Editors Richard S Irwin, MD Professor of Medicine and Nursing University of Massachusetts and Graduate School of Nursing Chair, Critical Care Operations UMass Memorial Medical Center Worcester, Massachusetts Craig M Lilly, MD Vice Chair, Critical Care Operations Director, elCU Program UMass Memorial Medical Center Professor of Medicine, Anesthesia, and Surgery Departments of Medicine and Surgery University of Massachusetts Medical School Worcester, Massachusetts James M Rippe, MD Professor of Biomedical Sciences University of Central Florida Orlando, Florida Founder and Director Rippe Lifestyle Institute Shrewsbury, Massachusetts/Orlando, Florida Founder and Director Rippe Health Orlando, Florida T h i s e d i t i o n is based on Irwin and Rippe's Intensive Care Medicine, seve nth ed i t i o n , ed ited by R i c h a rd S I rw i n a n d Ja mes M R i ppe • I Wolters Kluwer Lippincott Williams & Wilkins Health Philadelphia• Baltimore• New York• London Buenos Aires • Hong Kong · Sydney ·Tokyo Acquisitions Editor: Keith Donnellan Managing Editor: Nicole T Dernoski Marketing Manager: Dan Dressler Production Project Manager: Bridgett Dougherty Senior Manufacturing Manager: Bech Welsh Design Coordinator Teresa Mallon Compositor: SPi Global Sixth Edition Copyright© 20 14 by Richard S Irwin, MD and James M Rippe, MD Two Commerce Square 200 I Market Street Philadelphia, PA 19103 All rights reserved This book is protected by copyright No part of chis book may be reproduced or trans­ mitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 200 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via website at lww.com (products and services) Printed in China Library of Congress Cataloging-in-Publication Data I [edited by] Richard S Irwin, Craig M Lilly and James M Rippe - Sixth Manual of intensive care medicine edition p ; cm Preceded by Manual of intensive care medicine I edited by Richard S Irwin, James M Rippe 5th ed c2010 Abridgement of: Irwin and Rippe's intensive care medicine I editors, Richard S Irwin, James M Rippe 7ch ed c2012 Includes bibliographical references and index ISBN 978-1-4511-8500-3 I Irwin, Richard S., editor of compilation II Rippe, James M., editor [DNLM: Intensive Care-Handbooks Intensive Care Units-Handbooks WX 39] RC86.7 616.02'8-dc23 2013019315 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in chis book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of chis information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations The authors, editors, and publisher have exerted every effort to ensure char drug selection and dosage sec forth in chis text are in accordance with the current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of informa­ tion relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly impor­ tant when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in chis publication have U.S Food and Drug Administration (FDA) clearance for limited use in restricted research settings le is the responsibility of the health care provid­ ers to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of chis book, call our customer service department at (800) 638-3030 or orders to (301) 223-2320 Internacional customers should call (301) 223-2300 fax Visit Lippincott Williams & Wilkins on the Internee: http://www.lww.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST To Our Families Diane, Rachel, Sara, Jamie, Rebecca, Andrew K, Andrew M, and Adam; Leslie, Jonathan, Catherine, Stephanie, Hart, Jaelin, Devon, and Jamie C o ntributors KonstantinAbramov, MD Joshua M Ammerman, MD Assistant Professor ofInternal Medicine Division ofRenal Medicine University ofMassachusetts Medical School Worcester, Massachusetts Clinical Assistant Professor ofNeurosurgery Department ofNeurological Surgery George Washington University School of Medicine Washington, District of Columbia Christopher D Adams, PharmD, BCPS Gustavo G Angaramo, MD Clinical Pharmacy Specialist Department ofPharmacy Services Brigham and Womens Hospital Boston, Massachusetts Assistant Professor Department ofAnesthesiology and Critical Care Former Instructor in Surgery and Cardiothoracic Surgery Department ofSurgery University ofMassachusetts Medical School Worcester, Massachusetts