Evidence-Based Practice of Critical Care: Expert Consult: Online and Print, 1e PDF
Preview Evidence-Based Practice of Critical Care: Expert Consult: Online and Print, 1e
Evidence-Based Practice of Critical Care Evidence-Based Practice of Critical Care Clifford S. Deutschman, MS, MD, FCCM Professor of Anesthesiology and Critical Care and Surgery Director, Stavropoulos Sepsis Research Program University of Pennsylvania School of Medicine Philadelphia, Pennsylvania, USA Patrick J. Neligan, MA, MB, FRCARCSI Honorary Senior Lecturer Consultant in Anaesthesia and Intensive Care University College Galway Galway, Ireland 1600JohnF.KennedyBlvd. Ste1800 Philadelphia,PA19103-2899 EVIDENCE-BASEDPRACTICEOFCRITICALCARE ISBN:978-1-4160-5476-4 Copyright#2010bySaunders,animprintofElsevierInc. Allrightsreserved.Nopartofthispublicationmaybereproducedortransmittedinanyformor byanymeans,electronicormechanical,includingphotocopy,recording,oranyinformation storageandretrievalsystem,withoutpermissioninwritingfromthepublisher.Permissionsmaybe soughtdirectlyfromElsevier’sRightsDepartment:phone:(þ1)2152393804(US)or(þ44)1865 843830(UK);fax:(þ44)1865853333;e-mail:[email protected] yourrequeston-lineviatheElsevierwebsiteathttp://www.elsevier.com/permissions. Notice Medicineisanever-changingfield.Standardsafetyprecautionsmustbefollowed,butasnew researchandclinicalexperiencebroadenourknowledge,changesintreatmentanddrugtherapy maybecomenecessaryorappropriate.Readersareadvisedtocheckthemostcurrentproduct informationprovidedbythemanufacturerofeachdrugtobeadministeredtoverifythe recommendeddose,themethodanddurationofadministration,andcontraindications.Itis theresponsibilityofthetreatingphysician,relyingonexperienceandknowledgeofthepatient, todeterminedosagesandthebesttreatmentforeachindividualpatient.NeitherthePublishernor theeditorsassumeanyliabilityforanyinjuryand/ordamagetopersonsorpropertyarisingfrom thispublication. ThePublisher LibraryofCongressCataloging-in-PublicationData Evidence-basedpracticeofcriticalcare/[editedby]CliffordS.Deutschman,PatrickJ.Neligan. p.;cm. Includesbibliographicalreferences. ISBN978-1-4160-5476-4 1.Criticalcaremedicine.2.Evidence-basedmedicine. I.Deutschman,CliffordS.II.Neligan,PatrickJ. [DNLM:1.CriticalCare.2.Evidence-BasedMedicine.3.IntensiveCareUnits.WX218E9352010] RC86.7.E962010 616.02’8–dc22 2010013018 AcquisitionsEditor:NatashaAndjelkovic DevelopmentalEditor:BradleyMcIlwain PublishingServicesManager:AnithaRaj ProjectManager:BeulaChristopher DesignDirection:EllenZanolle PrintedinUnitedStatesofAmerica Lastdigitistheprintnumber:9 8 7 6 5 4 3 2 1 List of Contributors Moustafa Ahmed, MD Adrian Barbul, MD, FACS AnesthesiaSection,PhiladelphiaVeteransAdministration Department of Surgery Medical Center Sinai Hospital and Johns Hopkins Department of Anesthesiology and Critical Care Medical Institutions University of Pennsylvania Baltimore, Maryland Philadelphia, Pennsylvania John Bates, FCARCSI, MRCPI, FJFICM A. Katie Allen, Pharm Medical Director Intensive Care Services Butler University College of Pharmacy and Health Galway University Hospitals Sciences Galway, Ireland Clarian Health Partners at Methodist Hospital Simon V. Baudouin, MD, FRCP Indianapolis, Indiana Institute of Cellular and Medicine, University of Penny Andrews, RN, BSN Newcastle upon Tyne Staff Nurse Department of Anaesthesia, Royal Victoria Infirmary R. Adams Cowley Shock Trauma Center Newcastle upon Tyne, United Kingdom Education Specialist, ICON Rinaldo Bellomo, MBBS, MD, FRACP, Baltimore, Maryland FCCP Djillali Annane, MD, PhD Professor General Intensive Care Unit Department of Intensive Care and Department of Raymond Poincare´ Hospital (AP-HP) Medicine University of Versailles Austin Hospital Saint Quentin-en Yvelines, France Melbourne, Australia Valerie A. Arkoosh, MD, MPH Prof. Mette M. Berger Professor of Clinical Anesthesiology Service of Adult Intensive Care Medicine Professor of Clinical Obstetrics and Gynecology and Burns