Critical Care Medicine: Principles of Diagnosis and Management in the Adult

1754 Pages·2019·132.037 MB·English

by  Joseph E. Parrillo, R. Phillip Dellinger

Critical Care Medicine
Principles of Diagnosis and
Management in the Adult
FIFTH EDITION
Joseph E. Parrillo, MD
Justice Marie L. Garibaldi Endowed Chair
Chairman, Heart and Vascular Hospital
Hackensack University Medical Center,
Professor and Chair, Department of Cardiology
Hackensack Meridian School of Medicine at Seton Hall University
Hackensack, New Jersey;
Professor of Medicine
Rutgers New Jersey Medical School
Newark, New Jersey
R. Phillip Dellinger, MD, MSc, MCCM
Professor of Medicine and Distinguished Scholar
Cooper Medical School of Rowan University;
Director Cooper Research Institute,
Senior Critical Care Attending
Cooper University Hospital
Camden, New Jersey
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
CRITICAL CARE MEDICINE: PRINCIPLES OF DIAGNOSIS AND ISBN: 978-0-323-44676-1
MANAGEMENT IN THE ADULT, FIFTH EDITION
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Previous editions copyrighted 2014, 2008, 2002, and 1995.
Library of Congress Control Number: 2018958993
Content Strategist: Nancy Duffy
Content Development Specialist: Anne Snyder
Publishing Services Manager: Julie Eddy
Senior Project Manager: Rachel E. McMullen
Design Direction: Patrick Ferguson
Printed in China
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To our families
Gale, Nicholas, Jenny, and Lena
and
Christa, Bart, Michael, Kate, Walker,
Lauren, Reid, and Meg
Preface
Few fields in medicine have grown, evolved, and changed as rapidly sections devoted to the critical care aspects of cardiovascular,
as critical care medicine over the past 40 years. From its origins pulmonary, infectious, renal, metabolic, neurologic, gastrointestinal,
in the postoperative recovery room and the coronary care unit, and hematologic-oncologic diseases. Subsequent chapters are devoted
the modern intensive care unit (ICU) represents the ultimate to important social, ethical, and other issues such as psychiatric
example of medicine’s ability to supply the specialized personnel disorders, severity of illness scoring systems, and administrative
and technology necessary to sustain and restore seriously ill persons issues in the ICU. This fifth edition has significant content additions
to productive lives. In more recent years critical care has extended and revisions, including new chapter authors for approximately a
beyond the walls of the ICU to the emergency department where third of our chapters. Online videos are also available featuring a
partnerships between intensivists and emergency medicine physicians variety of content areas, including echocardiograms and bedside
have been forged. Critically ill patients now may be held for ultrasounds from a variety of exam sites. Further, a series of questions
significant time periods in the emergency department, the post- and answers with rationale for correct and incorrect answers are
operative recovery room or special critical care holding areas while provided for each chapter to assist readers in board review and to
awaiting an ICU bed. While the field continues to evolve rapidly, reinforce the important content of each chapter.
sufficient principles, knowledge, and experience have accumulated Each chapter is designed to provide a comprehensive review of
in the past few decades to warrant the production of a textbook pertinent clinical, diagnostic, and management issues. This is
dedicated to adult critical care medicine. We chose to limit the primarily a clinical text, so the emphasis is on considerations
subject matter of our book to the critical care of adult patients to important to the practicing critical care physician; also presented,
allow the production of a comprehensive textbook in a single however, are the scientific (physiologic, biochemical, and molecular
volume. biologic) data pertinent to the pathophysiology and management
This book was envisioned to be multidisciplinary and multi- issues. We have aimed for a textbook length that is comprehensive
specialty, authored by acknowledged leaders in the field, and aimed but manageable. Substantial references (most now online) are
primarily at practicing critical care physicians who spend the better provided for readers wishing to explore subjects in greater detail.
part of their time caring for patients in an ICU. Thus the book We have identified key points and key references to highlight the
would be appropriate for critical care internists as well as for surgical most important issues within each chapter. Continued popular
or anesthesia critical care specialists. The goal was to produce the features of this fifth edition include a color-enhanced design and
acknowledged “best practice” standard in critical care medicine. clinically useful management algorithms.
