive care of trauma victims and patients following congenital heart surgery make this a uniquely comprehensive text. The editors have assembled an outstanding collection of expert authors for this work. The large number of international contributors is striking, but speaks to the rapid growth of this specialty throughout the world. We hope that this volume will achieve a wide readership, thereby enhancing the exchange of current scientifi c and managerial knowledge for the care of critically ill children, and stimu- lating the student to seek answers to fi ll our obvious gaps in understanding.

Chicago, IL, USA Thomas P. Green New Haven, CT, USA George Lister

vii

Preface to the Second Edition

The specialty of pediatric critical care medicine continues to grow and evolve! The modern PICU of today is vastly different, even compared to as recently as 5 years ago. Technological innovations in the way we approach the diagnosis and treatment of critically ill children have seemingly changed overnight in some cases. Vast improvements in anesthesia and surgical techniques have resulted in better outcomes and shorter lengths of stay in the PICU. The outcomes of conditions that were, even less than a decade ago, almost uniformly fatal have greatly improved. Advances in molecular biology have led to the era of personalized medicine – we can now individualize our treatment approach to the unique and specifi c needs of a patient. We now routinely rely on a vast array of condition-specifi c biomarkers to initiate and titrate ther- apy. Some of these advances in molecular biology have uncovered new diseases and conditions altogether! At the same time, pediatric critical care medicine has become more global. We are sharing our knowledge with the world community. Through our collective efforts, we are advancing the care of our patients. Pediatric critical care medicine will continue to grow and evolve – more technological advancements and scientifi c achievements will surely come in the future. We will become even more global in scope. However, the human element of what pediatric critical care providers do will never change. “For all of the science inherent in the specialty of pediatric critical care medicine, there is still art in providing comfort and solace to our patients and their families. No technology will ever replace the compassion in the touch of a hand or the soothing words of a calm and gentle voice” [1]. I remain humbled by the gifts that I have received in my life. And I still remember the promise I made to myself so many years ago – the promise that I would dedicate the rest of my professional career to advancing the fi eld of pediatric critical care medicine as payment for these gifts. It is my sincere hope that the second edition of this textbook will educate a whole new generation of critical care professionals, and in so-doing help me continue my promise.

Cincinnati, OH, USA Derek S. Wheeler, MD, MMM

Reference

1. Wheeler DS. Care of the critically ill pediatric patient. Pediatr Clin North Am 2013;60:xv–xvi. Copied with permission by Elsevier, Inc.

Preface to the First Edition

Promises to Keep

The fi 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 benefi ted from some of the technological and scientifi 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. 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. Ryan was delivered through thick meconium-stained amni- otic fl uid and developed breathing diffi culty shortly after delivery. His breathing worsened over the next few hours, so he was placed on the ventilator. I will never forget the feelings of utter helplessness my wife and I felt as the NICU Transport Team wheeled Ryan away in the transport isolette. The transport physician, one of my supervising third year pediatrics resi- dents during my rotation the past month, told me that Ryan was more than likely going to require ECMO. I knew enough about ECMO at that time to know that I should be scared! The next 4 days were some of the most diffi cult moments I have ever experienced as a parent, watching the blood being pumped out of my tiny son’s body through the membrane oxygen- ator and roller pump, slowly back into his body (Figs. 1 and 2 ). I remember the fear of each day when we would be told of the results of his daily head ultrasound, looking for evidence of intracranial hemorrhage, and then the relief when we were told that there was no bleeding. I remember the hope and excitement on the day Ryan came off ECMO, as well as the concern when he had to be sent home on supplemental oxygen. Today, Ryan is happy, healthy, and strong. We are thankful to all the doctors, nurses, respiratory therapists, and ECMO specialists who cared for Ryan and made him well. We still keep in touch with many of them. Without the