Centre University of Pennsylvania School of Medicine University Hospital Philadelphia, Pennsylvania Lausanne, Switzerland Yuval Bitan, PhD John G.T. Augoustides, MD, FASE Department of Anesthesiology Associate Professor Cardiothoracic Section and Critical Care Medicine University of Chicago School of Medicine Department of Anesthesiology and Critical Care Chicago, Illinois University of Pennsylvania Philadelphia, Pennsylvania Edward A. Bittner, MD, PhD, JA Joan R. Badia, MD, PhD Program Director, Critical Care Fellowship Unitat de Vigila`ncia Intensiva Respirato`ria Department of Anesthesia and Critical Care ServeidePneumologia,InstitutClinicdelTo`rax,Hospital Massachusetts General Hospital Clinic de Barcelona, IDIBAPS, FUCAP Boston, Massachusetts Barcelona, Spain Jose´e Bouchard, MD Dimitry Baranov, MD Division of Nephrology, Department of Medicine Assistant Professor of Anesthesiology and Critical Care Hoˆpital du Sacre´-Coeur de Montre´al Hospital of the University of Pennsylvania Universite´ de Montre´al Philadelphia, Pennsylvania Montreal, Quebec, Canada Philip S. Barie, MD Pavan Brahmamdam, MD Professor of Surgery Departments of Surgery and Anesthesiology Weill Cornell Medical College Washington University School of Medicine New York, New York St. Louis, Missouri xi xii LIST OF CONTRIBUTORS Jason Brainard, MD Jason D. Christie, MD, MS Department of Anesthesiology and Critical Care Associate Professor of Medicine and Epidemiology University of Pennsylvania School of Medicine Division of Pulmonary, Allergy and Critical Philadelphia, Pennsylvania Care Medicine Center for Clinical Epidemiology and Biostatistics Aimee Brame, MRCP University of Pennsylvania School of Medicine Department of Critical Care, Imperial College School of Philadelphia, Pennsylvania Medicine Terence M. Cone, MD Royal Brompton Hospital London, United Kingdom The Division of Critical Care in the Department of Anesthesiology Benjamin Braslow, MD University of Iowa Carver College of Medicine Iowa City, Iowa Assistant Professor of Surgery Division of Trauma and Surgical Critical Care Maya Contreras, MB, FCARCSI University of Pennsylvania School of Medicine Research Fellow, Lung Biology Group Philadelphia, Pennsylvania National Centre of Biomedical Engineering Sciences National University of Ireland John Brennan, MD Department of Anaesthesia and Intensive Division of Pulmonary, Critical Care and Sleep Medicine Care Medicine Tufts-New England Medical Center University College Hospital Boston, Massachusetts Galway, Ireland Veronica Brito, MD David James Cooper, BM, BS, MD Research Fellow Australian and New Zealand Intensive Pulmonary and Critical Care Medicine Care-Research Centre Winthrop-University Hospital School of Public Health and Preventive Medicine Mineola, New York Monash University, The Alfred Hospital Melbourne, Australia Alain F. Broccard, MD Craig M. Coopersmith, MD, FACS, FCCM Professor of Medicine University of Minnesota School of Medicine Professor of Surgery Minneapolis, Minnesota Director, 5E Surgical Intensive Care Unit Associate Director, Emory Center for Critical Care Naomi E. Cahill, RD, MSc Emory University School of Medicine Department of Community Health and Atlanta, Georgia Epidemiology Queen’s University, Kingston Bryan A. Cotton, MD, FACS Clinical Evaluation Research Unit, Kingston General Hospital Assistant Professor of Surgery Kingston, Ontario, Canada Vanderbilt University Medical Center Department of Surgery/Trauma and Emergency Surgery Maurizio Cecconi, MD Director of Surgical Critical Care Tennessee Valley VA Medical Center Department of Intensive Care Medicine Nashville, Tennessee St George’s Healthcare NHS Trust London, United Kingdom Caitlin S. Curtis, PharmD Department of Surgery Maurizio Cereda, MD University of Wisconsin-Madison College of Medicine Assistant Professor of Anesthesiology and Critical Care and Public Health University of Pennsylvania Madison, Wisconsin Philadelphia, Pennsylvania