Harrisons Pulmonary and Critical Care Medicine

593 Pages·2010·10 MB·English

by  Joseph, Loscalzo,

HARRISON’S
Pulmonary
and Critical Care
Medicine
Derived from Harrison’s Principles of Internal Medicine, 17th Edition
Editors
ANTHONY S. FAUCI, EUGENE BRAUNWALD,
MD MD
Chief,Laboratory of Immunoregulation; Distinguished Hersey Professor of Medicine,
Director,National Institute of Allergy and Infectious Diseases, Harvard Medical School;Chairman,TIMI Study Group,
National Institutes of Health,Bethesda Brigham and Women’s Hospital,Boston
DENNIS L. KASPER, STEPHEN L. HAUSER,
MD MD
William Ellery Channing Professor of Medicine,Professor of Robert A.Fishman Distinguished Professor and Chairman,
Microbiology and Molecular Genetics,Harvard Medical School; Department of Neurology,University of California,San Francisco
Director,Channing Laboratory,Department of Medicine,
Brigham and Women’s Hospital,Boston
J. LARRY JAMESON, ,
MD PhD
Professor of Medicine;
DAN L. LONGO,
MD Vice President for Medical Affairs and Lewis Landsberg Dean,
Scientific Director,National Institute on Aging, Northwestern University Feinberg School of Medicine,Chicago
National Institutes of Health,Bethesda and Baltimore
JOSEPH LOSCALZO, ,
MD PhD
Hersey Professor of Theory and Practice of Medicine,
Harvard Medical School;Chairman,Department of Medicine;
Physician-in-Chief,Brigham and Women’s Hospital,Boston
HARRISON’S
Pulmonary
and CriticalCare
Medicine
Editor
Joseph Loscalzo, MD, PhD
Hersey Professor of Theory and Practice of Medicine,
Harvard Medical School;Chairman,Department of Medicine;
Physician-in-Chief,Brigham and Women’s Hospital,Boston
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
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CONTENTS
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii 14 Common Viral Respiratory Infections and
Severe Acute Respiratory
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Syndrome (SARS). . . . . . . . . . . . . . . . . . . . . . 149
Raphael Dolin
SECTION I
15 Pneumocystis Infection . . . . . . . . . . . . . . . . . . . 161
DIAGNOSIS OF RESPIRATORY DISORDERS
A.George Smulian,Peter D.Walzer
1 Approach to the Patient with Disease 16 Bronchiectasis and Lung Abscess. . . . . . . . . . . . 166
of the Respiratory System. . . . . . . . . . . . . . . . . . 2
Gregory Tino,Steven E.Weinberger
David A.Lipson,Steven E.Weinberger
17 Cystic Fibrosis. . . . . . . . . . . . . . . . . . . . . . . . . 172
2 Dyspnea and Pulmonary Edema . . . . . . . . . . . . . 7
Richard C.Boucher,Jr.
Richard M.Schwartzstein
18 Chronic Obstructive Pulmonary Disease. . . . . . 178
3 Cough and Hemoptysis. . . . . . . . . . . . . . . . . . . 14
John J.Reilly,Jr.,Edwin K.Silverman,
Steven E.Weinberger,David A.Lipson
Steven D.Shapiro
4 Hypoxia and Cyanosis. . . . . . . . . . . . . . . . . . . . 20 19 Interstitial Lung Diseases . . . . . . . . . . . . . . . . . 190
Eugene Braunwald
Talmadge E.King,Jr.
5 Disturbances of Respiratory Function . . . . . . . . 25 20 Deep Venous Thrombosis and Pulmonary
Steven E.Weinberger,Ilene M.Rosen
Thromboembolism . . . . . . . . . . . . . . . . . . . . . 204
Samuel Z.Goldhaber
6 Diagnostic Procedures in Respiratory Disease. . . 36
Scott Manaker,Steven E.Weinbeger 21 Disorders of the Pleura and Mediastinum . . . . . 215
Richard W.Light
7 Atlas of Chest Imaging . . . . . . . . . . . . . . . . . . . 41
Patricia A.Kritek,John J.Reilly,Jr. 22 Disorders of Ventilation. . . . . . . . . . . . . . . . . . 221
Eliot A.Phillipson
SECTION II
23 Sleep Apnea . . . . . . . . . . . . . . . . . . . . . . . . . . 228
DISEASES OF THE RESPIRATORY SYSTEM
Neil J.Douglas
8 Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 24 Lung Transplantation. . . . . . . . . . . . . . . . . . . . 233