The first edition of the textbook was published in 1995, co-edited We have been fortunate to attract a truly exceptional group of
by Joe Parrillo and Roger Bone. The book sold exceedingly well authors to write the chapters for Critical Care Medicine: Principles
for a first edition text. After the untimely death of Roger Bone in of Diagnosis and Management in the Adult. For each chapter, we
1997, Phil Dellinger joined Joe Parrillo as the co-editor for the have chosen a seasoned clinician-scientist actively involved in critical
second, third, fourth, and now this fifth edition. As co-editors, care who is one of a handful of recognized experts on his or her
we have labored to produce a highly readable text that can serve chapter topic. We have continued the international flavor of our
equally well for comprehensive review and as a reference source. authorship. To provide uniformity in content and style, one or
We felt that it was important for usability and accessibility to keep both of us have edited and revised each chapter.
the book to a single volume. This was a challenge, because critical We wish to thank the highly dedicated people who provided
care knowledge and technology have expanded significantly during us with the assistance needed to complete a venture of this mag-
the past decade. By placing emphasis on clear, concise writing and nitude. Our thanks go to Ellen Lawlor, for her administrative
keeping the focus on critical care medicine for the adult, this goal assistance; and to the excellent editorial staff at Elsevier, including
was achieved. Anne Snyder, Nancy Duffy, and Rachel McMullen.
Our view of critical care medicine is mirrored in the organization
of the textbook. Modern critical care is a multidisciplinary specialty Joseph E. Parrillo, MD
that includes much of the knowledge and technology contained Hackensack, New Jersey
in many disciplines represented by the classic organ-based subspecial- Newark, New Jersey
ties of medicine, as well as the specialties of surgery and anesthesiol-
ogy. The book begins with a section consisting of chapters on the R. Phillip Dellinger, MD, MSc, MCCM
technology, procedures, and pharmacology that are essential to Camden, New Jersey
the practicing critical care physician. This section is followed by
v
Contributors
Wissam Abouzgheib, MD Richard G. Barton, MD
Section Head, Interventional Pulmonary Professor of Surgery,
Associate Professor of Medicine Director, Surgical Critical Care Surgery
Cooper Medical School at Rowan University University of Utah, School of Medicine
Camden, New Jersey Salt Lake City, Utah
Mohanad Al-Obaidi, MD Thaddeus Bartter, MD
Infectious Disease Fellow Professor of Medicine
University of Texas Health Science Center at Houston Division of Pulmonary and Critical Care Medicine
Houston, Texas University of Arkansas for Medical Sciences
Little Rock, Arkansas
Mark B. Anderson, MD
Chief, Division of Cardiac Surgery Robert Berkowitz, MD, PhD
Heart and Vascular Hospital Director Heart Failure and Pulmonary Hypertension Program
Hackensack University Medical Center Heart and Vascular Hospital, Hackensack Meridian Health;
Hackensack, New Jersey Core Associate Professor
Department of Cardiology and Internal Medicine
Iram Aqeel, MD Hackensack Meridian School of Medicine at Seton Hall
Attending University
Hackensack University Medical Center Hackensack, New Jersey
Hackensack Meridian Health Network
Hackensack, New Jersey Thomas P. Bleck, MD, MCCM, FNCS
Professor of Neurology, Neurosurgery, Internal Medicine and
Sean M. Bagshaw, MD, MSc Anesthesiology
Associate Professor Rush University Medical Center
Department of Critical Care Medicine Chicago, Illinois
Faculty of Medicine and Dentistry
University of Alberta Ziad Boujaoude, MD, FCCP
Edmonton, Alberta, Canada Associate Professor of Medicine
Cooper Medical School of Rowan University
Robert A. Balk, MD Division of Pulmonary and Critical Care
Professor of Medicine Cooper University Hospital
Rush Medical College, Camden, New Jersey