Heidi Dalton, MD, FCCM John Chandler, FCARCSI Chief Fellow, Galway University Hospitals Critical Care, Phoenix Children’s Hospital Galway, Ireland Phoenix, Arizona Jill Cherry-Bukowiec, MD Tracey Dechert, MD Acute Care Surgery Fellow Division of Traumatology and Surgical Critical Care Lecturer, Department of Surgery Department of Surgery University of Michigan University of Pennsylvania School of Medicine Ann Arbor, Michigan Philadelphia, Pennsylvania List of Contributors xiii Edwin A. Deitch, MD John E. Ellis, MD Professor and Chair, Department of Surgery Adjunct Professor of Anesthesiology and Critical Care New Jersey Medical School University of Pennsylvania School of Medicine Newark, New Jersey Philadelphia, Pennsylvania Clifford S. Deutschman, MS, MD, FCCM E. Wesley Ely, MD, MPH Professor of Anesthesiology and Critical Department of Medicine/Allergy and Pulmonary Care and Surgery Critical Care Director, Stavropoulos Sepsis Research Program Vanderbilt University Medical Center University of Pennsylvania School of Medicine Nashville, Tennessee Philadelphia, Pennsylvania Timothy W. Evans, MD, PhD, FRCP, FRCA, Carol Donagh, MB, BCh, MRCPI FMedSci Galway University Hospitals Professor of Intensive Care Medicine Galway, Ireland Imperial College London Medical Director and Consultant in Intensive Care Todd Dorman, MD, FCCM and Thoracic Medicine Royal Brompton & Harefield NHS Trust Associate Dean and Director, Office of CME London, United Kingdom Professor and Vice Chair for Critical Care Department of Anesthesiology and Critical Adam Fang, BS Care Medicine Department of Medicine Johns Hopkins University School of Medicine Division of Pulmonary, Allergy and Critical Care Baltimore, Maryland Medicine University of Pennsylvania School of Medicine Tomas Drabek, MD Philadelphia, Pennsylvania Fellow Safar Center for Resuscitation Research Niall Fanning, MB, BCh, FCARCSI Pittsburgh, Pennsylvania Specialsist Registrar in Anaesthesia and Intensive Care University College Hospitals Galway Craig Dunlop, MBBS, FCARCSI Galway, Ireland University College Hospitals Galway, Ireland Niall D. Ferguson, MD, FRCPC, MSc Interdepartmental Division of Critical Care Medicine, Charles G. Durbin, Jr., MD, FCCM and Department of Medicine Division of Respirology, University Health Network Professor of Anesthesiology and Surgery University of Toronto, Toronto Western Hospital University of Virginia Ontario, Canada Charlottesville, Virginia Soumitra R. Eachempati, MD Katherine Finan, MB, BCh, MRCPI Professor of Surgery Respiratory Physician Weill Cornell Medical College Galway University Hospitals New York, New York Galway, Ireland Luminita Eid, MD Marianne Fitzgerald, MB, FCARCSI Attending Anesthesiologist Our Lady of Lourdes Hospital Department of Anesthesia and Critical Care Medicine Drogheda, Ireland Hadassah Hebrew University School of Medicine Hadassah Medical Organization Lee A. Fleisher, MD Jerusalem, Israel Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care Ali A. El Solh, MD, MPH Professor of Medicine Division of Pulmonary, Critical Care, University of Pennsylvania School of Medicine and Sleep Medicine Philadelphia, Pennsylvania Department of Medicine and Department of Social and Preventive Medicine State University of New York at Buffalo School of MedicineandBiomedicalSciencesandSchoolofPublic Health and Health Professions Buffalo, New York xiv LIST OF CONTRIBUTORS Noel M. Flynn, MD, FFARCSI Nader M. Habashi, MD, FACP, FCCP Clinical Lecturer, Department of Anaesthesia Associate Professor, University of Maryland Medical and Intensive Care Center National University of Ireland Medical Director, Multi-trauma Critical Care Unit, Consultant Anaesthetist and Medical Director of the R Adams Cowley Shock Trauma Center Hyperbaric Chamber Medical Director, The Living Legacy Foundation Galway University Hospitals of Maryland Galway, Ireland Medical Director, New York Organ Donor Network, Department of Critical