Table Of ContentEvidence-Based Practice
of Critical Care
Evidence-Based Practice
of Critical Care
Clifford S. Deutschman, MS, MD, FCCM
Professor of Anesthesiology and Critical Care and Surgery
Director, Stavropoulos Sepsis Research Program
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania, USA
Patrick J. Neligan, MA, MB, FRCARCSI
Honorary Senior Lecturer
Consultant in Anaesthesia and Intensive Care
University College Galway
Galway, Ireland
1600JohnF.KennedyBlvd.
Ste1800
Philadelphia,PA19103-2899
EVIDENCE-BASEDPRACTICEOFCRITICALCARE ISBN:978-1-4160-5476-4
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ISBN978-1-4160-5476-4
1.Criticalcaremedicine.2.Evidence-basedmedicine. I.Deutschman,CliffordS.II.Neligan,PatrickJ.
[DNLM:1.CriticalCare.2.Evidence-BasedMedicine.3.IntensiveCareUnits.WX218E9352010]
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List of Contributors
Moustafa Ahmed, MD Adrian Barbul, MD, FACS
AnesthesiaSection,PhiladelphiaVeteransAdministration Department of Surgery
Medical Center Sinai Hospital and Johns Hopkins
Department of Anesthesiology and Critical Care Medical Institutions
University of Pennsylvania Baltimore, Maryland
Philadelphia, Pennsylvania
John Bates, FCARCSI, MRCPI, FJFICM
A. Katie Allen, Pharm Medical Director Intensive Care Services
Butler University College of Pharmacy and Health Galway University Hospitals
Sciences Galway, Ireland
Clarian Health Partners at Methodist Hospital
Simon V. Baudouin, MD, FRCP
Indianapolis, Indiana
Institute of Cellular and Medicine, University of
Penny Andrews, RN, BSN Newcastle upon Tyne
Staff Nurse Department of Anaesthesia, Royal Victoria Infirmary
R. Adams Cowley Shock Trauma Center Newcastle upon Tyne, United Kingdom
Education Specialist, ICON
Rinaldo Bellomo, MBBS, MD, FRACP,
Baltimore, Maryland
FCCP
Djillali Annane, MD, PhD Professor
General Intensive Care Unit Department of Intensive Care and Department of
Raymond Poincare´ Hospital (AP-HP) Medicine
University of Versailles Austin Hospital
Saint Quentin-en Yvelines, France Melbourne, Australia
Valerie A. Arkoosh, MD, MPH Prof. Mette M. Berger
Professor of Clinical Anesthesiology Service of Adult Intensive Care Medicine
Professor of Clinical Obstetrics and Gynecology and Burns Centre
University of Pennsylvania School of Medicine University Hospital
Philadelphia, Pennsylvania Lausanne, Switzerland
Yuval Bitan, PhD
John G.T. Augoustides, MD, FASE
Department of Anesthesiology
Associate Professor
Cardiothoracic Section and Critical Care Medicine
University of Chicago School of Medicine
Department of Anesthesiology and Critical Care
Chicago, Illinois
University of Pennsylvania
Philadelphia, Pennsylvania
Edward A. Bittner, MD, PhD, JA
Joan R. Badia, MD, PhD Program Director, Critical Care Fellowship
Unitat de Vigila`ncia Intensiva Respirato`ria Department of Anesthesia and Critical Care
ServeidePneumologia,InstitutClinicdelTo`rax,Hospital Massachusetts General Hospital
Clinic de Barcelona, IDIBAPS, FUCAP Boston, Massachusetts
Barcelona, Spain
Jose´e Bouchard, MD
Dimitry Baranov, MD Division of Nephrology, Department of Medicine
Assistant Professor of Anesthesiology and Critical Care Hoˆpital du Sacre´-Coeur de Montre´al
Hospital of the University of Pennsylvania Universite´ de Montre´al
Philadelphia, Pennsylvania Montreal, Quebec, Canada
Philip S. Barie, MD Pavan Brahmamdam, MD
Professor of Surgery Departments of Surgery and Anesthesiology
Weill Cornell Medical College Washington University School of Medicine
New York, New York St. Louis, Missouri
xi
xii LIST OF CONTRIBUTORS
Jason Brainard, MD Jason D. Christie, MD, MS
Department of Anesthesiology and Critical Care Associate Professor of Medicine and Epidemiology