Director, Division of Pulmonary, Critical Care, and Sleep
Medicine Frank Bowen, MD
Rush University Medical Center Associate Professor of Surgery
Chicago, Illinois Cooper Medical School of Rowan University
Camden, New Jersey
James C. Barrese, MD
Assistant Professor of Neurosurgery Samantha K. Brenner, MD, MPH
Department of Neurosurgery Cardiothoracic Intensivist
Cooper Medical School of Rowan University Hackensack University Medical Center
Cooper University Hospital Hackensack, New Jersey
Camden, New Jersey
vi
Contributors vii
Timothy G. Buchman, MD, PhD Ismail Cinel, MD, PhD
Professor of Surgery, Anesthesiology, and Biomedical Infomatics, Professor
Founding Director, (Emeritus) Department of Anesthesiology and Reanimation
Emory Critical Care Center Marmara University Faculty of Medicine
Emory University School of Medicine Istanbul, Turkey
Atlanta, Georgia
Damon H. Clark, MD
Eugene Bunnell, MD Assistant Professor of Surgery
Medical Director of Cardiothoracic Intensive Care Unit, Department of Acute Care Surgery
Vice Chairman of Critical Care Services University of Southern California
Heart and Vascular Hospital Los Angeles, California
Hackensack University Medical Center
Hackensack, New Jersey T.R. Craig, MB, BCh, BaO, FRCP, PhD, DICM (UK)
Consultant
Jeffrey P. Burns, MD, MPH Mater Hospital
Chief and Shapiro Chair of Critical Care Medicine Belfast, Northern Ireland, United Kingdom
Boston Children’s Hospital;
Professor of Anaesthesia (Pediatrics) Quinn A. Czosnowski, PharmD, BCPS
Harvard Medical School Critical Care Pharmacy Specialist
Boston, Massachusetts Indiana University Health Methodist Hospital
Indianapolis, Indiana
Pietro Caironi, MD
Anestesia e Rianimazione Hayan Dayoub, MD
Azienda Ospedaliero-Universitaria S. Luigi Gonzaga Assistant Professor of Neurosurgery
Orbassano, Italy; Cooper Medical School of Rowan University;
Dipartimento di Oncologia Co-Director Interventional Neurosurgery
Università degli Studi di Torino Cooper University Hospital
Turin, Italy Camden, New Jersey
Eleonora Carlesso, MSc Daniel De Backer, MD, PhD
Dipartimento di Fisiopatologia Mecico-Chirurgica e dei Professor
Trapianti Department of Intensive Care
Università degli Studi di Milano CHIREC Hospitals
Milan, Italy Université Libre de Bruxelles
Brussels, Belgium
Maurizio Cecconi, MD, FRCA, FFICM, MD(Res)
Humanitas Research Hospital and Humanitas University R. Phillip Dellinger, MD, MSc, MCCM
Milan, Italy Professor of Medicine and Distinguished Scholar
Cooper Medical School of Rowan University;
Louis Chaptini, MD Director Cooper Research Institute,
Assistant Clinical Professor Senior Critical Care Attending
Section of Digestive Diseases Cooper University Hospital
Yale University School of Medicine Camden, New Jersey
New Haven, Connecticut
Guillermo Domínguez-Cherit, MD, FCCM
Cherylee W.J. Chang, MD, FCCM, FACP, FNCS Director
Medical Director, Neuroscience Institute/Neurocritical Care Division of Pulmonary, Anesthesia, and Critical Care
The Queen’s Medical Center; Instituto Nacional de Ciencias Médicas y Nutrición Salvador
Clinical Professor of Medicine and Surgery Zubirán
John A. Burns School of Medicine Mexico City, Distrito Federal, Mexico
University of Hawaii
Honolulu, Hawaii David J. Dries, MSE, MD
Chair
Kevin K. Chung, MD Department of Surgery
Brooke Army Medical Center HealthPartners Medical Group/Regions Hospital
Fort Sam Houston, Texas; St. Paul, Minnesota;
Uniformed Services University of the Health Sciences Professor of Surgery
Bethesda, Maryland Department of Surgery
University of Minnesota
Minneapolis, Minnesota
viii Contributors
Adam B. Elfant, MD Kevin C. Gordon, MD
Associate Professor of Medicine Division of Gastroenterology and Liver Disease
Cooper Medical School of Rowan University; Cooper University Hospital
Associate Head Camden, New Jersey
Division of Gastroenterology and Liver Diseases
Cooper University Hospital Sara R. Gregg, MHA
Camden, New Jersey Executive Administrator
Emory Critical Care Center
E. Wesley Ely, MD Emory University School of Medicine