Care Jonathan K. Frogel, MD Baltimore, Maryland Assistant Professor of Anesthesiology and Critical Care University of Pennsylvania Rachel A. Hadler, BA Philadelphia, Pennsylvania Research Fellow Department of Surgery Wesley M. Garmon, Pharm University of Pennsylvania School of Medicine Butler University College of Pharmacy and Health Philadelphia, Pennsylvania Sciences Clarian Health Partners at Methodist Hospital Isaac Halickman, MD Indianapolis, Indiana Division of Cardiovascular Disease Cooper University Hospital Erik Garpestad, MD Camden, New Jersey Division of Pulmonary, Critical Care and Sleep Medicine Scott D. Halpern, MD, PhD Tufts-New England Medical Center Center for Clinical Epidemiology and Biostatistics Boston, Massachusetts Division of Pulmonary, Allergy and Critical Care Medicine, Center for Bioethics Gerd G. Gauglitz, MD Leonard Davis Institute of Health Economics, and Center Department of Surgery for Clinical Epidemiology and Biostatistics University of Texas Medical Branch University of Pennsylvania School of Medicine Galveston, Texas Philadelphia, Pennsylvania Jane M. Gervasio, Pharm, BCNSP C. William Hanson III, MD Butler University College of Pharmacy and Health Professor of Anesthesiology and Critical Care Sciences Chief, Section of Critical Care Medicine Clarian Health Partners at Methodist Hospital University of Pennsylvania School of Medicine Indianapolis, Indiana Philadelphia, Pennsylvania Anthony C. Gordon, MD, FRCA Patrick Hassett, MB, FCARCSI Clinical Senior Lecturer and Consultant Research Fellow, Lung Biology Group Critical Care Medicine 11N National Centre of Biomedical Engineering Sciences Imperial College/Charing Cross Hospital National University of Ireland London, United Kingdom Department of Anaesthesia and Intensive Care Medicine University College Hospital Galway, Ireland Vicente Gracias, MD Professor of Surgery J. Steven Hata, MD, FCCP, MSc Chief, Trauma and Surgical Critical Care The Division of Critical Care in the Department of Robert Wood Johnson University Hospital Anesthesiology New Brunswick, New Jersey University of Iowa Carver College of Medicine Iowa City, Iowa Jacob Gutsche, MD Fellow, Critical Care Medicine Ivan Hayes, MBBCh, BAO, FCA, RCSI Department of Anesthesiology and Critical Care Mater Misercordiae Hospital University of Pennsylvania School of Medicine Dublin, Ireland Philadelphia, Pennsylvania List of Contributors xv Daren K. Heyland, MD, MSc Marc G. Jeschke, MD, PhD Department of Community Health and Epidemiology Associate Professor of Surgery Queen’s University Annie Laurie Howard Chair in Burn Surgery Clinical Evaluation Research Unit, Kingston General University of Texas Medical Branch Hospital Galveston, Texas Department of Medicine, Queen’s University Kingston, Ontario, Canada Jeremy M. Kahn, MD, MSc Assistant Professor Nicholas S. Hill, MD Division of Pulmonary, Allergy and Critical Care Department of Medicine Professor of Medicine Senior Scholar, Center for Clinical Epidemiology and Division of Pulmonary, Critical Care and Sleep Medicine Biostatistics Senior Fellow, Leonard Davis Institute of Health Tufts-New England Medical Center Economics, University of Pennsylvania School of Boston, Massachusetts Medicine Center for Clinical Epidemiology and Biostatistics, Eliotte Hirshberg, MD University of Pennsylvania School of Medicine Pulmonary and Critical Care Divisions Philadelphia, Pennsylvania Departments of Medicine, Intermountain Medical Center and University of Utah School of Medicine Sunil Karhadkar, MD Critical Care Division, Department of Pediatrics Department of Surgery University of Utah School of Medicine Sinai Hospital and Johns Hopkins Medical Institutions Salt Lake City, Utah Baltimore, Maryland R. Duncan Hite, MD Mark T. Keegan, MB, MRCPI Section on Pulmonary, Critical Care, Allergy and Associate Professor Immunologic Disease Division of Critical Care, Department of Anesthesiology, Wake Forest University School