Fig. 1

xi xii Preface to the First Edition

Fig. 2 technological advances and medical breakthroughs made in the fi elds of neonatal intensive care and pediatric critical care medicine, things very well could have been much different. I made a promise to myself long ago that I would dedicate the rest of my professional career to advancing the fi eld of pediatric critical care medicine as payment for the gifts that we, my wife and I, have been truly blessed. It is my sincere hope that this textbook, which has truly been a labor of joy, will educate a whole new generation of critical care professionals, and in so-doing help make that fi rst step towards keeping my promise. Acknowledgements

With any such undertaking, there are people along the way who, save for their dedication, inspiration, and assistance, a project such as this would never be completed. I am personally indebted to Michael D. Sova, our Developmental Editor, who has been a true blessing. He has kept this project going the entire way and has been an incredible help to me personally throughout the completion of this textbook. There were days when I thought that we would never fi n- ish – and he was always there to lift my spirits and keep me focused on the task at hand. I will be forever grateful to him. I am also grateful for the continued assistance of Grant Weston at Springer. Grant has been with me since the very beginning of the fi rst edition of this textbook. He has been a tremendous advocate for our specialty, as well as a great mentor and friend. I would be remiss if I did not thank Brenda Robb for her clerical and administrative assistance during the completion of this project. Juggling my schedule and keeping me on time during this whole process was not easy! I have been extremely fortunate throughout my career to have had incredible mentors, including Jim Lemons, Brad Poss, Hector Wong, and Tom Shanley. All four are gifted and dedicated clinicians and remain passionate advocates for critically ill children, the specialties of neonatology and pediatric critical care medicine, and me! I want to personally thank both Hector and Tom for serving again as Associate Editors for the second edition of this textbook. Their guidance and advice has been immeasurable. I have been truly fortunate to work with an outstanding group of contributors. All of them are my colleagues and many have been my friends for several years. It goes without saying that writing textbook chapters is a diffi cult and arduous task that often comes without a lot of benefi ts. Their exper- tise and dedication to our specialty and to the care of critically ill children have made this project possible. The textbook you now hold in your hands is truly their gift to the future of our specialty. I would also like to acknowledge the spouses and families of our contributors – par- ticipating in a project such as this takes a lot of time and energy (most of which occurs outside of the hospital!). Last, but certainly not least, I would like to especially thank my family – my wife Cathy, who has been my best friend and companion, number one advocate, and sounding board for the last 22 years, as well as my four children – Ryan, Katie, Maggie, and Molly, to whom I dedicate this textbook and all that I do.

xiii

Contents

Part I Anesthesia in the Critically Ill or Injured Child Stephen D. Playfor

1 Preparing the Critically Ill or Injured Child for Surgery ...... 3 Nancy S. Hagerman and Anna M. Varughese 2 Pharmacology of Inhalational and Intravenous Anesthetic Agents ...... 11 David P. Martin and Joseph D. Tobias 3 Sedation and Analgesia ...... 31 Eric Lloyd, Manal Alasnag, and Joseph D. Tobias 4 Tolerance, Physical Dependency, and Withdrawal...... 63 Joseph D. Tobias 5 Neuromuscular Blockade ...... 77 Paulo Sérgio Lucas da Silva, Henrique Monteiro Neto, and Werther Brunow de Carvalho 6 Procedural Sedation and Anesthesia in the PICU ...... 91 Stephen D. Playfor and Katherine Kirkpatrick 7 Blood Conservation in the Perioperative Setting ...... 103 B. Craig Weldon 8 Malignant Hyperthermia ...... 113 Thierry Girard and Albert Urwyler

Part II General Principles of Peri-operative Care Michael R. Anderson

9 Peri-operative Care of the General Pediatric Surgical Patient ...... 119 Robert T. Russell, David E. Carney, and Frederick J. Rescorla 10 Perioperative Care of the Pediatric Neurosurgical Patient ...... 141 Monica S. Vavilala and Sulpicio G. Soriano 11 Perioperative Care of the Urology Patient...... 167 Carley Riley and Shumyle Alam 12 Perioperative Care of the Orthopaedic Surgery Patient ...... 177 Seirhei Slinko 13 Peri-operative Care of the ENT Patient...... 187 Daisy A. Ciener, Obiageri Ekeh, and Katherine E. Mason