Professor of Medicine and Critical Care, Atlanta, Georgia
Associate Director of Aging Research, VA GRECC
Center for Health Services Research David P. Gurka, MD, PhD
Division of Allergy, Pulmonary and Critical Care Medicine Professor of Medicine
Vanderbilt University Medical Center Rush Medical College;
Nashville, Tennessee Director, Section of Critical Care Medicine
Department of Internal Medicine
Henry S. Fraimow, MD Rush University Medical Center
Associate Professor of Medicine Chicago, Illinois
Division of Infectious Diseases
Cooper Medical School of Rowan University Carmen M. Hernández-Cárdenas, MD, MSc
Camden, New Jersey Director
Department of Critical Care, Inhalotherapy, and Emergency
Heidi L. Frankel, MD, FACS Medicine
Department of Surgery Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío
University of Southern California-LAC Villegas”
Rancho Palos Verde, California Mexico City, Mexico
John F. Fraser, MBChB, PhD, FRCP (Glas), FRCA, Steven M. Hollenberg, MD
FFARCSI, FCICM Professor of Medicine
Professor of Anaesthesiology and Critical Care Cooper Medical School of Rowan University;
The University of Queensland School of Medicine; Director, Coronary Care Unit
Director, Critical Care Research Group Cooper University Hospital
The Prince Charles Hospital Camden, New Jersey
Brisbane, Queensland, Australia
Robert C. Hyzy, MD
Bruce C. Friedman, MD Professor
Joseph M. Still Burn Center at Doctor’s Hospital Division of Pulmonary and Critical Care Medicine
Augusta, Georgia University of Michigan
Ann Arbor, Michigan
Luciano Gattinoni, MD, FRCP
Department of Anesthesiology Judith Jacobi, BS, PharmD, BCCCP
Emergency and Intensive Care Medicine Critical Care Pharmacy Specialist
University of Göttingen Indiana University Health Methodist Hospital
Göttingen, Germany Indianapolis, Indiana
Martin Geisen, MD Vladimir Jelnin, MD
Institute of Anaesthesiology and Intensive Care Medicine Director, Cardiac Imaging Lab
Triemli Hospital Zurich Hackensack University Medical Center
Zurich, Switzerland Hackensack Meridian Health
Hackensack, New Jersey
Fredric Ginsberg, MD
Associate Professor of Medicine Amal Jubran, MD
Division of Cardiovascular Disease Professor of Medicine
Cooper Medical School of Rowan University Pulmonary and Critical Care Medicine
Camden, New Jersey Loyola University Medical Center
Maywood, Illinois;
Taya V. Glotzer, MD Section Chief
Associate Professor of Medicine Pulmonary and Critical Care Medicine
Hackensack Meridian Seton Hall School of Medicine Edward Hines Jr. Veterans Affairs Hospital
Rutgers New Jersey Medical School; Hines, Illinois
Director of Cardiac Research
Hackensack University Medical Center
Hackensack, New Jersey
Contributors ix
Navin K. Kapur, MD Anand Kumar, MD
Interventional Cardiologist Professor
Division of Cardiology Section of Critical Care Medicine,
Tufts Medical Center Section of Infectious Diseases
Boston, Massachusetts University of Manitoba
Winnipeg, Manitoba, Canada
George H. Karam, MD
Professor of Medicine Neil A. Lachant, MD
Louisiana State University Health Sciences Center Chief, Section of Hematology
Baton Rouge, Louisiana MD Anderson Cancer Center at Cooper;
Professor of Medicine
Constantine J. Karvellas, MD, SM, FRCPC, FCCM Cooper Medical School of Rowan University
Associate Professor of Medicine Camden. New Jersey;
Division of Gastroenterology (Liver Unit) Adjunct Professor Department of Lymphoma and Myeloma
Department of Critical Care Medicine; The University of Texas MD Anderson Cancer Center
Adjunct Professor, School of Public Health Sciences Houston, Texas
University of Alberta
Edmonton, Alberta, Canada Franco Laghi, MD
Professor of Medicine
Steven T. Kaufman, MD Division of Pulmonary and Critical Care Medicine
Associate Professor of Medicine Loyola University of Chicago Stritch School of Medicine
Cooper Medical School of Rowan University; Edward Hines Jr. Veterans Administration Hospital
Medical Director Hines, Illinois
Urban Health Institute,
Head, Division of Endocrinology Stephen E. Lapinsky, MBBCh, MSc, FRCPC