University of Pennsylvania School of Medicine Division of Pulmonary, Allergy and Critical
Philadelphia, Pennsylvania Care Medicine
Center for Clinical Epidemiology and Biostatistics
Aimee Brame, MRCP University of Pennsylvania School of Medicine
Department of Critical Care, Imperial College School of Philadelphia, Pennsylvania
Medicine
Terence M. Cone, MD
Royal Brompton Hospital
London, United Kingdom The Division of Critical Care in the Department
of Anesthesiology
Benjamin Braslow, MD University of Iowa Carver College of Medicine
Iowa City, Iowa
Assistant Professor of Surgery
Division of Trauma and Surgical Critical Care
Maya Contreras, MB, FCARCSI
University of Pennsylvania School of Medicine
Research Fellow, Lung Biology Group
Philadelphia, Pennsylvania
National Centre of Biomedical Engineering Sciences
National University of Ireland
John Brennan, MD
Department of Anaesthesia and Intensive
Division of Pulmonary, Critical Care and Sleep Medicine
Care Medicine
Tufts-New England Medical Center
University College Hospital
Boston, Massachusetts
Galway, Ireland
Veronica Brito, MD David James Cooper, BM, BS, MD
Research Fellow Australian and New Zealand Intensive
Pulmonary and Critical Care Medicine Care-Research Centre
Winthrop-University Hospital School of Public Health and Preventive Medicine
Mineola, New York Monash University, The Alfred Hospital
Melbourne, Australia
Alain F. Broccard, MD
Craig M. Coopersmith, MD, FACS, FCCM
Professor of Medicine
University of Minnesota School of Medicine Professor of Surgery
Minneapolis, Minnesota Director, 5E Surgical Intensive Care Unit
Associate Director, Emory Center for Critical Care
Naomi E. Cahill, RD, MSc Emory University School of Medicine
Department of Community Health and Atlanta, Georgia
Epidemiology Queen’s University, Kingston
Bryan A. Cotton, MD, FACS
Clinical Evaluation Research Unit, Kingston
General Hospital Assistant Professor of Surgery
Kingston, Ontario, Canada Vanderbilt University Medical Center
Department of Surgery/Trauma and Emergency Surgery
Maurizio Cecconi, MD Director of Surgical Critical Care
Tennessee Valley VA Medical Center
Department of Intensive Care Medicine
Nashville, Tennessee
St George’s Healthcare NHS Trust
London, United Kingdom
Caitlin S. Curtis, PharmD
Department of Surgery
Maurizio Cereda, MD
University of Wisconsin-Madison College of Medicine
Assistant Professor of Anesthesiology and Critical Care
and Public Health
University of Pennsylvania
Madison, Wisconsin
Philadelphia, Pennsylvania
Heidi Dalton, MD, FCCM
John Chandler, FCARCSI
Chief
Fellow, Galway University Hospitals Critical Care, Phoenix Children’s Hospital
Galway, Ireland Phoenix, Arizona
Jill Cherry-Bukowiec, MD Tracey Dechert, MD
Acute Care Surgery Fellow Division of Traumatology and Surgical Critical Care
Lecturer, Department of Surgery Department of Surgery
University of Michigan University of Pennsylvania School of Medicine
Ann Arbor, Michigan Philadelphia, Pennsylvania
List of Contributors xiii
Edwin A. Deitch, MD John E. Ellis, MD
Professor and Chair, Department of Surgery Adjunct Professor of Anesthesiology and Critical Care
New Jersey Medical School University of Pennsylvania School of Medicine
Newark, New Jersey Philadelphia, Pennsylvania
Clifford S. Deutschman, MS, MD, FCCM E. Wesley Ely, MD, MPH
Professor of Anesthesiology and Critical Department of Medicine/Allergy and Pulmonary
Care and Surgery Critical Care
Director, Stavropoulos Sepsis Research Program Vanderbilt University Medical Center
University of Pennsylvania School of Medicine Nashville, Tennessee
Philadelphia, Pennsylvania
Timothy W. Evans, MD, PhD, FRCP, FRCA,
