2nd Edition HARRISON’S TM Pulmonary and Critical Care Medicine Derived from Harrison’s Principles of Internal Medicine, 18th Edition Editors Dan L Longo, md Professor of Medicine, Harvard Medical School; Senior Physician, Brigham and Women’s Hospital; Deputy Editor, New England Journal of Medicine, Boston, Massachusetts Dennis L Kasper, md William Ellery Channing Professor of Medicine, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts J Larry Jameson, md, phd Robert G Dunlop Professor of Medicine; Dean, University of Pennsylvania School of Medicine; Executive Vice-President of the University of Pennsylvania for the Health System, Philadelphia, Pennsylvania Anthony S Fauci, md Chief, Laboratory of Immunoregulation; Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland Stephen L Hauser, md Robert A Fishman Distinguished Professor and Chairman, Department of Neurology, University of California, San Francisco, San Francisco, California Joseph Loscalzo, md, PhD Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-inChief, Brigham and Women’s Hospital, Boston, Massachusetts 2nd Edition HARRISON’S TM Pulmonary and Critical Care Medicine Editor Joseph Loscalzo, Md, Phd Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital, Boston, Massachusetts New York   Chicago   San Francisco   Lisbon   London   Madrid   Mexico City Milan   New Delhi   San Juan   Seoul   Singapore   Sydney   Toronto Copyright © 2013 by McGraw-Hill Education, LLC All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-181495-9 MHID: 0-07-181495-7 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-181494-2, MHID: 0-07-181494-9 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please e-mail us at bulksales@mcgraw-hill.com Dr Fauci’s work as an editor and author was performed outside the scope of his employment as a U.S government employee This work represents his personal and professional views and not necessarily those of the U.S government This book was set in Bembo by Cenveo® Publisher Services The editors were James F Shanahan and Kim J Davis The production supervisor was Catherine H Saggese Project management was provided by Tania Andrabi, Cenveo Publisher Services The cover design was by Thomas DePierro Cover illustration, x-ray of the lungs, from BSIP/Science Source TERMS OF USE This is a copyrighted work and McGraw-Hill Education, LLC and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill Education and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill Education has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise Contents Contributors vii 14 Common Viral Respiratory Infections 157 Raphael Dolin Preface xi 15 Pneuzmocystis Infections 168 A George Smulian, Peter D Walzer SECTION I Diagnosis of Respiratory Disorders 16 Bronchiectasis and Lung Abscess 172 Rebecca M Baron, John G Bartlett   Approach to the Patient with Disease of the Respiratory System Patricia Kritek, Augustine Choi 17 Cystic Fibrosis 179 Richard C Boucher   Dyspnea Richard M Schwartzstein 18 Chronic Obstructive Pulmonary Disease 185 John J Reilly, Jr., Edwin K Silverman, Steven D Shapiro   Cough and Hemoptysis 14 Patricia Kritek, Christopher Fanta   Hypoxia and Cyanosis 21 Joseph Loscalzo 19 Interstitial Lung Diseases 197 Talmadge E King, Jr   Disturbances of Respiratory Function 26 Edward T Naureckas, Julian Solway 20 Deep Venous Thrombosis and Pulmonary Thromboembolism 211 Samuel Z Goldhaber   Diagnostic Procedures in Respiratory Disease 36 Anne L Fuhlbrigge, Augustine M K Choi 21 Disorders of the Pleura and Mediastinum 221 Richard W Light   Atlas of Chest Imaging 45 Patricia Kritek, John J Reilly, Jr 22 Disorders of Ventilation 227 John F McConville, Julian Solway SECTION II 23 Sleep Apnea 232 Neil J Douglas Diseases of the respiratory system 24 Lung Transplantation 237 Elbert P Trulock   Asthma 66 Peter J Barnes   Hypersensitivity Pneumonitis and Pulmonary Infiltrates With Eosinophilia 85 Alicia K Gerke, Gary W Hunninghake Section III General Approach to the Critically Ill Patient 10 Occupational and Environmental Lung Disease 93 John R Balmes, Frank E Speizer 25 Approach to the Patient with Critical Illness 244 John P Kress, Jesse B Hall 11 Pneumonia 105 Lionel A Mandell, Richard Wunderink 26 Mechanical Ventilatory Support 256 Bartolome R Celli 12 Tuberculosis 121 Mario C Raviglione, Richard J O’Brien 27 Approach to the Patient with Shock 263 Ronald V Maier 13 Influenza 147 Raphael Dolin v Contents vi Section IV Common Critical Illnesses and Syndromes 28 Severe Sepsis and Septic Shock 276 Robert S Munford 29 Acute Respiratory Distress Syndrome 288 Bruce D Levy, Augustine M K Choi 37 Fluid and Electrolyte Disturbances 375 David B Mount 38 Acidosis and Alkalosis 400 Thomas D DuBose, Jr 39 Coagulation Disorders 414 Valder R Arruda, Katherine A High 30 Cardiogenic Shock and Pulmonary Edema 295 Judith S Hochman, David H Ingbar 40 Treatment and Prophylaxis of Bacterial Infections 427 Gordon L Archer, Ronald E Polk 31 Cardiovascular Collapse, Cardiac Arrest, and Sudden Cardiac Death 303 Robert J Myerburg, Agustin Castellanos 41 Antiviral Chemotherapy, Excluding Antiretroviral Drugs 450 Lindsey R Baden, Raphael Dolin 32 Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction 313 Christopher P Cannon, Eugene Braunwald 42 Diagnosis and Treatment of Fungal Infections 465 John E Edwards, Jr 33 ST-Segment Elevation Myocardial Infarction 321 Elliott M Antman, Joseph Loscalzo 34 Coma 341 Allan H Ropper 35 Neurologic Critical Care, Including HypoxicIschemic Encephalopathy, and Subarachnoid Hemorrhage 351 J Claude Hemphill, III, Wade S Smith, Daryl R Gress Section V Disorders Complicating Critical Illnesses and their Management 36 Dialysis in the Treatment of Renal Failure 368 Kathleen D Liu, Glenn M Chertow 43 Oncologic Emergencies 469 Rasim Gucalp, Janice Dutcher Appendix Laboratory Values of Clinical Importance 485 Alexander Kratz, Michael A Pesce, Robert C Basner, Andrew J Einstein Review and Self-Assessment 511 Charles Wiener, Cynthia D Brown, Anna R Hemnes Index 573 vii Contributors Numbers in brackets refer to the chapter(s) written or co-written by the contributor Agustin Castellanos, MD Professor of Medicine, and Director, Clinical Electrophysiology, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida [31] Elliott M Antman, MD Professor of Medicine, Harvard Medical School; Brigham and Women’s Hospital; Boston, Massachusetts [33] Gordon L Archer, MD Professor of Medicine and Microbiology/Immunology; Senior Associate Dean for Research and Research Training, Virginia Commonwealth University School of Medicine, Richmond, Virginia [40] Bartolome R Celli, MD Lecturer on Medicine, Harvard Medical School; Staff Physician, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [26] Valder R Arruda, MD, PhD Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania [39] Glenn M Chertow, MD, MPH Norman S Coplon/Satellite Healthcare Professor of Medicine; Chief, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California [36] Lindsey R Baden, MD Associate Professor of Medicine, Harvard Medical School; DanaFarber Cancer Institute, Brigham and Women’s Hospital, Boston, Massachusetts [41] Augustine M K Choi, MD Parker B Francis Professor of Medicine, Harvard Medical School; Chief, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [1, 6, 29] John R Balmes, MD Professor of Medicine, San Francisco General Hospital, San Francisco, California [10] Raphael Dolin, MD Maxwell Finland Professor of Medicine (Microbiology and Molecular Genetics), Harvard Medical School; Beth Israel Deaconess Medical Center; Brigham and Women’s Hospital, Boston, Massachusetts [13, 14, 41] Peter J Barnes, DM, DSc, FMedSci, FRS Head of Respiratory Medicine, Imperial College, London, United Kingdom [8] Neil J Douglas, MD, MB ChB, DSc, Hon MD, FRCPE Professor of Respiratory and Sleep Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom [23] Rebecca M Baron, MD Assistant Professor, Harvard Medical School; Associate Physician, Department of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [16] Thomas D DuBose, Jr., MD, MACP Tinsley R Harrison Professor and Chair, Internal Medicine; Professor of Physiology and Pharmacology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina [38] John G Bartlett, MD Professor of Medicine and Chief, Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland [16] Janice Dutcher, MD Department of Oncology, New York Medical College, Montefiore, Bronx, New York [43] Robert C Basner, MD Professor of Clinical Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York [Appendix] John E Edwards, Jr, MD Chief, Division of Infectious Diseases, Harbor/University of California, Los Angeles (UCLA) Medical Center, Torrance, California; Professor of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California [42] Richard C Boucher, MD Kenan Professor of Medicine, Pulmonary and Critical Care Medicine; Director, Cystic Fibrosis/Pulmonary Reseach and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina [17] Eugene Braunwald, MD, MA (Hon), ScD (Hon) FRCP