Irwin and Rippe's Intensive Care Medicine, 9th Edition
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9th edition
Copyright © 2024 Craig M. Lilly, MD, Richard S. Irwin, MD, and James M.
Rippe, MD.
Eighth edition Copyright © 2018 by Richard S. Irwin, MD, James M. Rippe,
MD, and Craig M. Lilly, MD Seventh edition © 2012 by Richard S. Irwin, MD
and James M. Rippe, MD Sixth edition © 2008 by Richard S. Irwin, MD and
James M. Rippe, MD Fifth edition © 2003 by Richard S. Irwin, MD and James
M. Rippe, MD Fourth edition © 1999 by Richard S. Irwin, MD, Frank B. Cerra,
MD, and James M. Rippe, MD Third edition © 1996 by James M. Rippe, MD,
Richard S. Irwin, MD, Mitchell P. Fink, MD, and Frank B. Cerra, MD Second
edition © 1991 by James M. Rippe, MD, Richard S. Irwin, MD, Joseph S.
Alpert, MD, and Mitchell P. Fink, MD First edition © 1985 by James M. Rippe,
MD, Richard S. Irwin, MD, Joseph S. Alpert, MD, and James E. Dalen, MD. All
rights reserved. This book is protected by copyright. No part of this book may be
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To Our Families and Patients
Section Editors
Neil Aronin, MD
Professor and Chief
Department of Medicine
Division of Endocrinology, Diabetes and Metabolism
UMass Chan Medical School
Worcester, Massachusetts
Paul F. Dellaripa, MD
Associate Professor
Division of Rheumatology
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts
Akshay S. Desai, MD, MPH
Associate Professor of Medicine
Harvard Medical School
Director, Cardiomyopathy and Heart Failure
Advanced Heart Disease Section
Cardiovascular Division
Brigham and Women’s Hospital
Boston, Massachusetts
Jon D. Dorfman, MD
Associate Professor of Surgery
Department of Surgery
UMass Chan Medical School
Worcester, Massachusetts
Pang-Yen Fan, MD
Professor and Vice Chair for Education
Department of Medicine
UMass Chan Medical School
Worcester, Massachusetts
Jonathan M. Gerber, MD
Professor of Medicine
Chief of Hematology & Oncology
Director of the Cancer Center
Eleanor Eustis Farrington Chair in Cancer Research
Department of Medicine
University of Massachusetts Chan Medical School and UMass Memorial Health
Worcester, Massachusetts
C. Prakash Gyawali, MD, MRCP
Professor of Medicine
Division of Gastroenterology
Washington University School of Medicine
St. Louis, Missouri
Wiley R. Hall, MD
Assistant Professor
Departments of Neurology, Anesthesiology and Surgery
UMass Chan Medical School
Worcester, Massachusetts
Neil A. Halpern, MD, MCCM, FACP, FCCP
Director, Critical Care Center, Service Chief, Critical Care Medicine
Department of Anesthesiology and Critical Care Medicine
Memorial Sloan Kettering Cancer Center
Professor of Clinical Medicine and Professor of Medicine in Clinical
Anesthesiology
Weill Cornell Medical College
New York, New York
David M. Harlan, MD
Professor and Co-Director, Diabetes Center of Excellence
Department of Medicine
UMass Chan Medical School
Worcester, Massachusetts
Stephen O. Heard, MD
Professor and Chair Emeritus
Anesthesiology and Perioperative Medicine
UMass Chan Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Michael Hill, MD
Assistant Professor of Emergency Medicine
Department of Emergency Medicine
UMass Chan Medical School
Worcester, Massachusetts
Jennifer LaFemina, MD, FACS
Associate Professor of Surgery
Division of Surgical Oncology, Department of Surgery
Program Director, General Surgery Residency Program
UMass Memorial Medical Center
Worcester, Massachusetts
Stephanie M. Levine, MD, FCCP
Professor of Medicine
Department of Medicine, Division of Pulmonary Diseases and Critical Care
UT Health- San Antonio
Staff Physician, South Texas Veterans Health Care System
San Antonio, Texas
J. Mark Madison, MD
Professor of Medicine and Microbiology and Physiological Systems
Chief, Division of Pulmonary, Allergy and Critical Care Medicine
Department of Medicine
UMass Chan Medical School
UMass Memorial Medical Center
Worcester, Massachusetts
Lawrence C. Mohr, MD, ScD, FACP, FCCP
Distinguished University Professor
Medical University of South Carolina
Charleston, South Carolina
David A. Morrow MD, MPH
Section Head, Critical Care Cardiology
Department of Cardiovascular Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts
Mark J. Neavyn, MD
Medical Director
Northern New England Poison Center
Maine Medical Center
Portland, Maine
Jennifer Reidy, MD, MS, FAAHPM
Chief and Associate Professor
Department of Family Medicine and Community Health
UMass Chan Medical SchoolUMass Memorial Health
Worcester, Massachusetts