Carol Donagh, MB, BCh, MRCPI FMedSci
Galway University Hospitals Professor of Intensive Care Medicine
Galway, Ireland Imperial College London
Medical Director and Consultant in Intensive Care
Todd Dorman, MD, FCCM and Thoracic Medicine
Royal Brompton & Harefield NHS Trust
Associate Dean and Director, Office of CME
London, United Kingdom
Professor and Vice Chair for Critical Care
Department of Anesthesiology and Critical
Adam Fang, BS
Care Medicine
Department of Medicine
Johns Hopkins University School of Medicine
Division of Pulmonary, Allergy and Critical Care
Baltimore, Maryland
Medicine
University of Pennsylvania School of Medicine
Tomas Drabek, MD
Philadelphia, Pennsylvania
Fellow
Safar Center for Resuscitation Research Niall Fanning, MB, BCh, FCARCSI
Pittsburgh, Pennsylvania Specialsist Registrar in Anaesthesia and Intensive Care
University College Hospitals Galway
Craig Dunlop, MBBS, FCARCSI Galway, Ireland
University College Hospitals
Galway, Ireland Niall D. Ferguson, MD, FRCPC, MSc
Interdepartmental Division of Critical Care Medicine,
Charles G. Durbin, Jr., MD, FCCM and Department of Medicine
Division of Respirology, University Health Network
Professor of Anesthesiology and Surgery
University of Toronto, Toronto Western Hospital
University of Virginia
Ontario, Canada
Charlottesville, Virginia
Soumitra R. Eachempati, MD Katherine Finan, MB, BCh, MRCPI
Professor of Surgery Respiratory Physician
Weill Cornell Medical College Galway University Hospitals
New York, New York Galway, Ireland
Luminita Eid, MD Marianne Fitzgerald, MB, FCARCSI
Attending Anesthesiologist
Our Lady of Lourdes Hospital
Department of Anesthesia and Critical Care Medicine
Drogheda, Ireland
Hadassah Hebrew University School of Medicine
Hadassah Medical Organization Lee A. Fleisher, MD
Jerusalem, Israel
Robert D. Dripps Professor and Chair of Anesthesiology
and Critical Care
Ali A. El Solh, MD, MPH
Professor of Medicine
Division of Pulmonary, Critical Care,
University of Pennsylvania School of Medicine
and Sleep Medicine Philadelphia, Pennsylvania
Department of Medicine and Department of Social and
Preventive Medicine
State University of New York at Buffalo School of
MedicineandBiomedicalSciencesandSchoolofPublic
Health and Health Professions
Buffalo, New York
xiv LIST OF CONTRIBUTORS
Noel M. Flynn, MD, FFARCSI Nader M. Habashi, MD, FACP, FCCP
Clinical Lecturer, Department of Anaesthesia Associate Professor, University of Maryland Medical
and Intensive Care Center
National University of Ireland Medical Director, Multi-trauma Critical Care Unit,
Consultant Anaesthetist and Medical Director of the R Adams Cowley Shock Trauma Center
Hyperbaric Chamber Medical Director, The Living Legacy Foundation
Galway University Hospitals of Maryland
Galway, Ireland Medical Director, New York Organ Donor Network,
Department of Critical Care
Jonathan K. Frogel, MD Baltimore, Maryland
Assistant Professor of Anesthesiology and Critical Care
University of Pennsylvania Rachel A. Hadler, BA
Philadelphia, Pennsylvania
Research Fellow
Department of Surgery
Wesley M. Garmon, Pharm
University of Pennsylvania School of Medicine
Butler University College of Pharmacy and Health
Philadelphia, Pennsylvania
Sciences
Clarian Health Partners at Methodist Hospital Isaac Halickman, MD
Indianapolis, Indiana
Division of Cardiovascular Disease
Cooper University Hospital
Erik Garpestad, MD
Camden, New Jersey
Division of Pulmonary, Critical Care
and Sleep Medicine Scott D. Halpern, MD, PhD
Tufts-New England Medical Center
Center for Clinical Epidemiology and Biostatistics
Boston, Massachusetts
Division of Pulmonary, Allergy and Critical Care
Medicine, Center for Bioethics