Distinguished Hersey Professor of Medicine, Harvard Medical School; Founding Chairman, TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts [32] Andrew J Einstein, MD, PhD Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons; Department of Medicine, Division of Cardiology, Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York [Appendix] Cynthia D Brown Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia [Review and Self-Assessment] Christopher Fanta, MD Associate Professor of Medicine, Harvard Medical School; Member, Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Boston, Massachusetts [3] Christopher P Cannon, MD Associate Professor of Medicine, Harvard Medical School; Senior Investigator, TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts [32] Anne L Fuhlbrigge, MD, MS Assistant Professor, Harvard Medical School; Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Boston, Massachusetts [6] vii viii Contributors Alicia K Gerke, MD Associate, Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, Iowa [9] Patricia Kritek, MD, EdM Associate Professor, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington [1, 3, 7] Samuel Z Goldhaber, MD Professor of Medicine, Harvard Medical School; Director, Venous Thromboembolism Research Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts [20] Bruce D Levy, MD Associate Professor of Medicine, Harvard Medical School; Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [29] Daryl R Gress, MD, FAAN, FCCM Professor of Neurocritical Care and Stroke; Professor of Neurology, University of California, San Francisco, San Francisco, California [35] Richard W Light, MD Professor of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee [21] Rasim Gucalp, MD Professor of Clinical Medicine, Albert Einstein College of Medicine; Associate Chairman for Educational Programs, Department of Oncology; Director, Hematology/Oncology Fellowship, Montefiore Medical Center, Bronx, New York [43] Kathleen D Liu, MD, PhD, MAS Assistant Professor, Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, California [36] Jesse B Hall, MD, FCCP Professor of Medicine, Anesthesia and Critical Care; Chief, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois [25] Joseph Loscalzo, MD, PhD Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital, Boston, Massachusetts [4, 33] Anna R Hemnes Assistant Professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee [Review and Self-Assessment] Ronald V Maier, MD Jane and Donald D Trunkey Professor and Vice-Chair, Surgery, University of Washington; Surgeon-in-Chief, Harborview Medical Center, Seattle, Washington [27] J Claude Hemphill, III, MD, MAS Professor of Clinical Neurology and Neurological Surgery, Department of Neurology, University of California, San Francisco; Director of Neurocritical Care, San Francisco General Hospital, San Francisco, California [35] Lionel A Mandell, MD, FRCP(C), FRCP(LOND) Professor of Medicine, McMaster University, Hamilton, Ontario, Canada [11] Katherine A High, MD Investigator, Howard Hughes Medical Institute; William H Bennett Professor of Pediatrics, University of Pennsylvania School of Medicine; Director, Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania [39] Judith S Hochman, MD Harold Snyder Family Professor of Cardiology; Clinical Chief, Leon Charney Division of Cardiology; Co-Director, NYU-HHC Clinical and Translational Science Institute; Director, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York [30] Gary W Hunninghake, MD Professor, Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, Iowa [9] David H Ingbar, MD Professor of Medicine, Pediatrics, and Physiology; Director, Pulmonary Allergy, Critical Care and Sleep Division, University of Minnesota School of Medicine, Minneapolis, Minnesota [30] John F McConville, MD Assistant Professor of Medicine, University of Chicago, Chicago, Illinois [22] David B Mount, MD, FRCPC Assistant Professor of Medicine, Harvard Medical School, Renal Division, VA Boston Healthcare System; Brigham and Women’s Hospital, Boston, Massachusetts [37] Robert S Munford, MD Bethesda, Maryland [28] Robert J Myerburg, MD Professor, Departments of Medicine and Physiology, Division of Cardiology; AHA Chair in Cardiovascular Research, University of Miami Miller School of Medicine, Miami, Florida [312] Edward T Naureckas, MD Associate Professor of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois [5] Richard J O’Brien, MD Head, Product Evaluation and Demonstration, Foundation for Innovative and New Diagnostics (FIND), Geneva, Switzerland [12] Talmadge E King, Jr., MD Julius R Krevans Distinguished Professor in Internal Medicine; Chair, Department of Medicine, University of California, San Francisco, San Francisco, California [19] Michael A Pesce, PhD Professor Emeritus of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons; Columbia University Medical Center, New York, New York [Appendix] Alexander Kratz, MD, PhD, MPH Associate Professor of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons; Director, Core Laboratory, Columbia University Medical Center, New York, New York [Appendix] Ronald E Polk, PharmD Professor of Pharmacy and Medicine; Chairman, Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University/ Medical College of Virginia Campus, Richmond, Virginia [40] John P Kress, MD Associate Professor of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois [25] Mario C Raviglione, MD Director, Stop TB Department, World Health Organization, Geneva, Switzerland [12] Contributors John J Reilly, Jr., MD Executive Vice Chairman; Department of Medicine; Professor of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania [7, 18] Allan H Ropper, MD Professor of Neurology, Harvard Medical School; Executive Vice Chair of Neurology, Raymond D Adams Distinguished Clinician, Brigham and Women’s Hospital, Boston, Massachusetts [34] Richard M Schwartzstein, MD Ellen and Melvin Gordon Professor of Medicine and Medical Education; Associate Chief, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts [1] Steven D Shapiro, MD Jack D Myers Professor and Chair, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania [18] Edwin K Silverman, MD, PhD Associate Professor of Medicine, Harvard Medical School; Channing Laboratory, Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts [18] Wade S Smith, MD, PhD Professor of Neurology, Daryl R Gress Endowed Chair of Neurocritical Care and Stroke; Director, University of California, San Francisco Neurovascular Service, San Francisco, San Francisco, California [35] A George Smulian, MBBCh Associate Professor of Medicine, University of Cincinnati College of Medicine; Chief, Infectious Disease Section, Cincinnati VA Medical Center, Cincinnati, Ohio [15] ix Julian Solway, MD Walter L Palmer Distinguished Service Professor of Medicine and Pediatrics; Associate Dean for Translational Medicine, Biological Sciences Division; Vice Chair for Research, Department of Medicine; Chair, Committee on Molecular Medicine, University of Chicago, Chicago, Illinois [5, 22] Frank E Speizer, MD E H Kass Distinguished Professor of Medicine, Channing Laboratory, Harvard Medical School; Professor of Environmental Science, Harvard School of Public Health, Boston, Massachusetts [10] Elbert P Trulock, MD Rosemary and I Jerome Flance Professor in Pulmonary Medicine, Washington University School of Medicine, St Louis, Missouri [24] Peter D Walzer, MD, MSc Professor of Medicine, University of Cincinnati College of Medicine; Associate Chief of Staff for Research, Cincinnati VA Medical Center, Cincinnati, Ohio [15] Charles M Wiener, MD Dean/CEO Perdana University Graduate School of Medicine, Selangor, Malaysia; Professor of Medicine and Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland [Review and Self-Assessment] Richard Wunderink, MD Professor of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois [11] Index infections in, 242 organ allocation and, 237–238 outcomes of, 239–242 procedure for, 238 pulmonary eosinophilia and, 91 recipient selection, 237 referral for, 527, 557 rejection of, 241 survival after, 527, 557 waiting list for, 237–238 Lung volume(s), 27, 31–32 assessment of, 10 ILDs and, 202 mineral dusts, 96 Lung volume reduction surgery (LVRS), 194 Lung water, 12 Lupus anticoagulant (LA), 426, 533, 568 LVRS See Lung volume reduction surgery Lymph node tuberculosis, 129–130, 130 Lymph nodes, 43–44 Lymphangioleiomyomatosis, 50f Lymphoblastoid, 463 Lymphocytic infiltrative disorders, 209 Lymphocytic interstitial pneumonitis, 209 Lymphomas, 225, 473, 476 Lymphomatoid granulomatosis, 209 Lymphopenia, 161 Lysis-centrifugation technique, 466 M africanum, 121 M avium complex (MAC), 136 M bovis, 121 M caprae, 121 Macrolide-resistant bacteria, 434 Macrolides, 107, 112–113, 430–431 C pneumoniae treated with, 82 drug interactions with, 441 pneumococcal resistance to, 111 Macrophage invasion, 124–125 Macrophage-activating response, Mycobacterium tuberculosis and, 126 Macrophages asthma and, 71 Mycobacterium tuberculosis and, 126–127 