Marino’s The ICU Book FOURTH EDITION Paul L Marino, MD, PhD, FCCM Clinical Associate Professor Weill Cornell Medical College New York, New York Illustrations by Patricia Gast Marino’s The ICU Book FOURTH EDITION Health Philadelphia • Baltimore • New York • London Buenos Aires • Hong Kong • Sydney • Tokyo Acquisitions Editor:] Brian Brown Product Development Editor: Nicole Dernoski Production Project Manager: Bridgett Dougherty Manufacturing Manager: Beth Welsh Marketing Manager: Dan Dressler Creative Director: Doug Smock Production Services: Aptara, Inc © 2014 by Wolters Kluwer Health/Lippincott Williams & Wilkins Two Commerce Square 2001 Market St Philadelphia, PA 19103 LWW.com 3rd Edition © 2007 by Lippincott Williams & Wilkins - a Wolters Kluwer Business 2nd Edition © 1998 by LIPPINCOTT WILLIAMS & WILKINS All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, 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 Printed in the USA Library of Congress Cataloging-in-Publication data available on request from the publisher ISBN-13: 9781451188691 Care has been taken to confirm the accuracy of the information presented 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 this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information 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 important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 2232300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6pm, EST 10 To Daniel Joseph Marino, my 26-year-old son, who has become the best friend I hoped he would be I would especially commend the physician who, in acute diseases, by which the bulk of mankind are cut off, conducts the treatment better than others HIPPOCRATES Preface to Fourth Edition The fourth edition of The ICU Book marks its 23rd year as a fundamental sourcebook for the care of critically ill patients This edition continues the original intent to provide a “generic textbook” that presents fundamental concepts and patient care practices that can be used in any adult intensive care unit, regardless of the specialty focus of the unit Highly specialized topics, such as obstetrical emergencies, burn care, and traumatic injuries, are left to more qualified specialty textbooks This edition has been reorganized and completely rewritten, with updated references and clinical practice guidelines included at the end of each chapter The text is supplemented by 246 original illustrations and 199 original tables, and five new chapters have been added: Vascular Catheters (Chapter 1), Occupational Exposures (Chapter 4), Alternate Modes of Ventilation (Chapter 27), Pancreatitis and Liver Failure ( Chapter 39), and Nonpharmaceutical Toxidromes ( Chapter 55) Each chapter ends with a brief section entitled “A Final Word,” which highlights an insight or emphasizes the salient information presented in the chapter The ICU Book is unique in that it represents the voice of a single author, which provides a uniformity in style and conceptual framework While some bias is inevitable in such an endeavor, the opinions expressed in this book are rooted in experimental observations rather than anecdotal experiences, and the hope is that any remaining bias is tolerable Acknowledgements Acknowledgements are few but well deserved First to Patricia Gast, who is responsible for all the illustrations and page layouts in this book Her talent, patience, and counsel have been an invaluable aid to this author and this work Also to Brian Brown and Nicole Dernoski, my longtime editors, for their trust and enduring support ... customer service department at (800) 638 -30 30 or fax orders to (30 1) 2 23- 232 0 International customers should call (30 1) 2 232 300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott... diseases, by which the bulk of mankind are cut off, conducts the treatment better than others HIPPOCRATES Preface to Fourth Edition The fourth edition of The ICU Book marks its 23rd year as a fundamental... in the mid-19th century They both observed that flow (Q) through rigid tubes is a function of the inner radius of the tube (r), the length of the tube (L) and the viscosity of the fluid (µ) Their