Todd W. Sarge, MD
Vice Chair of Anesthesia Critical Care
Department of Anesthesia, Critical Care and Pain Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Patrick Smallwood, MD
Vice Chair, Adult Psychiatry Clinical Services
Department of Psychiatry
UMass Chan Medical SchoolUMass Memorial Medical Center
Worcester, Massachusetts
Nicole M. Theodoropoulos, MD, MS
Associate Professor
Division of Infectious Diseases & Immunology
UMass Chan Medical School
Worcester, Massachusetts
Ulises Torres, MD, MEHP
Chief Quality Officer
Department of Trauma/Critical Care
George Washington University Hospital
Washington, DC
Luke Yip, MD
Rocky Mountain Poison & Drug Safety
Department of Medicine, Section of Medical Toxicology
Denver Health
Denver, Colorado
Contributors List
Contributors List
Cynthia Aaron, MD
Michigan Poison & Drug Information Center, Wayne State University School of
Medicine, Detroit, Michigan
George M. Abraham, MD, MPH
Professor, Department of Medicine, UMass Chan Medical School, Worcester,
Massachusetts
Konstantin Abramov, MD, MHL
Associate Professor, Division of Renal Medicine, UMass Chan Medical School,
Worcester, Massachusetts
Patrick Abt, MD
Assistant Professor of Medicine - Cardiology, University of Rochester,
Rochester, New York
Suresh “Mitu” Agarwal, MD, FACS, FCCM
Division Chief, Trauma, Acute & Critical Care Surgery, Professor, Department
of Surgery, Duke University Medical Center, Durham, North Carolina
Rishav Aggarwal, MD
Resident, Department of Surgery, University of Minnesota, Minneapolis,
Minnesota
Anas A. Ahmed, MBBS
Attending Physician and Assistant Professor of Medicine, Division of
Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston,
Massachusetts
Bushra Abdul Aleem, MD
Pediatric Anesthesiology Fellow, Department of Anesthesiology and
Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC
Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Alfred Aleguas, PharmD, DABAT, FAACT
Managing Director (Retired), Florida Poison Information Center, Tampa, Florida
Hasan Al-Harakeh, MD
Instructor, Department of Surgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania
Alaaedin Alhomosh, MD
Neuro-Critical Care Fellow, Department of Neurology, UMass Chan Medical
School, Worcester, Massachusetts
Asem H. Ali, MBBS
Assistant Professor, Department of Medicine, UMass Chan Medical School,
Worcester, Massachusetts
Satya Allaparthi, MD
Attending Physician, Eden Hospital, Castro Valley, California
Gilman Allen, MD
Professor, Department of Medicine, University of Vermont Larner College of
Medicine, Burlington, Vermont
Jennifer E. Allen, MD
Chief, Section of Palliative Medicine and Hospice, Department of Medicine,
LeHigh Valley Health Network, Allentown, Pennsylvania
Dalia Alwasiyah, MBBS
Emergency Medicine Physician, Department of Emergency Medicine, Cape Fear
Valley Hoke Hospital, Raeford, North Carolina
Surachai Amornsawadwattana, MD
Assistant Professor, Department of Internal Medicine, Washington University in
St. Louis, St. Louis, Missouri
Adrish Anand
MD Candidate, Division of Abdominal Transplantation, Michael E. Debakey
Department of Surgery, Baylor College of Medicine, Houston, Texas
Diana C. Anderson, MD, MArch
Instructor, Department of Neurology, Boston University Chobanian & Avedisian
School of Medicine, Boston, Massachusetts
Gustavo G. Angaramo, MD, FASA
Associate Professor of Anesthesiology, Critical Care and Pain Medicine,
Department of Anesthesiology and Perioperative Medicine, UMass Chan
Medical School, UMass Memorial Healthcare, Worcester, Massachusetts
Luis F. Angel, MD
Professor, Department of Medicine, NYU Grossman School of Medicine, NYU
Langone Health, New York, New York
Kevin E. Anger, PharmD, BCPS
Pharmacy Manager, Department of Pharmacy Services, Brigham and Women’s
Hospital, Boston, Massachusetts
MaryEllen C. Antkowiak, MD
Associate Professor, Department of Medicine, University of Vermont Larner
College of Medicine, Burlington, Vermont
Ioana Antonescu, MD, MS
Assistant Professor, Department of Surgery, Duke University School of
Medicine, Durham, North Carolina
Neil Aronin, MD
Professor and Chief, Department of Medicine, Division of Endocrinology,
Diabetes and Metabolism, UMass Chan Medical School, Worcester,
Massachusetts
Seth M. Arum, MD, FACE
Global Safety Officer, Department of Global Pharmacovigilance, Oncology,
SanofiTel Aviv University, Rutland, Massachusetts
Philip Ayvazian, MD
Assistant Professor, Department of Urology, UMass Memorial Health,
Worcester, Massachusetts