xv xvi Contents

Part III Trauma Richard A. Falcone

14 Head and Neck Trauma...... 199 Derek S. Wheeler, Derek Andrew Bruce, and Charles Schleien 15 Craniofacial Trauma ...... 221 Brian S. Pan, Haithem E. Babiker, and David A. Billmire 16 Thoracic Trauma ...... 229 Ivan M. Gutierrez and David P. Mooney 17 Abdominal Trauma ...... 237 Pleun E.A. Hermsen, Rene M.H. Wijnen, and Ivo de Blaauw 18 Genitourinary Trauma ...... 249 Shumyle Alam and Daniel Robertshaw 19 Pediatric Orthopaedic Trauma...... 263 Charles T. Mehlman and Alvin H. Crawford 20 Pediatric Burns...... 277 Itoro E. Elijah, Spogmai Komak, Celeste C. Finnerty, and David N. Herndon

Part IV Cardiac Surgery and Critical Care Bradley S. Marino

21 The Systemic Inﬂ ammatory Response to Cardiopulmonary Bypass: Pathophysiology and Treatment ...... 289 Ronald A. Bronicki and Mark S. Bleiweis 22 Myocardial Protection ...... 297 Aaron W. Eckhauser and Thomas L. Spray 23 Surgical Interventions for Congenital Heart Disease ...... 303 Stephanie Fuller, Bradley S. Marino, and Thomas L. Spray 24 Palliative Procedures ...... 323 Thomas B. Do, Mark A. Scheurer, and Andrew M. Atz 25 Peri-operative Care of the Child with Congenital Heart Disease ...... 329 Alejandro A. Floh, Catherine D. Krawczeski, and Steven M. Schwartz

Part V Critical Care of the Solid Organ Transplant Patient Denis Devictor

26 Pharmacology of Immunosuppression...... 355 John F. Sommerauer, Andrea R. Chamberlain, and Trina Devadhar Hemmelgarn 27 Heart Transplantation...... 387 Clifford Chin and John Lynn Jefferies 28 Pediatric Lung Transplantation ...... 401 Renee Potera and Charles B. Huddleston 29 Pediatric Liver Transplantation ...... 411 Denis Devictor and Pierre Tissieres Contents xvii

30 Intestinal/Multivisceral Transplantation ...... 425 Gwenn E. McLaughlin and Tomoaki Kato 31 Kidney Transplantation...... 443 Coral D. Hanevold, Travis R. Langner, Atsushi Aikawa, Takeshi Kawamura, Takashi Terada, and Derek S. Wheeler

Index ...... 455

Contributors

Atsushi Aikawa , MD, PhD Department of Nephrology , Toho University Omori Medical Center , Tokyo , Japan Shumyle Alam , MD Division of Pediatric Urology , Columbia University Medical Center, Morgan Stanley Children’s Hospital , New York , NY , USA Manal Alasnag , AB, MBBCh, MRCPCH(UK) Assistant Professor of Pediatrics , Head of Pediatric Intensive Care Unit, King Fahd Armed Forces Hospital, King Abdulaziz University Jeddah , Jeddah , Saudi Arabia Andrew M. Atz , MD Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA David A. Billmire , MD Division of Pediatric Plastic Surgery , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Mark S. Bleiweis , MD Department of Surgery and Pediatrics , University of Florida , Gainesville , FL , USA Ronald A. Bronicki , MD Cardiovascular Intensive Care Unit , Texas Children’s Hospital, Baylor College of Medicine , Houston , TX , USA Derek Andrew Bruce , MB, ChB Center for Neuroscience and Behavioral Medicine , Children’s National Medical Center , Washington , DC , USA David E. Carney , MD Division of Pediatric Surgery , Mercer School of Medicine , Savannah , Georgia , USA Andrea R. Chamberlain , PharmD Department of Pharmacy , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Clifford Chin , MD Pediatric Heart Transplant Services , The Heart Institute, Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Daisy A. Ciener , MD Department of Pediatrics , Medical College of Wisconsin, Children’s Hospital of Wisconsin , Milwaukee , WI , USA Alvin H. Crawford , MD, FACS Department of Orthopaedic Surgery , University of Cincinnati Health Center , Cincinnati , OH , USA Paulo Sérgio Lucas da Silva , MD, MsC Pediatric Intensive Care Unit, Department of Pediatrics , Hospital do Servidor Publico Municipal , São Paulo , Brazil Ivo de Blaauw , MD, PhD Department of Pediatric Surgery , Erasmus MC Sophia Childrens Hospital , Rotterdam , Zuid-Holland , Netherlands Werther Brunow de Carvalho , PhD Pediatric Intensive Care Unit/Division of Neonatology, Department of Pediatrics , Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil

xix xx Contributors

Denis Devictor , MD, PhD Department of Pediatrics , Hôpitaux Universitaires Paris Sud, Hôpital de Bicêtre. University Paris 11-Sud , Le Kremlin-Bicêtre , France Thomas B. Do , MD Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA Aaron W. Eckhauser , MD, MSCI Department of Pediatric Cardiothoracic Surgery , University of Utah and Primary Children’s Medical Center , Salt Lake City , UT , USA Obiageri Ekeh , MD, MBBS Pediatric ICU , Summerlin Hospital , Las Vegas , NV , USA Haithem Elhadi , MD Division of Plastic, Reconstructive, Hand and Burn Surgery , University of Cincinnati Health , Cincinnati , OH , USA Itoro E. Elijah , MD, MPH Department of Surgery , University of Texas Medical Branch – Galveston , Galveston , TX , USA Celeste C. Finnerty , PhD Department of Surgery , Shriners Hospitals for Children, Institute for Translational Sciences, and Sealy Center for Molecular Medicine at the University of Texas Medical Branch , Galveston , TX , USA Alejandro A. Floh , MD Department of Critical Care , Hospital for Sick Children , Toronto , ON , Canada Stephanie Fuller , MD, MS Department of Cardiothoracic Surgery , Children’s Hospital of Philadelphia , Philadelphia , PA , USA Thierry Girard , MD Department of Anesthesia , University Hospital , Basel , Switzerland Ivan M. Gutierrez , MD Department of General Surgery , Children’s Hospital Boston , Boston , MA , USA Nancy S. Hagerman , MD Department of Anesthesia , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Coral D. Hanevold , MD Division of Nephrology, Department of Pediatrics , Seattle Children’s Hospital , Seattle , WA , USA Trina Devadhar Hemmelgarn , PharmD Division of Pharmacy , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Pleun E. A. Hermsen , MD Department of Pediatric Surgery , Erasmus MC Sophia Childrens Hospital , Rotterdam , Zuid-Holland , Netherlands David N. Herndon , MD, FACS Department of Surgery , University of Texas Medical Branch – Galveston , Galveston , TX , USA Charles B. Huddleston , MD Department of Cardiothoracic Surgery , Cardinal Glennon Children’s Hospital , St. Louis , MO , USA Department of Surgery , Saint Louis University School of Medicine , St. Louis , MO , USA John Lynn Jefferies , MD, MPH Division of Cardiology , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Tomoaki Kato , MD Department of Surgery , Columbia University Medical Center , New York , NY , USA Takeshi Kawamura , MD, PhD Department of Nephrology , Toho University Omori Medical Center , Tokyo , Japan Katherine Kirkpatrick , MBChB, FRCA Department of Paediatric Anaesthesia , Royal Manchester Children’s Hospital , Manchester , UK Contributors xxi