Gerd G. Gauglitz, MD
Leonard Davis Institute of Health Economics, and Center
Department of Surgery
for Clinical Epidemiology and Biostatistics
University of Texas Medical Branch
University of Pennsylvania School of Medicine
Galveston, Texas
Philadelphia, Pennsylvania
Jane M. Gervasio, Pharm, BCNSP C. William Hanson III, MD
Butler University College of Pharmacy and Health Professor of Anesthesiology and Critical Care
Sciences Chief, Section of Critical Care Medicine
Clarian Health Partners at Methodist Hospital University of Pennsylvania School of Medicine
Indianapolis, Indiana Philadelphia, Pennsylvania
Anthony C. Gordon, MD, FRCA Patrick Hassett, MB, FCARCSI
Clinical Senior Lecturer and Consultant Research Fellow, Lung Biology Group
Critical Care Medicine 11N National Centre of Biomedical Engineering Sciences
Imperial College/Charing Cross Hospital National University of Ireland
London, United Kingdom Department of Anaesthesia and Intensive Care Medicine
University College Hospital
Galway, Ireland
Vicente Gracias, MD
Professor of Surgery
J. Steven Hata, MD, FCCP, MSc
Chief, Trauma and Surgical Critical Care
The Division of Critical Care in the Department of
Robert Wood Johnson University Hospital
Anesthesiology
New Brunswick, New Jersey
University of Iowa Carver College of Medicine
Iowa City, Iowa
Jacob Gutsche, MD
Fellow, Critical Care Medicine Ivan Hayes, MBBCh, BAO, FCA, RCSI
Department of Anesthesiology and Critical Care
Mater Misercordiae Hospital
University of Pennsylvania School of Medicine
Dublin, Ireland
Philadelphia, Pennsylvania
List of Contributors xv
Daren K. Heyland, MD, MSc Marc G. Jeschke, MD, PhD
Department of Community Health and Epidemiology Associate Professor of Surgery
Queen’s University Annie Laurie Howard Chair in Burn Surgery
Clinical Evaluation Research Unit, Kingston General University of Texas Medical Branch
Hospital Galveston, Texas
Department of Medicine, Queen’s University
Kingston, Ontario, Canada Jeremy M. Kahn, MD, MSc
Assistant Professor
Nicholas S. Hill, MD Division of Pulmonary, Allergy and Critical Care
Department of Medicine
Professor of Medicine
Senior Scholar, Center for Clinical Epidemiology and
Division of Pulmonary, Critical Care and
Sleep Medicine Biostatistics
Senior Fellow, Leonard Davis Institute of Health
Tufts-New England Medical Center
Economics, University of Pennsylvania School of
Boston, Massachusetts
Medicine
Center for Clinical Epidemiology and Biostatistics,
Eliotte Hirshberg, MD
University of Pennsylvania School of Medicine
Pulmonary and Critical Care Divisions
Philadelphia, Pennsylvania
Departments of Medicine, Intermountain Medical Center
and University of Utah School of Medicine Sunil Karhadkar, MD
Critical Care Division, Department of Pediatrics
Department of Surgery
University of Utah School of Medicine
Sinai Hospital and Johns Hopkins Medical Institutions
Salt Lake City, Utah
Baltimore, Maryland
R. Duncan Hite, MD
Mark T. Keegan, MB, MRCPI
Section on Pulmonary, Critical Care, Allergy and
Associate Professor
Immunologic Disease
Division of Critical Care, Department of Anesthesiology,
Wake Forest University School of Medicine
Mayo Clinic
Winston-Salem, North Carolina
Director, Transplant/General ICU, Rochester Methodist
Hospital
Daniel Holena, MD
Rochester, Minnesota
Assistant Professor of Surgery
Division of Traumatology and Surgical Critical Care Rachel R. Kelz, MD, MSCE
University of Pennsylvania School of Medicine
Assistant Professor of Surgery
Philadelphia, Pennsylvania
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania
Steven M. Hollenberg, MD
Professor of Medicine Leo G. Kevin, MD, FCARCSI
University of Medicine and Dentistry