Magnesium deficiency, 391–392, 409 Magnetic resonance imaging (MRI) metastatic brain cancer, 475–476 MSCC and, 474–475 neoplastic meningitis, 476 respiratory system disease and, 39 Main pulmonary artery, 46f Malignancy hemoptysis and, 18 intestinal obstruction and, treatment, 472 lung transplantation and, 237 SVCS and, 469 Malignant biliary obstruction, 472–473 Malignant lesions, 40 Malignant obstruction, 472–473 Malignant pericardial disease, 470 Malignant pleural effusions, 222–223 Malignant spinal cord compression (MSCC), 473–475 Malnourishment, 169 Malnutrition, 359 Mandibular repositioning splint, 235 MAP See Mean systemic arterial pressure Massive hemoptysis, 19–20 Massive pulmonary embolism, 213, 216–217 Mast cells asthma and, 70–71 of asthmatics, 70–71 Mastadenovirus, 166 Material Safety Data Sheets, 93 Maternal smoking asthma and, 68 COPD and, 186 Matrix protein antigens, 147 Maximal inspiratory force (MIF), 360 MBC See Minimal bactericidal concentration MCA bifurcation aneurysms, 362–363 MDMA, 383 MDR pathogens See Multidrug-resistant pathogens Mean systemic arterial pressure (MAP), 353 Mechanical revascularization, 338 Mechanical ventilation, 119, 247, 256–262, 301, 412 cholestasis, 261 complications of, 261 conventional, 257 COPD and, acute exacerbations of, 196 failure to wean, 360–361 hypoventilation and, 229 idiopathic pulmonary fibrosis, 204 indications for, 256 593 modes of, 257–260, 259t, 527, 558 noninvasive, 257t patient, care of, 249–250 physiology of, 257, 528, 558 pneumonia and, 115 principles of, 257 prolonged, 262 prone positioning during, 260 pulmonary complications of, 261 pulse pressure change during, 247f support during, 261, 528, 558 types of, 256 weaning from, 261–262, 262f Meconium ileus, 181–182 Mediastinal compartments, 225 Mediastinal masses, 225 Mediastinoscopy, 43–44 Mediastinotomy, 43–44 Mediastinum disorders, 221–226, 225–226 Medical thoracoscopy, 43 Medication-associated hyperkalemia, 396 Megalodiatrizoate, 183 Megestrol acetate, 479 Melanoma, 473, 475 neoplastic meningitis, 476 small bowel resection and, 471 Meningitis, 349, 439 Meniscus, clear, 60f Mesenchymal tumors, 479 Mesotheliomas, 97, 223, 515, 542 Metabolic acidosis, 403 extracellular fluid volume expansion and, 410 high-anion-gap, 403t hyperaldosteronism and, 410 hypertension and, 410 non-anion gap, 407, 407t treatment, 403–404 Metabolic alkalosis, 408 causes of, 409t differential diagnosis, 408–409 of gastrointestinal origin, 409 hypoventilation and, 229 pathogenesis of, 408 of renal origin, 409 treatment, 410 Metabolic disorders, 343–344 Metabolic encephalopathies, 344, 354, 358 Metabolic support, 285 594 Metabolism, shock and, 266 Metal fume fever, 100–102 Metallic mercury, 103 Metapneumoviruses, 157 Metastatic brain cancer, 475–476 Metastatic disease, 222–223 Metastatic lung cancer, 25 Metastatic sarcoma, 62f Metastatic tumor, 473 Metastatic vertebral tumors, 475 Metered dose inhaler, 77, 77t Methacholine, 75 Methacholine challenge, 76, 102 Methanol, 406 Methanol-induced acidosis, 406 Methemoglobin, 23–24 Methenamine salts, 440 Methicillin-resistant Staphylococcus aureus See MRSA Methotrexate, 476, 482 asthma and, 80 ILDs and, 204 Methylprednisolone, 209 Methylxanthines, 196 Metronidazole, 177, 432 adverse reactions, 446 bioavailability of, 435 MIC See Minimal inhibitory concentration Micafungin, 468 Miconazole, 468 Microaspiration, 115, 120 Microbes, sensing, 278 Microbial molecules, 278 Microcirculation, 264 Microorganisms, 276, 277t Midazolam, 250, 261 Midbrain, 343 Middle mediastinum, 225 Mild hypovolemia, 270 Miliary tuberculosis, 128f, 133 Mineral dusts, 96 Mineral fiber, 96 Mineralocorticoid excess, 389t Mineralocorticoid receptor, 391 Minerals, 498t Minimal bactericidal concentration (MBC), 439 Minimal inhibitory concentration (MIC), 111 Minimally conscious state, 341 Mining, 102 Index Mitogen-activated protein (MAP), 79 Mitotane, 479 Mitral regurgitation, 300 Mixed acid-base disorders, 401–402, 402t Mixed arterial oxygenation, 32f Mixed viral and bacterial pneumonia, 152 Modafinil, 235 Mode, ventilator, 257, 259t Moderate hypovolemia, 270 Monday chest tightness, 99 Monitoring ICP, 354, 356 of ICU, 250–252 shock and, 267–268 Monobactams, 429 Monocytes, Mycobacterium tuberculosis and, 126–127 Monotherapy, 137 Morbidity acute respiratory illness and, 157 HRSV pneumonia and, 163 Morphine, 301 asthma and, 257 mechanical ventilation and, 261 STEMI and, 327 Mortality, 338 ARDS and, 293 severe sepsis, 287 VAP and, 119 Mortality rates avian influenza viruses and, 148 for ESRD, 368 idiopathic pulmonary fibrosis, 204 Motor efferents, Mounier-Kuhn syndrome, 172 Mouth-to-mouth respiration, 309 Moxifloxacin, 138 MRI See Magnetic resonance imaging MRSA (Methicillin-resistant Staphylococcus aureus), 107, 115, 119, 534, 543, 569 MSCC See Malignant spinal cord compression Mucociliary clearance, 105 Mucocutaneous HSV infections, 458–459 Mucocutaneous infections, 465 Mucus clearance CF lung and, 183 in cystic fibrosis, 180 hypersecretion, 73 Multidetector computed tomography, 38–39 Multidetector-row spiral computed tomography, 215 Multidrug-resistance tuberculosis, 141f, 141–142 Multidrug-resistant pathogens (MDR pathogens), 105, 117–118 ICU and, 252 Multilobar pneumonia, 513, 539 Multiorgan dysfunction, 280 Multiorgan system failure syndrome, 250, 358 Multiple antibiotic resistance, 435 Multiple inflammatory genes, 72 Multiple myeloma, 473 Multiple organ failure, 263 Multiple potential pathogens, 440 Multiresistant bacterial isolates, 435 Multisystem organ failure, 263f, 360 Multivessel coronary artery disease, 308 Mupirocin, 431, 434 Muscarinic receptor antagonists, 78 Muscle tremor, 83 Muscle wasting, 266 Muscular dystrophy, 526, 556 Mushroom worker’s disease, 85 Mushrooms, 92 Myasthenia gravis, 9, 35, 360, 361 Mycetoma, 63f Mycobacterial culture, 135 Mycobacterium bovis, 546 Mycobacterium marinum, 125 Mycobacterium tuberculosis, 109, 121–122, 127, 176 from exposure to infection, 123–124 host response to, 126 infection, innate resistance to, 125 from infection to disease, 124 mycobacterial lipids, 127 virulence of, 125 Mycoplasma, 67, 483 Mycoplasma pneumoniae, 167, 196 Mycotic aneurysms, 362 Myocardial compliance, 265 Myocardial contractility, 265 Myocardial disease, Myocardial dysfunction, 282 Myocardial infarction (MI), 305, 307–308 See also Acute myocardial infarction Index Myocardial perfusion imaging, 325 Myocardial rupture, 339 Myocarditis, 152 Myoclonic status epilepticus, 358 Myoglobinuria, 152 Myopathy, 361 Myositis, 152 Myxoma, 10 N antigen, 147 Na+, K+-ATPase, 390–391 Na+, K+-ATPase membrane pump, 376 Na+-Cl−, 377 Naftifine, 468 NaHCO3 therapy, 404 Naive immune system, of asthmatics, 71 Naloxone, 349 Narcolepsy, 234 Narcotic overdose, 349 Nasogastric decompression, 472 National Cooperative Dialysis Study, 371 National Emphysema Treatment trial, 195 Natural killer CD4+ T cells, 71 NDI See Nephrogenic diabetes insipidus nd-NMBAs See Nondepolarizing neuromuscular blocking agents Nd:YAG laser, 478 Neck stiffness, 362 Necrotic cell death, 351 Necrotizing pneumonia, 119, 175 Nedocromil sodium, 79 Neisseria meningitidis, 281 Neoplasm CAP and, 114 cough and, 16 Neoplastic meningitis, 476 Nephrogenic diabetes insipidus (NDI), 378, 387 Nephrotic syndrome, 12 Nephrotoxicity, cidofovir and, 459 Neurally adjusted ventilatory assist ventilation, 260 Neuraminidase inhibitors, 456 Neurogenic shock, 272 Neuroleptics, 358 Neurologic assessment, 353–354, 473 Neurologic critical care, 351 Neuromuscular blockade See Nondepolarizing neuromuscular blocking agents Neuromuscular blocking agents, 250 Neuromuscular paralysis, 257 Neuromuscular transmission disorders, 361 Neuron-specific enolase (NSE), 356 Neuropathy, 138, 360–361 Neurotrophins, 73 Neutropenia, 287 Neutropenic enterocolitis, 483–484, 484f Neutrophils, 71 NFkB See Nuclear factor kB Nicardipine, 365 Niemann-Pick disease, 209 Night sweats, 129 Nimodipine, 365 Nitrates, 301, 315–317, 327 Prinzmetal’s variant angina and, 319 Nitric oxide (NO) asthma and, 72 cigarette smoking, 84 hypoxemic respiratory failure and, 260 shock and, 264 Nitrofurantoin, 432, 440 Nitrogen dioxide, 94 Nitroglycerin, 301, 327, 334 CHF and, 335 Nitrosoureas, 482 NIV See Noninvasive ventilation NO See Nitric oxide Nocturnal dyspnea, 10 Nocturnal nasal positive-pressure ventilation, CSA and, 236 Nocturnal noninvasive positive-pressure ventilation, 229 Nodular fibrosis, 98 Nodular opacities, 52f Nodular parenchymal infiltrates, 54f Non-anion gap metabolic acidosis, 392, 407 Noncardiogenic pulmonary edema, 12–13 Noncaseating granulomas, 99 Noncontrast CT scan, 364 Nondepolarizing neuromuscular blocking agents (nd-NMBAs), 361 Noninvasive positive pressure ventilation (NIPPV), 552, 556 Noninvasive ventilation (NIV), 249, 256–257, 360, 527, 557–558 Nonpositive pressure ventilation, 250 Non-Q-wave MI, 323 Nonreabsorbable anions, 409 595 Nonreactive miliary tuberculosis, 133 Nonrespiratory disease, Nonspecific interstitial pneumonia (NSIP), 205 Nonsteroidal anti-inflammatory drugs See NSAIDs