of Medicine Mayo Clinic Winston-Salem, North Carolina Director, Transplant/General ICU, Rochester Methodist Hospital Daniel Holena, MD Rochester, Minnesota Assistant Professor of Surgery Division of Traumatology and Surgical Critical Care Rachel R. Kelz, MD, MSCE University of Pennsylvania School of Medicine Assistant Professor of Surgery Philadelphia, Pennsylvania University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Steven M. Hollenberg, MD Professor of Medicine Leo G. Kevin, MD, FCARCSI University of Medicine and Dentistry Department of Anaesthesia of New Jersey - Camden University College Hospital Director, Cooper Coronary Care Unit Galway, Ireland Cooper University Hospital Camden, New Jersey Rachel G. Khadaroo, MD, PhD, FRSC The Keenan Research Centre Jiri Horak, MD Li Ka Shing Knowledge Institute Assistant Professor of Anesthesiology and St. Michael’s Hospital Critical Care Toronto, Ontario, Canada Director, Cardiothoracic Intensive Care Unit University of Pennsylvania School of Medicine Kurt Kleinschmidt, MD Philadelphia, Pennsylvania Professor of Surgery Division of Emergency Medicine Richard S. Hotchkiss, MD Chief, Section of Medical Toxicology Departments of Surgery and Anesthesiology University of Texas Southwestern Medical School Washington University School of Medicine Dallas, Texas St. Louis, Missouri Patrick M. Kochanek, MD John R. Hotchkiss, MD Director, Safar Center for Resuscitation Research Associate Professor of Critical Care Professor of Pediatrics and Critical Care Medicine Medicine and Medicine University of Pittsburgh Medical Center University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Staff Intensivist and Nephrologist, VAPHS Pittsburgh Pittsburgh, Pennsylvania xvi LIST OF CONTRIBUTORS W. Andrew Kofke, MD, MBA Richard J. Levy, MD Professor of Anesthesiology and Critical Care DirectorofCardiacAnesthesiology and Neurosurgery ViceChiefofAnesthesiologyandPainMedicine University of Pennsylvania School of Medicine Children’sNationalMedicalCenter Chief, Neuroanesthesia AssociateProfessorofAnesthesiologyandPediatrics Co-Director, Neuro Intensive Care Unit TheGeorgeWashingtonUniversitySchoolofMedicine Hospital of the University of Pennsylvania andHealthSciences Philadelphia, Pennsylvania Washington,DC Benjamin A. Kohl, MD Pamela A. Lipsett, MD Assistant Professor of Anesthesiology and Critical Care Professor of Surgery, Anesthesiology, Critical Care Hospital of the University of Pennsylvania Medicine, and Nursing Medical Director of PACU DepartmentofSurgery,JohnsHopkinsUniversitySchools Assistant Professor of Medicine, Hospital of the of Medicine and Nursing University of Pennsylvania The Johns Hopkins Hospital Director, Critical Care Fellowship Baltimore, Maryland Philadelphia, Pennsylvania Kathleen D. Liu, MD, PhD, MCR Jay L. Koyner, MD Assistant Professor Section of Nephrology Division of Nephrology, Department of Medicine Department of Medicine University of California, San Francisco University of Chicago San Francisco, California Chicago, Illinois Corry J. Kucik, MD Conan MacDougall, Pharm, BCPS Shriners Hospitals for Children Assistant Professor Harvard Medical School Department of Clinical Pharmacy Boston, Massachusetts UCSF School of Pharmacy San Francisco, California Kenneth A. Kudsk, MD Veterans Administration Surgical Services Larami MacKenzie, MD William S. Middleton Memorial Veterans Hospital Fellow, Neuro Critical Care Department of Surgery University of Pennsylvania School of Medicine University of Wisconsin-Madison College of Medicine Philadelphia, Pennsylvania and Public Health Madison, Wisconsin Brian Marsh, MBBCh, BAO, FCA, RCSI, FJFICM John G. Laffey, MD, MA, BSc, FCARCSI Consultant in Anaesthesia and Intensive Care Professor, Lung Biology Group Mater Misercordiae Hospital National Centre of Biomedical Engineering Sciences Dublin, Ireland National University of Ireland Department of Anaesthesia and Intensive Care Medicine John C. Marshall, MD