Department of Anaesthesia
of New Jersey - Camden
University College Hospital
Director, Cooper Coronary Care Unit
Galway, Ireland
Cooper University Hospital
Camden, New Jersey Rachel G. Khadaroo, MD, PhD, FRSC
The Keenan Research Centre
Jiri Horak, MD
Li Ka Shing Knowledge Institute
Assistant Professor of Anesthesiology and
St. Michael’s Hospital
Critical Care
Toronto, Ontario, Canada
Director, Cardiothoracic Intensive Care Unit
University of Pennsylvania School of Medicine Kurt Kleinschmidt, MD
Philadelphia, Pennsylvania
Professor of Surgery
Division of Emergency Medicine
Richard S. Hotchkiss, MD
Chief, Section of Medical Toxicology
Departments of Surgery and Anesthesiology
University of Texas Southwestern Medical School
Washington University School of Medicine
Dallas, Texas
St. Louis, Missouri
Patrick M. Kochanek, MD
John R. Hotchkiss, MD
Director, Safar Center for Resuscitation Research
Associate Professor of Critical Care
Professor of Pediatrics and Critical Care Medicine
Medicine and Medicine
University of Pittsburgh Medical Center
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Staff Intensivist and Nephrologist, VAPHS Pittsburgh
Pittsburgh, Pennsylvania
xvi LIST OF CONTRIBUTORS
W. Andrew Kofke, MD, MBA Richard J. Levy, MD
Professor of Anesthesiology and Critical Care DirectorofCardiacAnesthesiology
and Neurosurgery ViceChiefofAnesthesiologyandPainMedicine
University of Pennsylvania School of Medicine Children’sNationalMedicalCenter
Chief, Neuroanesthesia AssociateProfessorofAnesthesiologyandPediatrics
Co-Director, Neuro Intensive Care Unit TheGeorgeWashingtonUniversitySchoolofMedicine
Hospital of the University of Pennsylvania andHealthSciences
Philadelphia, Pennsylvania Washington,DC
Benjamin A. Kohl, MD
Pamela A. Lipsett, MD
Assistant Professor of Anesthesiology and Critical Care
Professor of Surgery, Anesthesiology, Critical Care
Hospital of the University of Pennsylvania Medicine, and Nursing
Medical Director of PACU
DepartmentofSurgery,JohnsHopkinsUniversitySchools
Assistant Professor of Medicine, Hospital of the
of Medicine and Nursing
University of Pennsylvania The Johns Hopkins Hospital
Director, Critical Care Fellowship
Baltimore, Maryland
Philadelphia, Pennsylvania
Kathleen D. Liu, MD, PhD, MCR
Jay L. Koyner, MD
Assistant Professor
Section of Nephrology
Division of Nephrology, Department of Medicine
Department of Medicine
University of California, San Francisco
University of Chicago
San Francisco, California
Chicago, Illinois
Corry J. Kucik, MD Conan MacDougall, Pharm, BCPS
Shriners Hospitals for Children Assistant Professor
Harvard Medical School Department of Clinical Pharmacy
Boston, Massachusetts UCSF School of Pharmacy
San Francisco, California
Kenneth A. Kudsk, MD
Veterans Administration Surgical Services Larami MacKenzie, MD
William S. Middleton Memorial Veterans Hospital Fellow, Neuro Critical Care
Department of Surgery University of Pennsylvania School of Medicine
University of Wisconsin-Madison College of Medicine Philadelphia, Pennsylvania
and Public Health
Madison, Wisconsin Brian Marsh, MBBCh, BAO, FCA, RCSI,
FJFICM
John G. Laffey, MD, MA, BSc, FCARCSI
Consultant in Anaesthesia and Intensive Care
Professor, Lung Biology Group
Mater Misercordiae Hospital
National Centre of Biomedical Engineering Sciences
Dublin, Ireland
National University of Ireland
Department of Anaesthesia and Intensive Care Medicine
John C. Marshall, MD
University College Hospital
Galway, Ireland Department of Surgery
Interdepartmental Division of Critical Care Medicine
David Lappin, FRCPI University of Toronto
Consultant Nephrologist Toronto, Ontario, Canada
University College Hospital