Nontransmural MI, 323 Norepinephrine hypovolemic shock and, 271 neurogenic shock and, 272 for shock, 264, 272 NRAMP1 gene, mycobacteria and, 125 NSAIDs (Nonsteroidal anti-inflammatory drugs), 329, 408 NSE See Neuron-specific enolase Nuclear factor kB (NFkB), 72 Nuclear medicine, 39–40 Nuclear workers, 94 Nucleic acid amplification test, 135 Nucleic acid synthesis, 432 Nucleoprotein antigens, 147 Nutrition, ICU and, 253 Nylon flock exposure, 102 Nystatin, 468 Obesity asthma and, 68 ventilatory restriction caused by, 34–35 Obesity-hypoventilation syndrome, 230 Obstructive airways disease, 29 Obstructive lung disease, 2–3, 33 Obstructive pattern (of ventilatory function), 29–30 Obstructive sleep apnea (OSA), 29, 232 Obstructive sleep apnea/hypopnea syndrome (OSAHS) clinical features, 233 diagnosis of, 234 differential diagnosis, 234 epidemiology, 233 health resources, 235 mechanism of obstruction, 232–233 treatment, 234–235 choice of, 235 how to treat, 235 whom to treat, 234–235 when to refer, 234 Obtundation, 341 596 Occupational lung diseases categories of, 95t disability assessment, 102 exposures, 3–4, 515, 542–543 asthma and, 68, 93 asthma triggers and, 75 COPD and, 93–94, 186 pulmonary disease association, 95t, 95–102, 102 patient history for, 93 physical examination for, 93 Octreotide, 472 Oculovestibular reflexes, 356 ODS See Osmotic demyelination syndrome ODTS See Organic dust toxic syndrome Ogilvie’s syndrome, 390 Oligonucleotides, 80 Oliguria, 559 Omalizumab asthma and, 80, 515, 541 refractory asthma, 83 Ommaya, 476 Oncologic emergencies, 469 metabolic, 479 structural-obstructive, 469–478 treatment-related, 480–484 Oncotic pressure, 12 Opacities, 204 OPAT See Outpatient parenteral antibiotic therapy Open lung biopsy, 44, 88, 88f Opiates endotracheal intubation and, 248 mechanical ventilation and, 250, 261 withdrawing care, 255 Oral alkali replacement, 406 Oral candidiasis, 79 Oral corticosteroids, 79, 84 Oral therapy, 435–436 Ores, 102 Organ allocation, lung transplantation and, 237–238 Organ failure, 250 Organ hypoperfusion, 285 Organ hypoxia, specific, 22 Organ perfusion, 285 Organ transplantation, 183 Organic dust toxic syndrome (ODTS), 89 Organic dusts, 99–100 Oropharyngeal decontamination, 120 Oropharyngeal thrush, 468 Index Orthodeoxia, 538 Orthomyxoviridae, 147 Orthopnea, 10, 12 OSA See Obstructive sleep apnea OSAHS See Obstructive sleep apnea/hypopnea syndrome Oseltamivir, 455–456 CAP and, 114 influenza and, 153, 154, 154t resistance to, 456 Osmolality, 375 Osmolar gap, 406 Osmotic demyelination syndrome, 383–384 Osteomyelitis, 439 Outdoor air pollution, 102–103 Outpatient parenteral antibiotic therapy (OPAT), 436 Oxazepam, 332 Oxiconazole, 468 Oxidative stress asthma and, 72 hypersensitivity pneumonitis and, 87 Oximetric studies, 23 Oxygen, 301 acute severe asthma and, 81 CAP and, 113 COPD and, 194 acute exacerbations of, 196 CSA and, 236 diffusion of, 30–31 humidified, airway obstruction and, 478 hypoventilation and, 229 for hypoxemia, 203 improper utilization, 23 increased requirement, hypoxia and, 22–23 pulmonary circulation and, 30–31 supplementation dyspnea and, 11 hypovolemic shock and, 271 Oxygen delivery, 252 Oxygen tension, Mycobacterium tuberculosis and, 126 Oxygen transport, 268, 268t Oxygenation, 292 Ozone, 68, 102–103 P aeruginosa, 113, 115, 281, 448 antibiotic resistance, 118 P jiroveci pneumonia, 41 Pacing electrodes, sinus bradycardia and, 338 Pain, 129 back, with cancer, 473–475 β-blockers, 327 cervical, 362 chest, 296, 322–323 cord compression and, 473 intestinal obstruction and, 472 leg, differential diagnosis for, 212–213, 213t mechanical ventilation and, 250 palliation, 475 shock and, 265 from STEMI, 322–323 Palatal weakness, 360 Palivizumab, 163 Palliative urinary diversion, 472 PAMPs See Pathogen-associated molecular patterns Pancreatic enzyme replacement, 183 Pancreatic islet cell tumors, 479 Pancytopenia, 133 Pandemics avian influenza viruses and, 148–149 influenza A virus, 148, 148t, 149 Panton-Valentine leukocidin, 111 PAP See Pulmonary alveolar proteinosis Papanicolaou method, 41 Para-aminosalicylic acid (PAS), 137–138 Paracentesis, 132 Parainfluenza virus, 157, 164, 518, 546 epidemiology of, 164–165 laboratory findings and diagnosis, 165 pathogenesis and clinical manifestations, 165 treatment of, 165 Paraneoplastic neuropathy, 472 Paraplegia, 131 Parapneumonic effusion, 222, 555–556 Parasitic infections, 200 Parenchyma (of lung), 197 Parenchymal cavity, 51f Parenchymal infection, Parenchymal lung diseases, 3, 44 Parenchymal spinal cord metastasis, 473 Parenteral antibiotic therapy, 374 Paresis of cranial nerves, 132 Parkinsonian syndrome, 358 Partial liquid ventilation (PLV), 260, 292 Index Particles, 94 Particulate exposures, 102–103 PAS See Para-aminosalicylic acid Patchy fibrosis, 100 Pathogen resistance, 118 Pathogen-associated molecular patterns (PAMPs), 267 Pathogens alveolar macrophages and, 105–106 in HCAP, 106t Patient history ILDs and, 198–201 UA/NSTEMI and, 314 Patient-ventilator dyssynchrony, 251 PBPs See Penicillin-binding proteins PCI See Percutaneous coronary intervention PcP See Pneumocystis pneumonia PCR See Polymerase chain reaction PCV See Pressure-control ventilation PDD See Tuberculin purified protein derivative PE See Pulmonary embolism PEA See Pulseless electrical activity Peak airway pressure, mechanical ventilation and, 251 Peak expiratory flow (PEF), 75 PEEP (Positive end-expiratory pressure), 258, 291–292, 293–294, 558 PEF See Peak expiratory flow Pegylated IFN, 464 Penciclovir, 460–461 Penicillamine, 204 Penicillin, 111, 113, 429 CAP and, 111 CF lung and, 183 eosinophilic pneumonias and, 91 minimal inhibitory concentration of, pneumococcal resistance and, 111 Penicillin-binding proteins (PBPs), 429 Penicillium, 90 Pentamidine, 170, 170t–171t, 396, 408 Penumbra, 351 Peptidoglycan, 427 Peramivir, 153, 455–456, 547 Percussion assessment, Percutaneous coronary intervention (PCI), 299–300, 313 Percutaneous needle aspiration, 41 Percutaneous transluminal angioplasty, 365 Percutaneous vertebroplasty, 475 Perfluorocarbon, 292 Pericardial effusion, 470–471 Pericardial fluid, 133 Pericardial metastasis, 470 Pericardial tamponade, 271–272, 470–471 Pericardial tuberculosis (tuberculous pericarditis), 132–133 Pericardiocentesis, 470–471 Pericarditis, 152, 338 Pericardium, 46f Periodic acid-Schiff, 466, 553 Perioperative mortality, 239 Perioperative respiratory failure, 249 Peripheral cyanosis, 23–24, 512, 538 Peripheral eosinophilia, 89 Peripheral leukocytosis, 106 Peripheral nerve stimulator, 361 Peripheral nervous system (PNS), critical care disorders of, 360–361 Peripheral vascular resistance, 280 Peritoneal cavity, 373 Peritoneal dialysis, 372–374 complications of, 373–374, 532, 566 forms of, 373 solutions, additives to, 373 Peritoneal equilibrium test, 373 Peritoneal fluid leukocyte count, 373 Peritoneal solute transport, 372 Peritonitis, 373, 566 Permissive hypercapnia, 257 Persistent vegetative state, 341, 349–350 Pertussis infection, 15 pH, 400, 402 Mycobacterium tuberculosis and, 126 Phagocytosis, 125 Pharmacokinetic profile, 435 Pharmacotherapy COPD, 193–194 for STEMI, 332–334 Pharyngeal surgery, 235 Phase alteration syndromes, 234 Phenobarbital, 254 Phenylephrine, 272, 559 Phenytoin CNS metastases and, 477 seizures, 254 Phosgene, 94 Phosphodiesterase inhibition, 78, 80 Physical examination dyspnea and, 10 597 hemoptysis and, 19–20 UA/NSTEMI and, 314 Physiologic dead space, 212 Pigeon breeder’s disease, 200 Piperacillin, 433 Plaque rupture, 313 Plasma aldosterone:PRA ratio, 392 Plasma HCO3−, 400 Plasmapheresis, 482 Plateau pressure, 251 Platelet adhesion, 318f Platinum compounds, 484 Platypnea, 10, 538 PLCH See Pulmonary Langerhans cell histiocytosis Pleural disorders, 221–226 Pleural effusion, 12, 60f, 221 algorithm for, 222f asbestos exposure and, 96 causes of, 224, 224t, 526, 556 complications of, 525, 555 diagnostic approach, 221 etiology, 221 exudative, 555 left, with clear meniscus, 60f mesothelioma and, 515, 542 pleural tuberculosis vs., 130 protein levels and, 221 treatment of, 515, 541–542 viral infection as cause of, 223 Pleural fluid, 223 Pleural liquid, 40 Pleural plaques, 96 Pleural thickening, 60f–61f Pleural tuberculosis, 130 Pleural tumor, 98 Pleuritic chest pain, 129 PLV See Partial liquid ventilation PM/DM See Polymyositis/dermatomyositis PMF See Progressive massive fibrosis Pneumatic compression boots, 261 Pneumatic compression stockings, 366 Pneumatosis intestinalis, 483 Pneumococcal pneumonia, 108 Pneumococcal resistance, 111 to fluoroquinolones, 111 to macrolides, 111 Pneumococcal urine antigen test, 110 Pneumococcal vaccines, 114 Pneumocystis carinii pneumonia, 483 598 Pneumocystis infection, 168 chest x-ray findings, 169f clinical features and diagnosis, 168–169 course of, 169–170 definition and description, 168 developmental stages of, 168 epidemiology of, 168 pathogenesis and pathology, 168 prevention of, 171 prognosis of, 169–170 treatment of, 170, 170t Pneumocystis jiroveci pneumonia, 519–520, 548–549 