University College Hospital Galway, Ireland Department of Surgery Interdepartmental Division of Critical Care Medicine David Lappin, FRCPI University of Toronto Consultant Nephrologist Toronto, Ontario, Canada University College Hospital Jeevendra A. Martyn, MB, BS Galway, Ireland Director, Clinical and Biochemical Pharmacology Peter Le Roux, MD, PhD Laboratory Anesthetist-in-Chief, Shriners Hospitals for Children Associate Professor of Neurosurgery Professor, Harvard Medical School University of Pennsylvania School of Medicine Boston, Massachusetts Philadelphia, Pennsylvania Joshua M. Levine, MD Michael A. Matthay, MD Assistant Professor of Neurology Professor of Medicine and Anesthesia University of Pennsylvania School of Medicine University of California at San Francisco Philadelphia, Pennsylvania Senior Associate, Cardiovascular Research Institute University of California, San Francisco San Francisco, California List of Contributors xvii Mervyn Maze, MB, ChB Vivek K. Moitra, MD Professor and Chair Assistant Professor of Anesthesiology Department of Anesthesia and Perioperative Care Division of Critical Care University of California, San Francisco Columbia University College of Physicians and Surgeons San Francisco, California New York, New York Alan H. Morris, MD Danny F. McAuley, MRCP, DICM, MD Pulmonary and Critical Care Divisions Senior Lecturer and Consultant in Intensive Care Departments of Medicine, Intermountain Medical Center Medicine and University of Utah School of Medicine Respiratory Research Programme Pulmonary Division Centre of Infection and Immunity, Queens University Sorenson Heart-Lung Center of Belfast Intermountain Medical Center Regional Intensive Care Unit, Royal Victoria Hospital Salt Lake City, Utah Belfast, Northern Ireland Patrick T. Murray, MD, FASN, FRCPI Gra´inne McDermott, MB, FCARCSI Professor of Clinical Pharmacology Department of Anaesthesia Consultant in Nephrology and Clinical Pharmacology University College Hospitals Galway University College Dublin School of Medicine and Galway, Ireland Medical Science Dublin, Ireland E.R. McFadden, Jr., MD Pulmonary, Critical Care and Sleep Medicine Lena Napolitano, MD, FACS, FCCP, FCCM MetroHealth Medical Center Professor of Surgery Cleveland, Ohio University of Michigan School of Medicine Chief, Surgical Critical Care Michael McKenny, MB, FCARCSI Associate Chair, Department of Surgery Our Lady of Lourdes Hospital University of Michigan Medical Center Drogheda, Ireland Ann Arbor, Michigan James S. McKinney, MD Patrick J. Neligan, MA, MB, FRCARCSI Assistant Professor of Neurology Honorary Senior Lecturer Robert Wood Johnson Medical School Consultant in Anaesthesia and Intensive Care New Brunswick, New Jersey University College Galway Galway, Ireland Maureen O. Meade, MSc, MD Associate Professor, Department of Medicine Ana Paula Neves, MD Joint Member, Department of Clinical Epidemiology DepartmentofIntensiveCare,Erasme and Biostatistics UniversityHospital Faculty of Health Sciences Universite´ LibredeBruxelles McMaster University Health Sciences Centre Brussels,Belgium Hamilton, Ontario, Canada Alistair Nichol, MB, PhD Ravindra L. Mehta, MD, FACP, FASN Australian and New Zealand Intensive Care- Research Professor of Medicine Centre Division of Nephrology School of Public Health and Preventive Medicine University of California, San Diego Medical Center Monash University, The Alfred Hospital San Diego, California Melbourne, Australia Steven R. Messe´, MD Michael S. Niederman, MD, FACP, FCCP, Assistant Professor of Neurology FCCM University of Pennsylvania School of Medicine Professor of Medicine, Vice-Chairman Department Philadelphia, Pennsylvania of Medicine SUNY at Stony Brook Ben Messer, FRCA Chairman, Department of Medicine Department of Anaesthesia, Royal Victoria Infirmary Winthrop University Hospital Newcastle upon Tyne, United Kingdom Mineola, New York
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