SOCIETY OF CRITICAL CARE ANESTHESIOLOGISTS ICU Resident’s Guide 2017 Welcome to critical care. Whether you are using this review guide for your first Foreword rotation in critical care or your tenth, we hope that you find it useful as a supplement to the other reading materials at your disposal. The delivery of critical care continues to change rapidly. Therapies that were deemed beneficial in the past (drotrecogin alfa, tight glucose control, etc) are now considered harmful, so it’s difficult to keep up-to-date with textbooks alone. Our goal is to provide concise clinically relevant chapters that are useful for the trainee working in the ICU. Each chapter’s relevance is illustrated with a sample case and the concepts are then reviewed with self-test multiple choice questions. Further in depth learning can be obtained with the selected reference list at the end of each chapter. For those who grew up with digital media, we have also tried to incorporate new technologies by adding videos, hyperlinks, and interactivity. Finally, we would like to give our heartfelt gratitude to the many trainees and faculty mentors across the nation who have contributed to this edition or past editions. Without their help and expertise, we would have never succeeded. Thank you to the prior editors as well, for without their vision, we would not be here with the sixth edition. Best wishes to the newcomers. May you enjoy the field as much as we have. Lindsey L. Huddleston, MD Linda L. Liu, MD Kevin C. Thornton, MD i Section 1 Contributors Eric Amaro, MD Stephanie Cha, MD University of Miami Miller School of Medicine The Johns Hopkins Hospital Department of Anesthesiology Department of Anesthesiology and Critical Care Medicine Fellow Assistant Professor Ruben J Azocar, MD MHCM FCCM Nisha Chhabra, MD Tufts Medical Center University of Chicago Medical Center Department of Anesthesiology Department of Anesthesia and Critical Care Associate Professor Fellow Edward A Bittner, MD PhD MSEd Anoop K Chhina, MD MBBS Massachusetts General Hospital Cleveland Clinic Department of Anesthesia, Critical Care and Pain Medicine Department of Anesthesiology and Pain Management Assistant Professor Fellow Jason C Brainard, MD Kathleen Claus, MD University of Colorado School of Medicine Tufts Medical Center Department of Anesthesiology Department of Anesthesiology Assistant Professor Assistant Professor Guarav Budhrani, MD Elizabeth KH Cotter, MD Emory University School of Medicine University of Chicago Medical Center Division of Critical Care Medicine Department of Anesthesia and Critical Care Assistant Professor Fellow 2 Aaron Dahl, MD Albert W Feng, MD Washington University David Geffen School of Medicine at UCLA Department of Anesthesiology Department of Anesthesiology and Perioperative Medicine Fellow Resident Murtaza Diwan, MD Natalie Ferrero, MD University of Michigan University of Michigan Department of Anesthesiology, Division of Critical Care Medicine Department of Anesthesiology, Division of Critical Care Medicine Clinical Lecturer Resident Anila B. Elliott, MD Babar Fiza, MD Oregon Health & Science University University of Michigan Department of Anesthesiology and Perioperative Medicine Department of Anesthesiology, Division of Critical Care Medicine Fellow Clinical Lecturer Katie M Ellis, MD Alexander C Fort, MD Portland VA Healthcare System University of Miami Miller School of Medicine Critical Care Anesthesiologist Department of Anesthesiology Assistant Professor Assistant Professor Kelly K Everhart, MD MS Samuel Gilliland, MD University of Washington/Harborview Medical Center University of Colorado School of Medicine Department of Anesthesiology and Pain Medicine Department of Anesthesiology Resident Assistant Professor Brenda G Fahy, MD Thomas J Graetz, MD University of Florida Washington University Department of Anesthesiology Department of Anesthesiology Professor Assistant Professor 3 Caroline Gross, MD Ryan J Horvath, MD PhD College of Physicians & Surgeons, Columbia University Massachusetts General Hospital Department of Anesthesiology Department of Anesthesia, Critical Care and Pain Medicine Resident Fellow Holden Groves, MD Leila Hosseinian, MD College of Physicians & Surgeon, Columbia University Mount Sinai Medical Center Department of Anesthesiology Department of Anesthesiology Resident Assistant Professor Vadim Gudzenko, MD Walter J Hoyt, MD David Geffen School of Medicine at UCLA University of Virginia Department of Anesthesiology and Perioperative Medicine Department Cardiology Assistant Professor Fellow J Michael Guthrie, MD John Huidekoper, MD David Geffen School of Medicine at UCLA University of Alabama Birmingham Hospital Department of Anesthesiology and Perioperative Medicine Department of Anesthesiology and Perioperative Medicine Fellow