Pneumocystis pneumonia (PcP), 168, 548 Pneumocystosis prophylaxis of, 171t treatment, 170, 170t Pneumomediastinum, 226 Pneumonia, 105, 483 central cyanosis and, 24 community-acquired, 107–114 definition of, 105 health care-associated, 114–120 hemoptysis caused by, 18 hospital acquired, 120 influenza and, 151–152 lung allograft and, 242 multilobar, 513, 539 pathology of, 106–107 pathophysiology of, 105–106 right lower lobe, 56f secondary bacterial, 152 Pneumonia Severity Index (PSI), 110 Pneumothorax, 3–4, 59f, 224–225, 261, 526, 556 bronchoscopy and, 42 primary spontaneous, 556 right-sided, 59f PNS See Peripheral nervous system Pollutants indoor exposures, 103 outdoor air, 102–103 Polyarteritis nodosa, 76 Polyclonal immunoglobulins, 286 Polycythemia vera, 23 Polymer fume fever, 100 Polymerase chain reaction (PCR) amplification, in sputum sample, 41 CAP and, 110 HMPV and, 165 P carinii and, 483 Index Pneumocystis infection, 160 rhinoviruses and, 158 tuberculous meningitis and, 132 Polymyositis, 207 Polymyositis/dermatomyositis (PM/DM), 207 Polymyxins, 432 Polyneuropathy, 359 Polyuria, 388 Pontine hemorrhage, 348 Porins, 433 Posaconazole, 467–468 Positive end-expiratory pressure See PEEP Positive-pressure ventilation, 229, 301 Positron emission tomography, 40 Post nasal drip, 16–17 Posterior mediastinum, 225 Posthypercapnia, 410 Postictal state, 344 Post-infarction, 312, 339 Postparalytic syndrome, 250 Postphlebitic syndrome, 211, 220 Postprimary tuberculosis, 128–129 Postresuscitation care, 311 Potassium aldosterone effects on excretion of, 389 depletion, metabolic alkalosis and, 410 dietary, 392 homeostasis of plasma concentrations of, 388 nonrenal loss of, 390 renal loss of, 390–391 Potassium bicarbonate, 394 Potassium disorders, 388 hyperkalemia See Hyperkalemia hypokalemia See Hypokalemia Pott’s disease, 131, 131f Prasugrel, 318, 333 Prednisolone, 84 Prednisone, 90, 170t Pregnancy acyclovir and, 459 antibacterial agents and, 438, 439t asthmatics in, 83–84 drug toxicity and, 438, 439t pyrazinamide and, 143 ribavirin and, 457 venous thromboembolism disease and, 539 warfarin and, 218 Preload reduction of, 301 shock and, 265 Preload reduction, 302 Preload-reducing agents, 301 Pressure cycling, 257 Pressure-control ventilation (PCV), 259 Pressure-support ventilation (PSV), 258–260, 262 Pressure-volume curves, 27f Primary airway tumors, 478 Primary biliary cirrhosis, 424 Primary brain tumors, 477 Primary cardiac arrests, 309 Primary ciliary dyskinesia, 550 Primary drug resistance, 141 Primary infection, 281 Primary influenza viral pneumonia, 151–152 Primary multidrug-resistant tuberculosis, 141 Primary percutaneous intervention (PCI), 329, 330 Primary prevention, 306 Primary spontaneous pneumothorax, 224, 556 Primary tuberculosis, 124, 128 Primary ventricular fibrillation, 336 Prinzmetal’s variant angina, 319–320, 532 Prodromal complaints, 308 Prodromal symptoms, 362 Progressive lung injury, 291f Progressive massive fibrosis (PMF), 98 Progressive mechanical obstruction, 313 Progressive primary tuberculosis, 128 Progressive systemic sclerosis, 206 Prophylactic antiarrhythmic drugs, 336 Prophylactic intubation, 81 Propofol, 250, 257 Proportional assist ventilation, 260 Propoxyphene, 417 Propranolol, 393 Propylene glycol, 404 Prostaglandins, 71, 264 Prostatic malignancies, 472 Protamine sulfate, 218 Protease inhibitors, 187, 279, 464 Protein kinase A, 376 Prothrombin complex concentrate, 218 Prothrombin time, 534, 568 Prothrombotic states, 211 599 Index Proton pump inhibitors, 410 Provocative stress testing, 314 Provoked proximal leg DVT, 218 Pseudoaneurysm, 339 Pseudohyperkalemia, 394, 480 Pseudohypoaldosteronism, 396 Pseudohyponatremia, 384 Pseudomonas infection, 118, 120 Pseudomonas spp description of, 440 P aeruginosa, 173, 261, 521, 550 in cystic fibrosis, 180 lung allograft and, 242 PSI See Pneumonia Severity Index PSV See Pressure-support ventilation Public health resources, SARS and, 161 Pulmonary alveolar proteinosis (PAP), 207–208, 523, 553 Pulmonary angiography, 40, 216 Pulmonary arteries, 64f Pulmonary arteriovenous fistulae, 24 Pulmonary arteriovenous malformations (AVM), 63f Pulmonary artery catheter, 252 Pulmonary artery catheterization, 298, 301 Pulmonary capillary pressures, Pulmonary circulation, disturbances in, 29–30 Pulmonary compliance, 212 Pulmonary congestion, 334 Pulmonary dead space, 289, 291 Pulmonary disease, 95–102, 102 Pulmonary edema, 11–13, 51f, 300 central cyanosis and, 24 cytosine arabinoside and, 482 early signs, 12 noncardiogenic, 12–13 treatment of, 301 types of, 302 Pulmonary embolectomy, 219 Pulmonary embolism (PE), 63f, 211, 212, 365, 366 d-dimer, 524, 554 diagnostic modalities, 213f, 216, 216f, 524, 554 dyspnea associated with, 214 effusion secondary to, 223 fibrinolysis for, 555 integrated diagnostic approach, 216 massive, 524, 554 nonthrombotic, 213 scintigraphic imaging of, 39–40 treatment, risk stratification for, 216 Pulmonary eosinophilia, 91 Pulmonary fibrosis, 28, 197 ARDS and, 290–291 hypersensitivity pneumonitis and, 87 pathogenesis of, 199f Pulmonary function abnormalities, 34f Pulmonary function testing byssinosis and, 100 CBD and, 99 COPD and, 188, 522, 551 environmental lung disease and, 94 hypersensitivity pneumonitis and, 88 ILDs and, 202 respiratory system disease evaluations, Pulmonary hemorrhage hemoptysis and, 478 necrotizing pneumonia and, 119 Pulmonary hypertension, 33, 201 Pulmonary infarction, 213 Pulmonary infiltrates with eosinophilia, 90t, 90–91 treatment of, 515, 541–542 Pulmonary inflammation, 292 Pulmonary Langerhans cell histiocytosis (PLCH), 3, 206 Pulmonary lymphangioleiomyomatosis, 208 Pulmonary lymphangitic carcinomatosis, 482 Pulmonary mycotoxicosis, 89 Pulmonary nodules, 36 Pulmonary paragonimiasis, 18 Pulmonary parenchyma, examination, 10 MRI and, 39 Pulmonary parenchymal disease, 29 Pulmonary physiology, 507t Pulmonary receptors, Pulmonary rehabilitation programs, 11, 194 Pulmonary secretions, 181 Pulmonary thromboembolism (PE), 40, 217f Pulmonary thromboembolism-related shock, 219 Pulmonary thromboendarterectomy, 219–220 Pulmonary tuberculosis, 128 Pulmonary vascular resistance (PVR), 212 Pulmonary vasculature, 33–35 Pulmonary venous obstruction, 240 Pulse oximetry, 33, 251 Pulse rate, atropine and, 349 Pulseless electrical activity (PEA), 304, 309 Pulseless sustained ventricular tachycardia, 304 Pulseless ventricular tachycardia, 311f Pulsus paradoxus, 81, 272 Pupillary changes, 355 Pupillary reactions, 345–346 Pupillary reactivity, 342 Purified protein derivative (PPD), 136, 518, 545 Purpura fulminans, 423 Pyogenic bacterial osteomyelitis, 131 Pyrazinamide chronic renal failure and, 142 recommended dosage, 137t tuberculosis and, 137 Pyridoxine, 138 Pyroglutamic acidemia, 404 QO2 See Oxygen delivery Quality of life, lung transplantation and, 239–240 Quantitative-culture methods, 117 Quinidine, 336 Quinolones, 432, 434–435 Quinupristin, 431 Quinupristin/dalfopristin, 445 Q-wave MI, 323 Q waves, 323 Radiation injury, 482 Radiation pneumonitis, 483 Radiation therapy, 470 airway obstruction and, 478 glucocorticoids and, 475 Radiation units, 509t Radiation-induced lung toxicity, 483 Radicular pain, 473 Radiography COPD and, 192 M tuberculosis and, 135 for respiratory diseases, 36 Radioisotope scan, 40 Radiolabeled xenon gas, 40 600 Radionuclide imaging techniques, 325, 349 Radon gas, 103 Rales, 4, 106, 334 Randomized SHOCK, 299 RAS See Reticular activating system Rasburicase, 480, 571 Rasmussen’s aneurysm, 129 RAST, for asthma, 76 Raynaud’s disease, 10, 24 Reactivation tuberculosis, 128–129 Reactive oxygen species, 267 Rebleeding, 365 β-receptors, 73 Recombinant activated protein C (aPC), 286 Recombinant human DNAse, 183 Rectal examination, 332 Red hepatization phase, 106 Refractory asthma, 82 differential diagnosis of, 82 mechanisms of, 82 treatment for, 83 Refractory hypotension, 282 Regional hydrocephalus, 343 Reinfection, HRSV and, 162 Relapse, 447 Renal collecting duct, 377f Renal failure, 343–344 dialysis and, 368–374 hyperchloremic acidosis and, 406 treatment of, 406 Renal function tests, 501t–502t Renal tuberculosis, 131f Renal water excretion, 378 Renin, 265 Renin-angiotensin-aldosterone system, 334 Renin-angiotension-aldosterone axis, 396 Reperfusion, cardiogenic shock, 335 Reperfusion therapy, 295, 326, 327–329 STEMI and, 328f Rescue PCI, 330 Residual capacity, 28 Resistant mutants, 440 Resistant nosocomial organisms, 441 Respirator, brain death and, 349 Respiratory acid-base disorders, 411t Respiratory acidosis, 410, 412 Respiratory alkalosis, 412 Respiratory bronchiolitis, 201 Index Respiratory diseases, 36–44 Respiratory distress, 256 Respiratory drive, 229, 230 SIMV and, 258 Respiratory epithelium, 150 Respiratory failure, 21, 248, 256–257 CF lung and, 181–182 ICU and, 250–252 type II, 249 type III, 249 type IV, 249 Respiratory function, 26 disturbances of, 26–35 screening, mechanical ventilation and, 250 Respiratory hypoxia, 21–22 Respiratory infections antiviral drugs against, 455–457 in COPD, 186 viruses that cause, 