DeepAdhikari, MD Renal Division University ofMassachusetts Medical School Worcester, Massachusetts SrinathAdusumalli, MD Resident Physician Department ofInternal Medicine Massachusetts General Hospital Boston, Massachusetts Sumera R Ahmad, MD Department ofPulmonary and Critical Care Medicine University ofMassachusetts Medical School Worcester, Massachusetts David H Ahrenholz, MD, FACS Associate Professor ofSurgery University ofMinnesota Medical School Minneapolis, Minnesota Burns Program Director Regions Burn Center Regions Hospital St Paul, Minnesota SewitAmde, MD Medical Fellow Department ofSurgery University ofMinnesota Minneapolis, Minnesota Kevin E Anger, PharmD, BCPS Clinical Pharmacist Specialist Department ofPharmacy Services Brigham and Womens Hospital Boston, Massachusetts AntonioAponte-Feliciano, MD Assistant Professor ofAnesthesiology, Surgery, and Critical Care Medicine Department ofAnesthesiology University ofMassachusetts Medical School Worcester, Massachusetts NeilAronin, MD Professor and Chief Division ofEndocrinology and Metabolism Department ofMedicine University ofMassachusetts Medical School Worcester, Massachusetts Seth M Arum, MD, FACE Assistant Professor ofMedicine Division of Endocrinology and Metabolism University ofMassachusetts Medical School Worcester, Massachusetts vii viii I Contr i b utors Gerard P Aurigemma, MD Isabelita R Bella, MD Professor ofMedicine and Radiology University ofMassachusetts Medical School Director, Noninvasive Cardiology UMass Memorial Medical Center Worcester, Massachusetts Associate Professor ofNeurology Department ofNeurology University ofMassachusetts Medical School Worcester, Massachusetts RiadAzar, MD Consultant Cardiologist Department of Cardiology Imperial College Healthcare NHS Trust Hammersmith Hospital London, United Kingdom Associate Professor ofMedicine Washington University School ofMedicine Division of Gastroenterology Department ofInternal Medicine Barnes-Jewish Hospital - North Campus St Louis, Missouri Michael F Bellamy, MD, MRCP David Cachia, MD Director, Leukemia Program Massachusetts General Hospital Boston, Massachusetts ChiefResident Department ofNeurology University ofMassachusetts Medical School Worcester, Massachusetts Gisela I Banauch, MD, MS Jason P Caplan, MD Karen K Ballen, MD Assistant Professor ofMedicine Division ofPulmonary, Allergy, Critical Care, and Sleep Medicine University ofMassachusetts Medical School Worcester, Massachusetts Daniel T Baran, MD Adjunct Professor ofMedicine and Orthopedics University ofMassachusetts Medical School Worcester, Massachusetts Director, Medical Affairs Merck & Co., Inc Upper Gwynedd, Pennsylvania Michael L Barretti, DO Fellow, Pulmonary and Critical Care Medicine Division ofPulmonary, Allergy, and Critical Care Medicine University ofMassachusetts Medical School Worcester, Massachusetts David M Bebinger, MD Assistant Professor ofMedicine Division ofInfectious Diseases and Immunology University ofMassachusetts Medical School Worcester, Massachusetts Associate Professor ofPsychiatry ChiefofPsychiatry Creighton University School ofMedicine at St Joseph's Hospital and Medical Center Phoenix, Arizona RaphaelA Carandang, MD Assistant Professor ofNeurology and Surgical Critical Care Department ofNeurology University ofMassachusetts Medical School Worcester, Massachusetts Stewart R Carter, MD Resident Department of Surgery Loyola University Health System Maywood, Illinois DavidA Chad, MD Associate Professor ofNeurology Harvard Medical School Massachusetts General Hospital EMC Laboratory Neuromuscular Diagnostic Center Boston, Massachusetts ... University ofMassachusetts Medical School Worcester, Massachusetts xv i i Assistant Professor Department ofAnesthesiology University ofMassachusetts Medical School Worcester, Massachusetts Suchitra... DO Assistant Professor Division ofInfectious Disease and Immunology Department ofMedicine University ofMassachusetts Medical School Worcester, Massachusetts Assistant Professor ofAnesthesiology... Department ofSurgery Division of Trauma University ofMassachusetts Medical School Worcester, Massachusetts Clinical Associate Professor ofAnesthesiology and Surgery University ofMassachusetts Medical School