Spogmai Komak , MD Department of Anesthesiology , UTMB, Shriners Hospitals for Children & University of Texas Medical Branch , Galveston , TX , USA Catherine D. Krawczeski , MD Division of Pediatric Cardiology , Stanford University School of Medicine , Palo Alto , CA , USA Travis R. Langner , MD Department of Critical Care , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Eric Lloyd , MD Department of Critical Care Medicine , Nationwide Children’s Hospital , Columbus , OH , USA Bradley S. Marino , MD, MPP, MSCE Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA David P. Martin , MD Department of Anesthesiology & Pain Medicine , Nationwide Children’s Hospital , Columbus , OH , USA Katherine E. Mason , MD Department of Pediatrics , Rainbow Babies Children’s Hospital , Cleveland , OH , USA Gwenn E. McLaughlin , MD, MSPH Holtz Children’s Hospital/Jackson Health System, University of Miami Miller School of Medicine , Miami , FL , USA Charles T. Mehlman , DO, MPH Department of Pediatric Orthopaedics , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA David P. Mooney , MD, MPH Department of General Surgery , Children’s Hospital Boston , Boston , MA , USA Henrique Monteiro Neto , MD Emergency Department , Hospital Israelita Albert Einstein , Barueri , SP , Brazil Brian S. Pan , MD Division of Pediatric Plastic Surgery , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Stephen D. Playfor , MBBS, DCH, MRCP, MRCPCH, DM Paediatric Intensive Care Unit , Royal Manchester Children’s Hospital , Manchester , UK Renee Potera , MD Department of Pediatrics , Saint Louis Children’s Hospital , St. Louis , MO , USA Frederick J. Rescorla , MD Division of Pediatric Surgery , Indiana University School of Medicine, Riley Hospital for Children , Indianapolis , IN , USA Carley Riley , MD, MPP Department of Critical Care Medicine , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Daniel Robertshaw , MD Department of Urology , University of Cincinnati , Cincinnati , OH , USA Robert T. Russell , MD, MPH Division of Pediatric Surgery , Indiana University School of Medicine, Riley Hospital for Children , Indianapolis , IN , USA Children’s of Alabama, University of Alabama at Birmingham , Birmingham , AL , USA Mark A. Scheurer , MD, MSc, FACC Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA Charles Schleien , MD, MBA Department of Pediatrics , Cohen Children’s Medical Center, Hofstra North Shore-LIJ School of Medicine , New Hyde Park , NY , USA xxii Contributors

Steven M. Schwartz , MD, MS, RCPSC Critical Care Medicine and Pediatrics , The Hospital for Sick Children , Toronto , ON , Canada Seirhei Slinko , MD, PhD PICU , Cardon Children’s Medical Center , Mesa , AZ , USA John F. Sommerauer, MD, FRCPC Department of Pediatrics , Children’s Mercy Hospital and Clinics , Kansas City , MO , USA Sulpicio G. Soriano , MD Department of Anesthesiology, Perioperative and Pain Medicine , Children’s Hospital Boston, Harvard Medical School , Boston , MA , USA Thomas L. Spray , MD Division of Pediatric Cardiothoracic Surgery , The Children’s Hospital of Philadelphia , Philadelphia , PA , USA Takashi Terada , MD, PhD Department of Anesthesiology , Toho University Omori Medical Center , Tokyo , Japan Pierre Tissieres , MD, PhD Department of Pediatrics , Hôpitaux Universitaires Paris Sud, Hôptal de Bicêtre. University Paris 11-Sud , Le Kremlin-Bicêtre , France Joseph D. Tobias , MD Department of Anesthesiology & Pain Medicine , Nationwide Children’s Hospital , Columbus , OH , USA Albert Urwyler , MD Department of Anesthesia , University Hospital , Basel , Switzerland Anna M. Varughese , MD, MPH Department of Anesthesiology , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA Monica S. Vavilala , MD Department of Anesthesiology and Pain Medicine , Harborview Medical Center , Seattle , WA , USA B. Craig Weldon , MD Department of Anesthesiology and Pediatrics , Duke University Hospital , Durham , NC , USA Derek S. Wheeler , MD, MMM Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine , Cincinnati , OH , USA Rene M. H. Wijnen , MD, PhD Department of Pediatric Surgery , Erasmus MC Sophia Children’s Hospital , Rotterdam , Zuid-Holland , Netherlands