518, 547 Respiratory muscle strength, 33 Respiratory neuromuscular disorders, 229 Respiratory quotient, 30 Respiratory response, 95t Respiratory support, 285 Respiratory syncytial virus (RSV), 67, 107, 157, 518, 547 ribavirin for, 457 Respiratory system, 26 compliance, 251 dyspnea, 8–9 cardiovascular disease v., 10–11 mechanics, 251 strength and load, 228f Respiratory system disease, approach to patient with, 2–6 clinical presentation chest radiography, 5, 5f patient history, 2–5 physical examination, common types, 3t, diagnostic studies, 5–6 pulmonary function testing for, Respiratory tract cystic fibrosis and, 181–182 infections of, 16–17 Respiratory viruses, 107, 157, 158t, 518, 546 Respiratory-bronchiolitis-associated interstitial lung disease (RB-ILD), 206 Resting volume, 27 Reteplase, 329 Reticular activating system (RAS), 342 Retroperitoneal hemorrhages, 425 Retrosternal clear space, normal, 45f Revascularization, 299–300 Reversible hematopoietic toxicity, 457 Reversible posterior leukoencephalopathy syndrome, 477 Rewarming, shock and, 273 Reye’s syndrome, 150, 152, 155 Rhabdomyolysis, 152, 405 Rheumatoid arthritis, 207 Rheumatoid factors HP and, 87 ILDs and, 201 Rhinoviruses, 157, 463–464, 518, 547 clinical manifestations of, 159 diagnosis and treatment, 159 epidemiology of, 158–159 etiologic agent, 157–158 pathogenesis of, 159 prevention, 159–160 Rhizopus spp., 465 Rhonchi, 4, 12 Ribavirin, 457 adenovirus infections, 167 HRSV and, 163 influenza treated with, 154 SARS-CoV and, 161 Rifabutin, 142 Rifampin, 432, 435, 436 adverse reactions, 446 dosage of, tuberculosis and, 137t M tuberculosis and, 135 tuberculosis and, 137, 139 Right atrial pressure, 247f Right atrium, 45f Right hemi-diaphragm, 45f Right mainstream bronchus, 46f Right middle lobe opacity, 55f Right upper lobe collapse chest x-ray of, 48f computed tomography of, 48f Right upper lobe infiltrate, 129f Right ventricle, normal, 45f Right ventricular dysfunction, 212 Right ventricular infarction shock secondary to, 300 treatment, 335–336 Right-to-left shunts, 24 Index Rimantadine, 456–457 influenza and, 153–155, 154t, 547 Ringer’s lactate, 270 Rituximab, 418, 484 Rivaroxaban, 218 RNA segment, 149 ROMK, 389 RSVIg, 163 Ruptured aneurysm, 362 S apiospermum infection, 467 S aureus pneumonia influenza infection and, 107 methicillin resistance in, 111 S pneumoniae, 109–110, 448 S pneumoniae resistance, 111 SABAs See Short-acting β2-agonists Saccular aneurysms, 362–364 clinical manifestations, 362–363 pathophysiology of, 362 SAH See Subarachnoid hemorrhage Salicylates acidosis induced by, 405 influenza and, 155 Salt-losing nephropathies, 380 Sandblasting, silicosis and, 97 SAPS scoring system, 246 Sarcoid, 53f stage I of, 53f stage II of, 54f stage IV of, 55f Sarcoidosis, 99, 197 SARS See Severe acute respiratory syndrome SARS-CoV See Severe acute respiratory syndrome-associated coronavirus SCD See Sudden cardiac death Scedosporium, 467 Scleroderma, 98 Sclerotherapy, 471 Scrofula, 130 Secondary brain injury, 355–356 Secondary brain insults, 351, 354 Secondary cardiac arrests, 309 Secondary hyperaldosteronism, 409 Secondary pneumothorax, 224–225 Secondary prevention, 306, 308 Secondary tuberculosis, 124, 128–129 Secretory antibodies, 151 Sedatives acute severe asthma and, 82 mechanical ventilation and, 250 Seizures, 254, 344, 354, 365, 457 cancer and, 477 Self-expanding metal stents, 472 Self-extubation, 120 Self-inoculation, 162 Semicoma, 341 Sensory afferents, 7–8 Sensory loss, 473 Sentinel bleeds, 363 Sepsis, 115, 250, 287, 358–359, 360, 361, 529, 560 See also Severe sepsis in critical care unit, 252 definitions, 276, 277t genetic factors in, 281 incidence, 276 mortality rates, 276 pathogenesis of, 529–530, 561 Sepsis-induced hypotension, 282 Septic encephalopathy, 358–359 Septic myopathy, 361 Septic response, 276, 283 Septic shock, 247, 276, 280 definitions, 276 mortality, 530, 561 pathogenesis of, 529–530, 561 treatment, 283–287 Serology, CAP and, 110 Serum albumin levels, 281 Serum antibody responses, 150–151 Serum brain injury biomarker S-100?, 359 Serum cardiac biomarkers, 323, 323–325 Serum immunoglobulins, 87 Serum magnesium, 334 Serum precipitins, 87–88 Severe acute respiratory syndrome (SARS), 107, 157, 160–162 Severe acute respiratory syndromeassociated coronavirus (SARS-CoV), 160–162 diagnosis, 161 prevention, 161–162 Severe anemia, 23 Severe central nervous system dysfunction, 353–356 Severe cerebral edema, 363 Severe inflammatory conditions, 250 Severe pulmonary hypertension, 64f Severe rhinosinusitis, 82 601 Severe sepsis, 276 cardiopulmonary complications, 282 clinical manifestations of, 281 definitions, 276, 277t diagnosis, 283 epidemiology, 276 etiology, 276 general support in, 285–286 laboratory findings, 283 microorganisms involved, 276, 277t neurologic complications, 282 pathophysiology of, 276–281 prevention of, 287 prognosis, 287 renal complications, 282 single pathogenesis to, 280–281 treatment, 283–287 Severity-of-illness scoring systems, 244–246 Shallow breathing, 289 Shock, 246, 250 adjunctive therapies, 272–273 cardiovascular response, 265 cellular responses to, 264 classification of, 264t EGDT and, 246f forms of, 269t, 270–272 hypoperfusion in, 249 inflammatory responses, 266–267 initial evaluation of, 246, 247 mechanical ventilation and, 247–248 metabolic derangements, 266 neuroendocrine response to, 265 organ dysfunction and, 280 pathogenesis and organ response to, 264–269 patient in, approach to, 263–273 patient monitoring, 267–268 patient resuscitation from, 269f pulmonary response, 265–266 renal response, 266 right ventricular infarction and, 300 treatment of, 267–269 Shock-induced tachypnea, 265 Shock-induced vicious cycle, 263, 263f Shohl’s solution, 406 Short-acting β2-agonists (SABAs), 77–78, 81 Short-course chemotherapy, 145 Short-course therapy, 449 Shortness of breath, 2–3, 8t 602 Shunt, 539 Shunting, 31 Signal transduction pathways, 80 “Signet-ring sign,” 174 Silent ischemia, 319 Silhouette sign, 55f Silica, 98 Silicates, 98 Silicosis, 97, 97–98, 515, 542 Silicotic nodules, 97 Silicotuberculosis, 143 Simple acid-base disorders, 400–401, 401t Simple coal worker’s pneumoconiosis (CWP), 98 Simple silicosis, 97 SIMV See Synchronized intermittent mandatory ventilation Sinus bradycardia, 337, 338 Sinus tachycardia, 302 SIRS See Systemic inflammatory response syndrome Sjögren’s syndrome, 207 Skeletal tuberculosis, 131 Skin lesions, 281 Skin prick tests for allergens, 76 BPA and, 84 toxic exposure and, 94 Skin testing See also Tuberculin skin test for asthma, 76 reactivity, Mycobacterium tuberculosis and, 127 SLE See Systemic lupus erythematosus SLED (Slow, low-efficiency dialysis), 368 Sleep hypoventilation and, 227 sleep apnea and, 234 small-volume aspiration in, 105 Sleep apnea, 232 Sleepy patient, 232t Small airway COPD and, 189 fatal asthma and, histopathology of, 69f Small bowel resection, 471 Small-cell lung cancer, 62f, 472 Small-particle aerosol, 150 Small-volume aspiration, 105 Smoke inhalation, 100 Smoking, 3, 19 See also Cigarette smoke asthma and, 66 cessation of, 193 Index Smooth muscle cells, 78 Smooth muscle hyperplasia, 204 Sodium modeling, 370 plasma levels of, 383 Sodium bicarbonate, 479, 480 Sodium citrate, 406 Sodium disorders, 379 hypernatremia See Hypernatremia hyponatremia See Hyponatremia overview of, 379–380 Sodium polystyrene sulfonate, 398–399 Sodium/water balance, 344 Solitary pulmonary nodules, 40, 62f, 135 Somatosensory evoked potentials (SSEPs), 356 Spectinomycin, 430 Speech therapy, 82 Spinal cord compression, 535, 570 Spinal tuberculosis, 131 Spine sign, 56f Spirometry, 188, 202 ARDS and, 294 lung volume determinations using, 32–33 Spontaneous breathing trials, 250 Spontaneous central sleep syndrome, 236 Spontaneous expectoration, 41 Spontaneous reperfusion of coronary artery, 328 Sputum, 16, 17 blood in, 16 collection, 41 culture, 109 tuberculosis and, 138–140 induction, 41 M tuberculosis and, 123, 135–136 production, primary influenza viral pneumonia, 152 purulent, 16, 129 sample, squamous epithelial cells in, 41 smear HIV-associated tuberculosis, 134 miliary tuberculosis and, 133 Squamous cell carcinoma, 61f Squamous epithelial cells, 41 SSEPs See Somatosensory evoked potentials ST elevation MI See STEMI Stable angina pectoris, 313 Staphylococcal chromosomal cassette types, 111 Staphylococcus aureus, 261, 374, 521, 550 in cystic fibrosis, 180 lung abscess caused by, 180 lung allograft and, 242 vancomycin and, 433–434 Staphylococcus epidermidis, vancomycinresistant, 433–434 Starling forces, 375 Starling’s law of capillary-interstitial liquid exchange, 264 Statins, 317, 319 Status asthmaticus, 514 Status epilepticus, 254 STEMI (ST elevation MI), 295, 300, 321, 326f, 330 ACE inhibitors and, 333, 334 arrhythmias after, 336 clinical presentation, 322–323 complications of, management, 334–339 elderly, 321–323 emergency department, 326–327 hospital phase management, 331–332 initial management, 325–331 discomfort control, 327 laboratory findings, 323–325 pathophysiology of, acute