Fellow Theresa L Hartsell, MD PhD Jose C Humanez, MD The Johns Hopkins University University of Alabama Birmingham Hospital Department of Anesthesiology and Critical Care Medicine Department of Anesthesiology and Perioperative Medicine Assistant Professor Assistant Professor C Patrick Henson, DO Michael Hutchens, MD Vanderbilt University Oregon Health and Science University Department of Anesthesiology, Division of Critical Care Department of Anesthesiology and Perioperative Medicine Assistant Professor Associate Professor 4 Rhea Ittoop, MD Jeffrey A Katz, MD College of Physicians & Surgeons, Columbia University Northshore University Department of Anesthesiology Department of Anesthesia and Critical Care Resident Attending Physician Thomas Jan, MD MPH John C Klick, MD Mount Sinai Medical Center Case Western Reserve University School of Medicine Department of Anesthesiology Department of Anesthesiology and Perioperative Medicine Fellow Assistant Professor Allison M Janda, MD Matthew D Koff, MD Vanderbilt University Medical Center Geisel School of Medicine, Dartmouth-Hitchcock Medical Center Department of Anesthesiology, Division of Critical Care Department of Anesthesiology Resident Assistant Professor Aaron M Joffe, DO FCCM Michael R Lasky, MD University of Washington/Harborview Medical Center Saint Louis University Hospital Department of Anesthesiology and Pain Medicine Department of Anesthesiology and Critical Care Associate Professor Associate Professor Maurice F Joyce, MD EdM Stuart Lowson, MD Massachusetts General Hospital University of Virginia Department of Anesthesia, Critical Care and Pain Medicine Department of Anesthesiology Fellow Associate Professor Aalok K Kacha, MD PhD Elvedin Lukovic, MD University of Chicago Medical Center College of Physicians & Surgeons, Columbia University Department of Anesthesia and Critical Care Department of Anesthesiology Assistant Professor Resident 5 Michael Maile, MD Lydia Miller, MD University of Michigan Massachusetts General Hospital Department of Anesthesiology, Division of Critical Care Medicine Department of Anesthesia, Critical Care and Pain Medicine Assistant Professor Resident Darren J Malinoski, MD Teresa A Mulaikal, MD Oregon Health and Science University College of Physicians & Surgeons, Columbia University Department of Surgery Department of Anesthesiology Associate Professor Assistant Professor Sarah McCormick, MD Douglas F Naylor, MD FACS MCCM University of Alabama Birmingham Hospital Cleveland Clinic Department of Anesthesiology and Perioperative Medicine Department of Anesthesiology and Pain Medicine Fellow Staff Intensivist Tracy J McGrane, MD Christopher O Ortiz, MD PhD Vanderbilt University Medical Center David Geffen School of Medicine at UCLA Department of Anesthesiology, Division of Critical Care Department of Anesthesiology and Perioperative Medicine Assistant Professor Assistant Professor Joseph Meltzer, MD Jamel P Ortoleva, MD David Geffen School of Medicine at UCLA Massachusetts General Hospital Department of Anesthesiology and Perioperative Medicine Department of Anesthesia, Critical Care and Pain Medicine Associate Professor Fellow David W Miller, MD David B Page, MD University of Alabama Birmingham Hospital Washington University Department of Anesthesiology and Perioperative Medicine Department of Anesthesiology Associate Professor Fellow 6 Ryan Parker, MD PhD Amanda Powers, MD Vanderbilt University Medical Center College of Physicians & Surgeons, Columbia University Department of Anesthesiology, Division of Critical Care Department of Anesthesiology Assistant Professor Assistant Professor Mona K Patel, PharmD Meghan Prin, MD NewYork-Presbyterian Hospital College of Physicians & Surgeons, Columbia University Columbia University Medical Center Department of Anesthesiology Department of Pharmacy Fulbright Fellow Critical Care Clinical Pharmacist Rahul Raghavan, MD Rohit P Patel, MD The Johns Hopkins University University of Florida Department of Anesthesiology and Critical Care Medicine Department of Anesthesiology Fellow Assistant Professor Sirisha Rao, MD Ronald Pauldine, MD David Geffen School of Medicine at UCLA University of Washington Department of Anesthesiology and Perioperative Medicine Department of Anesthesiology and Pain Medicine Fellow Professor Matthew M Reschke, MD Nicholas Pesa, MD Saint Louis University Hospital University Hospitals Case Medical Center Department of Anesthesiology and Critical Care Department of Anesthesiology Resident Clinical Instructor Lauren D Rosenberg, MD Julia C Peters, MD MA College of Physicians & Surgeons, Columbia University Geisel School of Medicine, Dartmouth-Hitchcock Medical Center Department of Anesthesiology Department of Anesthesiology Resident Fellow 7 Daniel Rubin, MD Philip Sommer, MD University