Camden, New Jersey Professor of Medicine
University of Toronto;
Tapan Kavi, MD Site Director
Assistant Professor of Neurology Intensive Care Unit
Cooper Medical School of Rowan University Mount Sinai Hospital
Cooper Neurological Institute Toronto, Ontario, Canada
Camden, New Jersey
Jennifer LaRosa, MD, FCCM, FCCP
Bernard Kim, MD Newark Beth Israel Medical Center—Robert Wood Johnson
Associate Medical Director of Heart Failure and Pulmonary Barnabas Health
Hypertension Program Newark, New Jersey
Heart and Vascular Hospital, Hackensack Meridian Health;
Core Assistant Professor G.G. Lavery, MB, BCh, BaO (Hons), MD, FJFICMI, FFARCSI
Department of Cardiology and Internal Medicine Consultant
Hackensack Meridian School of Medicine at Seton Hall Critical Care
University Royal Victoria Hospital
Hackensack, New Jersey Belfast, Northern Ireland, United Kingdom
Jason A. Kline, MD Kenneth V. Leeper, Jr., MD†
Assistant Professor of Medicine Professor of Medicine
Cooper Medical School of Rowan University Division of Medicine/Pulmonary and Critical Care
Division of Nephrology Emory University School of Medicine
Cooper University Health Care Atlanta, Georgia
Camden, New Jersey
Hsuan Lu, DO
Zoulficar Kobeissi, MD Department of Neurology
Assistant Professor of Clinical Anesthesiology and Critical Care Cedars Sinai Medical Center
Anesthesiology and Critical Care Los Angeles, California
Houston Methodist Hospital
Houston, Texas Veeranna Maddipati, MD
Assistant Professor of Medicine
James A. Kruse, MD, FCCM Division of Pulmonary and Critical Care Medicine
Chief, Critical Care Brody School of Medicine
Bassett Medical Center; East Carolina University
Clinical Professor of Medicine Greeneville, North Carolina
Columbia University College of Physicians and Surgeons
New York, New York †Deceased.
x Contributors
Dennis G. Maki, MD Paul Mayo, MD
Ovid O. Meyer Professor of Medicine Professor of Clinical Medicine
Divisions of Infectious Diseases and Pulmonary/Critical Care Hofstra Northwell School of Medicine,
Medicine; Division of Pulmonary Medicine, Critical Care, and Sleep
Attending Physician, Center for Trauma and Life Support Medicine
University of Wisconsin Hospital and Clinics Northwell LIJ/NSUH Medical Center
Madison, Wisconsin Zucker School of Medicine at Hofstra/Northwell
New Hyde Park, New York
John Marini, MD
Professor of Medicine Christopher B. McFadden, MD
Pulmonary and Critical Care Medicine Associate Professor of Medicine
University of Minnesota Cooper Medical School of Rowan University
Minneapolis, Minnesota; Camden, New Jersey
Regions Hospital
St. Paul, Minnesota Melissa Mercado, MD
Assistant Professor of Neurology and Neurosurgery
Annachiara Marra, MD, PhD Boston University School of Medicine
Department of Neurosciences Boston, Massachusetts
Reproductive and Odontostomatological Sciences
University of Naples, Federico II Walter Mickey, DO
Naples, Italy; Critical Care Fellow
Visiting Research Fellow Critical Care Medicine Fellowship
Center for Health Services Research Saint Louis University School of Medicine/Mercy Hospital
Division of Allergy, Pulmonary and Critical Care Medicine St. Louis
Vanderbilt University Medical Center St. Louis, Missouri
Nashville, Tennessee
Kristin Miller, MD
John C. Marshall, MD, FRCSC Assistant Professor
Department of Surgery and the Interdepartmental Division of Division of Pulmonary Disease and Critical Care Medicine
Critical Care Medicine Virginia Commonwealth University Health System
University of Toronto Richmond, Virginia
St. Michael’s Hospital
Toronto, Ontario, Canada Thomas R. Mirsen, MD
Associate Professor
Henry Masur, MD Neurology
Critical Care Medicine Department Cooper Medical School of Rowan University
Clinical Center Camden, New Jersey
National Institutes of Health
Bethesda, Maryland Farah Morgan, MD
Assistant Professor of Medicine
Dirk M. Maybauer, MD, PhD Division of Endocrinology
Professor of Anesthesiology Cooper Medical School of Rowan University
Philipps University Camden, New Jersey