plaque rupture and, 321–322 patient transportation options, 328f pharmacotherapy, 332–334 physical findings, 323 pre-hospital care, 325–326 reinfarction and death, preventing, 339 reperfusion therapy, 328f return to work, 339 secondary prevention, 339–340 sedation and, 332 Stenotrophomonas maltophilia, 118 Stepwise therapy, chronic asthma, 81, 81f Stereotactic radiosurgery, 476 Steroid-sparing therapies asthma and, 80 refractory asthma, 83 Stiff lungs, 248 Stimulant drugs, 234 Stool analysis, 500t Streptococcus pneumoniae, 107 COPD and, acute exacerbations of, 196 macrolide resistant, 434 Streptogramins, 431, 434 Streptokinase, 329, 330, 333 Index Streptomycin, 137, 139 Stress, asthma triggers and, 75 Stress ulcers, 281 ICU and, 253 mechanical ventilation, 261 prophylaxis, 285 Stridor, 82 Stroke, 254, 348 Stroke volume, 265 Structural cells, 71 Structural lesion, 354 ST-segment elevation, 327 Stupor, 341, 343f Subacute hypersensitivity pneumonitis (HP), 87 Subacute-onset dyspnea, 511, 536 Subarachnoid blood, 365–366 Subarachnoid hemorrhage (SAH), 254, 354, 361 clinical presentation of, 531–532, 565 delayed neurologic deficits of, 363–364 laboratory evaluation and imaging, 364, 364f treatment, 364–366 Subcutaneous emphysema, 59f Subpleural atelectasis, 61f Subxiphoid pericardiotomy, 471 Succinylcholine chloride, 257, 395, 528, 559 Sudden cardiac death (SCD), 303 age factors, 304, 306f bradyarrhythmias and, 338 causes, 305t electrical mechanisms, 530, 563 epidemiology of, 304–305 etiology of, 304–305 forms of, 303–304 incidence of, 306f initiating events, 304–305 pathology, 305 population subsets/risk predictors, 307f prediction of, 305–308 prevention of, 306, 312 resuscitation from, 530–531, 563 Sudden collapse, 309 Sudden coma, 348 Sudden deaths, 303 Sudden infant death syndrome, 304 Sudden loss of consciousness, 362 Sudden natural death, 304 Sufentanil, 257 Sulconazole, 468 Sulfhemoglobin, 23–24 Sulfonamides, 432, 434 adverse reactions, 446 eosinophilic pneumonias and, 91 resistance, 170 Sulfur dioxide, asthma and, 68 Superior vena cava, 46f Superior vena cava syndrome (SVCS), 469, 469–470, 471f, 535, 570 Supportive therapy adenovirus infections, 167 coronaviruses and, 161 Suppressive therapy, with valacyclovir, 459 Suprapubic cystostomy, 472 Suprasternal mediastinoscopy, 44 Supraventricular arrhythmias, 337 Surfactant replacement therapy, 292 Surgery asthma and, 84 obstructive sleep apnea and, 235 oral, hemophilia and, 417 for SAH, 365 Survival ARDs, 294 lung transplantation and, 239 malignant pericardial disease and, 470 of out-of-hospital cardiac arrest, long-term management, 311–312 primary ventricular fibrillation and, 336 recipient, by pretransplantation diagnosis, 239t after sudden death See Sudden cardiac death Survivors, tuberculosis, 124 Susceptibility, infecting organism, 437 SVCS See Superior vena cava syndrome SVR See Systemic vascular resistance Swan-Ganz catheter, 301, 335 Sweat gland, 180 Sweat test, 182 Swine influenza vaccine, 153 Synchronized intermittent mandatory ventilation (SIMV), 258, 262, 527, 558 Syndrome of acute hydrocephalus, 348 Syndrome of apparent mineralocorticoid excess, 391 Syndrome of inappropriate antidiuresis, 381, 382t, 385 603 Syndrome of inappropriate antidiuretic hormone secretion (SIADH), 479 Syndromes of interstitial lung disease with diffuse alveolar hemorrhage, 208–209 Synercid, 431 Synergistic activity, 440 Systemic anticoagulation, 366 Systemic arterial pH, 400 Systemic corticosteroids, 79 Systemic diseases, 4, 322 Systemic host response, 278 Systemic inflammatory response syndrome (SIRS), 106, 250, 276, 358, 360, 361, 560 Systemic lupus erythematosus (SLE), 207, 524, 553 Systemic vascular resistance (SVR), 264 Systemic wasting, COPD and, 192 T cell lymphoma, 91 T cell-mediated hypersensitivity reaction, 85 T helper cells, asthma and, 68 T lymphocytes, 85, 87 asthma and, 69, 71 Mycobacterium tuberculosis and, 126–127 Tachyarrhythmias, 302 Tachycardia, 81 Tachypnea, 201, 214, 258, 289–290 TACTICS-TIMI, 315 Talc dusts, 98, 102 TARC See Thymus and activationregulated chemokine Target-site modification, 111 Task Force on Ethics, 254 Taxanes, 477, 484 TBI See Traumatic brain injury T-cell mediated immunity, 165 Teicoplanin, 429 Telaprevir, 464 Telbivudine, 463 Telithromycin, 113, 434 Temporary electrical pacing, 338 Tenecteplase (TNK), 329–330 Tenofovir, 462 Tension pneumothorax, 225 Teratomatous neoplasms, 225 Terbinafine, 468 Terbutaline, 77 604 Terconazole, 468 Tetracyclines, 107, 434 characteristics of, 431 drug interactions with, 445–446 TFPI See Tissue factor pathway inhibitor Thalamic hemorrhage, 346, 348 Theophylline, 77–78, 81, 552 clearance of, 78t COPD and, 194 plasma concentrations of, 78 refractory asthma and, 83 side effects, 78 Therapeutic drug monitoring, 496t–498t Thermodilution technique, cardiac output and, 268 Thermophilic actinomycetes, 100 Thermophilic antigens, 85 Thiamine, 359–360 Wernicke disease and, 349 Thiazide diuretics, 91, 380, 389–390, 399 Thick ascending limb of the loop of Henle, 376–377 Thiotepa, 476 Third nerve palsy, 343f, 564 Third space, fluid sequestration in, 378 Thirst, 375, 379 Thoracentesis, 41–42, 525, 555 for parapneumonic effusion, 222 pleural effusions and, 222 Thoracic radiation therapy, 483 Thoracoscopy medical, 43 metastatic disease and, 223 Thoracotomy, 44 Thorax infections, Thrombin, 322 Thrombocytopenia, 283, 422–424 Thromboembolism, 338, 424–425 Thrombolysis in Myocardial Infarction (TIMI) Grading System, 329 Thrombolysis in Myocardial Infarction Risk Score (TIMI risk score), 314, 315f Thrombosis, 318f Thrombotic thrombocytopenic purpura (TTP), 481 Thromboxane A2, 264 Thunderclap headache, 363 Thymus and activation-regulated chemokine (TARC), 72 Thyroid masses, 225 Index Thyrotoxic periodic paralysis, 390, 393 Ticagrelor, 318, 333 Tigecycline, 434 Time cycling, 257 TIMI risk score See Thrombolysis in Myocardial Infarction Risk Score Tioconazole, 468 Tipifarnib, 477 Tissue examination, ILDs and, 202 oxygenation, 280 perfusion, 404 samples, flexible fiberoptic bronchoscopy and, 42 Tissue factor pathway inhibitor (TFPI), 286f Tissue necrosis, 395 Tissue plasminogen activator (tPA), 254, 329–330 Tissue-damaging response, 126 TLC See Total lung capacity TLRs See Toll-like receptors TLS See Tumor lysis syndrome TMP-SMX See Trimethoprimsulfamethoxazole TNF-α See Tumor necrosis factor-α TNK See Tenecteplase Tobacco smoke, 102–103 Tobramycin, 183 Toll-like receptors (TLRs), 267, 278 Tolnaftate, 468 Tolvaptan, 385 Topical acyclovir, 458 Topical antifungal agents, 468 Torsades des pointes, 336 Torsemide, 301 Total body water, 375 Total cholesterol, 499t Total dead space ventilation, 31 Total disability, 102 Total lung capacity (TLC), 28 Toxic agents, 94, 100–102, 101t portal of entry, 103 Toxic chemicals, 100–102 Toxic drug-induced coma, 344 Toxic injury, shock and, 266 Toxic substances, blood-brain barrier and, 344 Toxicology, 496t–498t Toxin-induced acidosis, 405 tPA See Tissue plasminogen activator T-piece weaning, 261 Trace minerals, 498t Trachea chest tomogram of, 46f normal, 39f, 45f obstruction of, 470 Tracheal intubation, 349 Tracheostomy obstructive sleep apnea and, 235 in ventilated patients, 262 Traction bronchiectasis, 52f Transbronchial biopsy, 42 Transbronchial needle aspiration, 42 Transcription factors, 72 Transesophageal echocardiography, 216 Transfalcial herniation, 343 Transforming growth factor β (TGFβ), 85 Transgenic knockout mice, Mycobacterium tuberculosis and, 127 Transient ischemia, 305 Transmural myocardial infarction, 323 Transmural pressure, 28f Transpeptidation, 429 Transplant recipients, infections in, 242 Transplantation See Organ transplantation Transtentorial herniations, 342 Transthoracic echocardiography, PE and, 216 Transtubular potassium gradient, 392 Transudative pleural effusions, 221, 224t Trastuzumab, 484 Trauma patients, 119, 351 Traumatic brain injury (TBI), 354 Traumatic pneumothorax, 225 Traumatic shock, 271 “Tree in bud” opacities, and bronchiectasis, 58f Tretinoin, 477 Tricyclic depressants, 91 Trifluridine, 461 Trigger-induced asthma, 80–81 Trimethoprim, 432, 434 Trimethoprim-plus dapsone and clindamycin plus primaquine, pneumocystosis and, 170, 170t Trimethoprim-sulfamethoxazole (TMP-SMX), 483 bioavailability of, 435 pneumocystosis and, 170t, 170–171 “Triple H,” 365 Triple-drug regimen, 118t, 119 605 Index Tropical eosinophilia, 90 TST See Tuberculin skin test TTP See Thrombotic thrombocytopenic purpura Tube thoracostomy metastatic disease and, 223 secondary pneumothorax, 225 Tuberculin purified protein derivative (PPD), 136, 518, 545 Tuberculin skin test (TST), 124 Bacille Calmette-Guérin vaccination and, 143 HIV-associated tuberculosis, 134 latent M tuberculosis infection, 136 LTBI and, 143–144 miliary tuberculosis and, 133 Tuberculoma, 132 Tuberculosis, 17–18, 98, 121 alternative treatment regimens, 139t, 139–140 as etiologic agent, 121–122 cavities (in lungs), 126, 128, 129f central nervous system, 132 chest radiograph of, 517, 545 clinical manifestations of, 