Riad Azar, MD
Associate Professor of Medicine, Washington University School of Medicine,
Gastroenterology Division, Department of Internal Medicine, Barnes-Jewish
Hospital – North Campus, St. Louis, Missouri
Larry M. Baddour, MD
Professor Emeritus, Division of Public Health, Infectious Diseases, and
Occupational Medicine, Department of Medicine, Mayo Clinic College of
Medicine and Science, Rochester, Minnesota
K. C. Balaji, MD
Professor and Chair, Department of Urology, University of Florida College of
Medicine, Jacksonville, Florida
Ian Ball, MD, MSc
Associate Professor, Departments of Medicine, Epidemiology and Biostatistics,
Office of Academic Military Medicine, Western University, London, Ontario,
Canada
Ashfaq Balla, MD
Assistant Professor of Medicine, Division of Renal Medicine, UMass Chan
Medical School, Worcester, Massachusetts
Gisela I. Banauch, MD, MS, Dr Med (German)
Professor, Department of Medicine, UMass Chan Medical School, Worcester,
Massachusetts
Stephen L. Barnes, MD
Professor, Department of Surgery, University of Missouri, Columbia, Missouri
David M. Bebinger, MD
Assistant Professor, Department of Internal Medicine, Division of Infectious
Diseases and Immunology, UMass Chan Medical School, Worcester,
Massachusetts
Robert W. Belknap, MD
Associate Professor, Division of Infectious Diseases, Department of Medicine,
University of Colorado Anschutz Medical Campus, Aurora, Colorado
Isabelita R. Bella, MD
Associate Professor, UMass Chan Medical School, Department of Neurology,
UMass Memorial Medical Center, Worcester, Massachusetts
Emanuelle Bellaguarda, MD
Assistant Professor of Medicine, Northwestern University Feinberg School of
Medicine, Chicago, Illinois
Ricardo J. Bello, MD, MPH
Chief Resident, General Surgery, UMass Chan Medical School, Worcester,
Massachusetts
William Beninati, MD, FCCM
Senior Medical for TeleHealth, Patient Placement and Transfer, and Air Medical
Transport, Intermountain Healthcare, Salt Lake City, Utah
Michael C. Bennett, MD
Assistant Professor, Department of Internal Medicine, Washington University in
St. Louis, St. Louis, Missouri
Hannah F. Bensimhon, MD
Assistant Professor, Department of Medicine, Geisel School of Medicine,
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Andrew C. Bernard, MD
Professor, Department of Surgery, University of Kentucky College of Medicine,
Lexington, Kentucky
Kristen G. Berrebi, MD
Clinical Assistant Professor, Director of Pediatric Dermatology, Departments of
Dermatology and Pediatrics, University of Iowa Stead Family Children’s
Hospital, Iowa City, Iowa
Michael C. Beuhler, MD
Professor of Emergency Medicine, North Carolina Poison Control, Atrium
Healthcare System, Charlotte, North Carolina
Christine L. Bielick Kotkowski, MD
Assistant Professor of Medicine, Department of Medicine, Division of
Pulmonary, Allergy, and Critical Care Medicine, UMass Chan Medical School,
Worcester, Massachusetts
Steven B. Bird, MD
Professor, Department of Emergency Medicine, UMass Chan Medical School,
Worcester, Massachusetts
Erin A. Bohula, MD, DPhil
Assistant Professor, Department of Internal Medicine, Cardiology Division,
Harvard Medical School, Brigham and Women’s Hospital, Boston,
Massachusetts
Marc P. Bonaca, MD, MPH
Professor of Medicine, Cardiology and Vascular Medicine, University of
Colorado School of Medicine, Aurora, Colorado
Lilly A. Bothwell, MBA
Partner Engagement Associate, Department of Strategy & Innovation, Memorial
Sloan Kettering Cancer Center, New York, New York
Suzanne F. Bradley, MD
Professor Emerita, Department of Internal Medicine/Division of Infectious
Diseases, University of Michigan Medical School, Ann Arbor, Michigan
Emmanouil S. Brilakis, MD, PhD
Director, Center for Complex Coronary Interventions, Allina Health Minneapolis
Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis,
Minnesota
Or Bruck, DO
Fellow, Pulmonary and Critical Care, Baylor College of Medicine, Houston,
Texas
Jennie A. Buchanan, MD
Associate Professor, Department of Emergency Medicine, University of
Colorado School of Medicine, Denver Health and Hospital Authority/Rocky
Mountain Poison & Drug Safety, Denver, Colorado
Keith K. Burkhart, MD
Senior Advisor for Medical Toxicology, Food and Drug Administration, Silver
Spring, Maryland
Mitchell Cahan, MD, MBA, FACS
Chairman, Department of Surgery, Mount Auburn Hospital, Cambridge,
Massachusetts, Vice Chairman, Roberta and Stephen R. Weiner Department of
Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