Marburg, Germany
Nicholas Murphy, MBBS, FRCP
Marc O. Maybauer, MD, PhD Consultant Intensivist
Professor of Anesthesiology The Liver Unit and Department of Critical Care
Philipps University Queen Elizabeth Hospital
Marburg, Germany; Birmingham, United Kingdom
Honorary Professor
The University of Queensland and the Critical Care Research Kamyar Nader, MD
Group Division of Hematology/Oncology
Prince Charles Hospital MD Anderson Cancer Center at Cooper
Brisbane, Australia; Camden, New Jersey
Consultant
Lead for Research and Director of ECMO Hollis R. O’Neal, MD, MSc
Cardiothoracic Anaesthesia and Intensive Care Assistant Professor of Clinical Medicine
Manchester Royal Infirmary Louisiana State University Health Sciences Center
Manchester University NHS Foundation Trust, Baton Rouge, Louisiana
Honorary Senior Lecturer
University of Manchester and Manchester Academic Health
Science Centre
Manchester, United Kingdom
Contributors xi
Luis Ostrosky-Zeichner, MD, FACP, FIDSA Nitin Puri, MD
Professor of Medicine and Epidemiology Associate Professor of Medicine
University of Texas Health Science Center at Houston Cooper Medical School of Rowan University
Houston, Texas Camden, New Jersey
Joseph E. Parrillo, MD Annette C. Reboli, MD
Justice Marie L. Garibaldi Endowed Chair Dean,
Chairman, Heart and Vascular Hospital Professor of Medicine
Hackensack University Medical Center, Division of Infectious Diseases
Professor and Chair, Department of Cardiology Cooper Medical School of Rowan University
Hackensack Meridian School of Medicine at Seton Camden, New Jersey
Hall University
Hackensack, New Jersey; John Adam Reich, MD
Professor of Medicine Assistant Professor
Rutgers New Jersey Medical School Department of Anesthesiology
Newark, New Jersey Tufts Medical Center
Boston, Massachusetts
Tilak K.R. Pasala, MD
Structural and Congenital Heart Disease Fellow Marcos I. Restrepo, MD, PhD
Hackensack University Medical Center Associate Professor
Hackensack Meridian Health Department of Medicine
Hackensack, New Jersey Division of Pulmonary/Critical Care Medicine
University of Texas Health Science Center at San Antonio
Dave D. Paskar, MD, FRCSC San Antonio, Texas
Division of General Surgery and the Interdepartmental Division
of Critical Care Medicine Oleksa G. Rewa, MD
University of Toronto, Clinical Scholar and Lecturer
St. Michael’s Hospital Department of Critical Care Medicine
Toronto, Ontario, Canada Faculty of Medicine and Dentistry
University of Alberta
Stephen M. Pastores, MD Edmonton, Alberta, Canada
Professor of Medicine and Anesthesiology,
Weill Cornell Medical College and Program Director Andrew Rhodes, FRCA, FCRP FFICM
Critical Care Medicine Professor
Department of Anesthesiology and Critical Care Medicine Intensive Care Medicine
Memorial Sloan Kettering Cancer Center St George’s University Hospitals NHS Foundation Trust
New York, New York London, United Kingdom
Steven Peikin, MD, FACG, AGAF Fred Rincon, MD
Professor of Medicine Associate Professor
Division of Gastroenterology and Liver Diseases Neurology and Neurosurgery
Cooper Medical School of Rowan University and Cooper Thomas Jefferson University
University Hospital Philadelphia, Pennsylvania
Camden, New Jersey
Brian W. Roberts, MD
Priscilla Peters, BA, RDCS, FASE Associate Professor of Emergency Medicine
Echocardiographic Clinical Specialist Cooper Medical School of Rowan University
Cooper University Hospital, Cooper University Hospital
Assistant Professor of Medicine Camden, New Jersey
Cooper Medical School of Rowan University
Camden, New Jersey Katie M. Rocawich, PharmD, BCPS
Department of Pharmacy
Melvin R. Pratter, MD Virginia Commonwealth University Health System
Head, Division of Pulmonary Diseases and Critical Care Richmond, Virginia
Medicine
Pulmonary and Critical Care Axel Rosengart, MD, PhD, MPH
Cooper University Hospital; Director
Professor of Medicine Neuroscience Critical Care
Cooper Medical School of Rowan University Cedars-Sinai Medical Center
Camden, New Jersey Los Angeles, California