127–134 control, 145–146 cutaneous forms, 133 death from, 123f diagnosis of, 134–137 diseases and conditions favoring, 124, 124t disseminated, 133 epidemiology of, 122f, 122–124, 123f ethambutol, 137, 137t ethionamide, 138 Europe and, 122–123 extrapulmonary, 129 HIV co-infection and, 124, 518, 545 incidence rates, 122f latent, 518, 545–546 natural history of, 124 pathogenesis and immunity, 124–127 prevention, 143 pulmonary, 128 reactivation, 517, 544–545 resistant to first line drugs, second-line drugs, 138 risk factors for, 124t serologic tests, 136 spontaneous remission, 128 transmission of, 517, 544 treatment of, 137t, 137–143, 139t breastfeeding and, 143 clinical situations, 142–143 drug toxicity, monitoring, 139–140 drug-resistant strains, 140 drugs, 137–138 failure and relapse, 140–141 regimens, 138–139 response, monitoring, 139–140 upper airways, 130 Tuberculous empyema, 130 Tuberculous lymphadenitis See Lymph node tuberculosis Tuberculous meningitis, 132 Tuberculous otitis, 133 Tuberculous pericarditis See Pericardial tuberculosis Tuberculous peritonitis, 132 Tuberculous pleuritis, 223 Tuberculous spondylitis, 131 Tumor(s), 472 airway obstruction and, 478, 478f DIC and, 421 insulin-like growth factor II and, 479 masses, pain and, 472 SVCS and, 469–470 Tumor lysis syndrome (TLS), 480, 481f, 571 Tumor necrosis factor (TNF), 106, 278 Tumor necrosis factor-α (TNF-α), 82, 280, 481 asthma and, 71, 72 COPD and, 191, 192 host defense and, 278–279 Mycobacterium tuberculosis and, 126 shock and, 267 Tungsten carbide exposures, 99 Tunnel infections, 374 Tunneled dialysis catheter, 371 12-lead ECG, 327 Two-dimensional echocardiography, 325 left ventricular aneurysm, 339 right ventricular infarction and, 336 Type brittle asthma, 83 Type brittle asthma, 83 Type II fiber atrophy, 361 Tyrosine kinases, 482 UA/NSTEMI (Unstable angina/non-STelevation myocardial infarction), 313 clinical presentation, 314 definitions, 313 diagnostic evaluation and, 314, 315f long-term management, 319 pathophysiology, 313 risk stratification and prognosis, 314–315 treatment, 315–319 drugs in, 316t, 317t, 319 invasive v conservative, 318–319 UFH See Unfractionated heparin UIP See Interstitial pneumonitis Ultrafiltration, 370, 371–372 Ultrasonography, lung disease and, 40–41 Ultraviolet radiation, 145–146 Uncal transtentorial herniation, 342 Undecylenic acid, 468 Unfractionated heparin (UFH), 217, 318, 333, 366 UNICEF, 136 Unstable angina, 313 Upper airway function, ventilator weaning and, 261 obstruction, 470 Uranium miners, cancers and, 102 Urate oxidase, 480 Uremic acidosis, 407 oral alkali replacement and, 406 Ureteral stents, 472 Urgent PCI, 330 Urinalysis genitourinary tuberculosis and, 130 HUS and, 482 Urinary tract infections (UTIs), 440 Urinary tract obstruction, 472 Urine electrolytes, 408 heavy metal concentrations in, 94 Urine analysis, 501t–502t Ursodeoxycholic acid, cholestatic liver disease and, 184 Usual interstitial pneumonitis, 52f, 552–553 UTIs See Urinary tract infections Vaccines, 427 adenovirus infections, 167 influenza, 155–156 SARS and, 162 Vaginal candidiasis, 468 606 Valacyclovir, 457, 457–459 Valganciclovir, 460 Valproate, 358 Vancomycin, 429 CA-MRSA ad, 113 MRSA and, 119 Vancomycin-resistant bacteria, 433–434 Vancomycin-resistant enterococci (VRE), 433 VAP See Ventilator-associated pneumonia Vaptans, 385 Varicella-zoster virus (VZV), 152, 458, 460 Vascular receptors, 380 Vascular responses, 73 Vascular structures, 36 Vasoconstrictors, 404 Vasodepressor syncope, 303 Vasodilation, shock and, 264 Vasodilators, 335 circulating, shock and, 264 Vasogenic edema, 351 Vasopressin, 310, 375, 561 antagonists of, 385 glucocorticoids effect on, 381 hypovolemic shock and, 271 MDMA effects on, 383 osmolality changes, 376f secretion of, 381 shock and, 264 water balance affected by, 375–376 water permeability and, 377f Vasopressin infusion, 285 Vasopressors, 298–299 Vasospasm, 363, 364, 365 VATS See Video-assisted thoracic surgery VC See Vital capacity Vegetative state, 341 Venous obstruction, 24 Venous oxygen saturation, 252 Venous system, shock and, 265 Venous thromboembolism (VTE), 211 blood tests for, 214 cardiac biomarkers associated with, 214 clinical evaluation of, 212 diagnosis of, 212–214, 212–216 epidemiology of, 211 noninvasive imaging modalities for, 214–216 physiology of, 212 Index in pregnancy, 539 prevention, 220, 220t syndromes associated with, 212–214 treatment of, 525, 555 venous ultrasonography evaluations, 214 warfarin for, 555 Venous ultrasonography, 214 Ventilation, 26 acute severe asthma and, 81 adequacy of, 30 idiopathic pulmonary fibrosis effects on, 34 interventions used with, 261 measurement of, 31–33 nonconventional strategies, 260 obesity effects on, 34–35 restrictions in, 34–35 Ventilation disorders, 227–231 Ventilation scans, 215 Ventilation-perfusion lung scanning, 40, 524, 554 Ventilation-perfusion matching, 31 Ventilation-perfusion mismatch, 12, 22, 538–539 in chronic obstructive pulmonary disorder, 189 hypoxemia and, 31 severe sepsis, 282 Ventilation-perfusion ratios, 31 Ventilator management principles, 260 operation, terminology for, 259–260 weaning, 261–262 Ventilator-associated pneumonia (VAP), 105, 114, 261, 516–517, 544 clinical manifestations of, 116 complications of, 119 diagnosis, 116–117 differential diagnosis of, 116 empirical therapy, 118, 118t epidemiology of, 115–116 etiology of, 115 failure to improve, 119 follow-up, 119 microbiologic causes of, 115t pathogenic mechanisms for, 116t prevention strategies for, 116t, 119–120 prognosis, 119 treatment, 118–119 Ventilator-dependent respiratory failure, lung transplantation and, 237 Ventilator-induced lung injury, 291, 291f Ventilator-induced volutrauma, 248 Ventilatory function, 26 disturbances in, 26–30 measurement of, 28–29 Ventilatory pump, 10 Ventricular dysfunction, 323, 334 Ventricular fibrillation (VF), 303, 336 Ventricular pacing, 338 Ventricular premature beats, 336 Ventricular remodeling, 334 Ventricular septal rupture, 300 Ventricular tachycardia description of, 336 fibrillation and, 336–337 Ventriculostomy, 365, 476 Verapamil, 337, 365 Vertebral column metastatic tumor, 473 VF See Ventricular fibrillation Vidarabine, 461 Video-assisted thoracic surgery (VATS), 44 Video-assisted thoracoscopy, 225 Viral DNA, 458 Viral infections asthma and, 67 exudative pleural effusions, 223 inflammatory reaction and, 74 Viral neuraminidase enzyme, 455 Viral pathogens, 115 Viral respiratory infections, 157 adenovirus, 166–167 coronavirus, 160–162 general considerations, 157 human metapneumovirus, 164 parainfluenza virus, 164–165 rhinovirus, 157–160 Viral RNA, HRSV and, 162 Virtual bronchoscopy, 41, 540 Virus load, 450 Virus shedding, 151 Virus-coded thymidine kinase, 458 Viruses, 157, 450 Vital capacity (VC), 28, 28f, 359–360 Vitamin B6, 138 Vitamin E, 182 Vitamin K CF lung and, 182–183 cycle, 420f, 420–421 deficiency, 423–424 607 Index Vitamin K-dependent coagulation factors, 420–421, 533, 567–568 Vitamins, 498t Vocal cord dysfunction, 82 Vole bacillus, 121 Volume depletion, 408 Volume resuscitation, 272 Volume-controlled ventilation, 251 Volume-cycled ventilation, 257 Vomiting, 362, 408, 455 intestinal obstruction and, 472 Voriconazole, 467 VRE See Vancomycin-resistant enterococci VTE See Venous thromboembolism VZV See Varicella-zoster virus Waiting list, for lung transplantation, 237–238 Warfarin, 217–218, 333, 340, 525, 555 Warning arrhythmias, 336 Water, 375 dialysis and, 370 insensible losses of, 386 transport, in cystic fibrosis, 180 Water balance, 375–376 Water deprivation therapy, for hyponatremia, 385 Water excretion, 375–376 Water intake, 375 Watershed infarcts, 357 Water-soluble gases, 94 Watery diarrhea, 483 Wegener’s granulomatosis, 17, 209 Weight gain, 373–374 Weight loss, 129, 201 Wernicke’s disease, 358, 359, 360f pathogenesis of, 359–360 pathology of, 359 thiamine and, 349 treatment of, 360 “Wet” crackles, 536 Wheezes, 4, 12 WHO (World Health Organization), 136 tuberculosis and, 122, 123f tuberculosis control, 146 Whole-brain radiation therapy, 476 Williams–Campbell syndrome, 172 Winking owl sign, 474 Withdrawing care, 254–255 Withholding care, 254–255 Work of breathing, 256 Workers’ compensation systems, 102 World Federation of Neurosurgical Societies Scale, 363, 363t World Health Organization See WHO World Trade Center (WTC) disaster, environmental dust and, 102 Wuchereria bancrofti, 90 XDR-TB, 141, 142t Zanamivir, 114, 455–456, 547 influenza and, 153–154, 154t, 155 resistance to, 456 ... Associate, Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, Iowa [9] Patricia Kritek, MD, EdM Associate Professor, Division of Pulmonary and Critical Care Medicine, University... of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, Iowa [9] David H Ingbar, MD Professor of Medicine, Pediatrics, and Physiology; Director, Pulmonary Allergy, Critical Care. .. Anesthesia and Critical Care; Chief, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois [25] Joseph Loscalzo, MD, PhD Hersey Professor of the Theory and Practice