Jeevendra A. Martyn, MB, BS
Galway, Ireland
Director, Clinical and Biochemical Pharmacology
Peter Le Roux, MD, PhD Laboratory
Anesthetist-in-Chief, Shriners Hospitals for Children
Associate Professor of Neurosurgery
Professor, Harvard Medical School
University of Pennsylvania School of Medicine
Boston, Massachusetts
Philadelphia, Pennsylvania
Joshua M. Levine, MD Michael A. Matthay, MD
Assistant Professor of Neurology Professor of Medicine and Anesthesia
University of Pennsylvania School of Medicine University of California at San Francisco
Philadelphia, Pennsylvania Senior Associate, Cardiovascular Research Institute
University of California, San Francisco
San Francisco, California
List of Contributors xvii
Mervyn Maze, MB, ChB Vivek K. Moitra, MD
Professor and Chair Assistant Professor of Anesthesiology
Department of Anesthesia and Perioperative Care Division of Critical Care
University of California, San Francisco Columbia University College of Physicians and Surgeons
San Francisco, California New York, New York
Alan H. Morris, MD
Danny F. McAuley, MRCP, DICM, MD
Pulmonary and Critical Care Divisions
Senior Lecturer and Consultant in Intensive Care
Departments of Medicine, Intermountain Medical Center
Medicine
and University of Utah School of Medicine
Respiratory Research Programme
Pulmonary Division
Centre of Infection and Immunity, Queens University
Sorenson Heart-Lung Center
of Belfast
Intermountain Medical Center
Regional Intensive Care Unit, Royal Victoria Hospital
Salt Lake City, Utah
Belfast, Northern Ireland
Patrick T. Murray, MD, FASN, FRCPI
Gra´inne McDermott, MB, FCARCSI
Professor of Clinical Pharmacology
Department of Anaesthesia
Consultant in Nephrology and Clinical Pharmacology
University College Hospitals Galway
University College Dublin School of Medicine and
Galway, Ireland
Medical Science
Dublin, Ireland
E.R. McFadden, Jr., MD
Pulmonary, Critical Care and Sleep Medicine Lena Napolitano, MD, FACS, FCCP, FCCM
MetroHealth Medical Center
Professor of Surgery
Cleveland, Ohio
University of Michigan School of Medicine
Chief, Surgical Critical Care
Michael McKenny, MB, FCARCSI
Associate Chair, Department of Surgery
Our Lady of Lourdes Hospital University of Michigan Medical Center
Drogheda, Ireland Ann Arbor, Michigan
James S. McKinney, MD Patrick J. Neligan, MA, MB, FRCARCSI
Assistant Professor of Neurology Honorary Senior Lecturer
Robert Wood Johnson Medical School Consultant in Anaesthesia and Intensive Care
New Brunswick, New Jersey University College Galway
Galway, Ireland
Maureen O. Meade, MSc, MD
Associate Professor, Department of Medicine Ana Paula Neves, MD
Joint Member, Department of Clinical Epidemiology DepartmentofIntensiveCare,Erasme
and Biostatistics UniversityHospital
Faculty of Health Sciences Universite´ LibredeBruxelles
McMaster University Health Sciences Centre Brussels,Belgium
Hamilton, Ontario, Canada
Alistair Nichol, MB, PhD
Ravindra L. Mehta, MD, FACP, FASN
Australian and New Zealand Intensive Care- Research
Professor of Medicine Centre
Division of Nephrology School of Public Health and Preventive Medicine
University of California, San Diego Medical Center Monash University, The Alfred Hospital
San Diego, California Melbourne, Australia
Steven R. Messe´, MD Michael S. Niederman, MD, FACP, FCCP,
Assistant Professor of Neurology FCCM
University of Pennsylvania School of Medicine
Professor of Medicine, Vice-Chairman Department
Philadelphia, Pennsylvania
of Medicine
SUNY at Stony Brook
Ben Messer, FRCA
Chairman, Department of Medicine
Department of Anaesthesia, Royal Victoria Infirmary
Winthrop University Hospital
Newcastle upon Tyne, United Kingdom
Mineola, New York