Peter J.Barnes Elbert P.Trulock
9 Hypersensitivity Pneumonitis and Pulmonary 25 Infections in Lung Transplant Recipients. . . . . . 239
Infiltrates with Eosinophilia. . . . . . . . . . . . . . . . 79 Robert Finberg,Joyce Fingeroth
Joel N.Kline,Gary W.Hunninghake
10 Environmental Lung Disease . . . . . . . . . . . . . . . 86 SECTION III
Frank E.Speizer,John R.Balmes GENERAL APPROACH TO THE
CRITICALLY ILL PATIENT
11 Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Lionel A.Mandell,Richard Wunderink
26 Principles of Critical Care Medicine. . . . . . . . . 246
12 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . 115 John P.Kress,Jesse B.Hall
Mario C.Raviglione,Richard J.O’Brien
27 Mechanical Ventilatory Support . . . . . . . . . . . . 258
13 Influenza. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Edward P.Ingenito
Raphael Dolin
28 Approach to the Patient with Shock. . . . . . . . . 266
Ronald V.Maier
v
vi Contents
SECTION IV 38 Dialysis in the Treatment of Renal Failure. . . . . 386
COMMON CRITICAL ILLNESSES Kathleen D.Liu,Glenn M.Chertow
AND SYNDROMES
39 Fluid and Electrolyte Disturbances . . . . . . . . . . 393
29 Severe Sepsis and Septic Shock. . . . . . . . . . . . . 278 Gary G.Singer,Barry M.Brenner
Robert S.Munford
40 Acidosis and Alkalosis . . . . . . . . . . . . . . . . . . . 410
30 Acute Respiratory Distress Syndrome. . . . . . . . 290 Thomas D.DuBose,Jr.
Bruce D.Levy,Steven D.Shapiro
41 Coagulation Disorders. . . . . . . . . . . . . . . . . . . 424
31 Cardiogenic Shock and Pulmonary Edema. . . . 297 Valder Arruda,Katherine A.High
Judith S.Hochman,David H.Ingbar
42 Treatment and Prophylaxis
32 Cardiovascular Collapse,Cardiac Arrest,and of Bacterial Infections . . . . . . . . . . . . . . . . . . . 434
Sudden Cardiac Death. . . . . . . . . . . . . . . . . . . 306 Gordon L.Archer,Ronald E.Polk
Robert J.Myerburg,Agustin Castellanos
43 Antiviral Chemotherapy,Excluding
33 Unstable Angina and Non–ST-Elevation Antiretroviral Drugs . . . . . . . . . . . . . . . . . . . . 456
Myocardial Infarction . . . . . . . . . . . . . . . . . . . 316 Lindsey R.Baden,Raphael Dolin
Christopher P.Cannon,Eugene Braunwald
44 Diagnosis and Treatment of
34 ST-Segment Elevation Myocardial Infarction . . 324 Fungal Infections. . . . . . . . . . . . . . . . . . . . . . . 470
Elliott M.Antman,Eugene Braunwald John E.Edwards,Jr.
35 Coma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 45 Oncologic Emergencies. . . . . . . . . . . . . . . . . . 475
Allan H.Ropper Rasim Gucalp,Janice P.Dutcher
36 Neurologic Critical Care,Including Hypoxic- Appendix
Ischemic Encephalopathy and Subarachnoid Laboratory Values of Clinical Importance . . . . . 491
Hemorrhage. . . . . . . . . . . . . . . . . . . . . . . . . . 353 Alexander Kratz,Michael A.Pesce,Daniel J.Fink
J.Claude Hemphill,III,Wade S.Smith
Review and Self-Assessment. . . . . . . . . . . . . . . 513
Charles Wiener,Gerald Bloomfield,
SECTION V Cynthia D.Brown,Joshua Schiffer,Adam Spivak
DISORDERS COMPLICATING CRITICAL
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
ILLNESSES AND THEIR MANAGEMENT
37 Acute Renal Failure . . . . . . . . . . . . . . . . . . . . 370
Kathleen D.Liu,Glenn M.Chertow
CONTRIBUTORS
Numbers in brackets refer to the chapter(s) written or co-written by the contributor.
GORDON L.ARCHER,MD AGUSTIN CASTELLANOS,MD
Professor of Medicine and Microbiology/Immunology;Associate Professor of Medicine;Director,Clinical Electrophysiology,
Dean for Research,School of Medicine,Virginia Commonwealth University of Miami Miller School of Medicine,Miami [32]
University,Richmond [42]
GLENN M.CHERTOW,MD
VALDER ARRUDA,MD,PhD Professor of Medicine,Epidemiology and Biostatistics,University of
Associate Professor of Pediatrics,University of Pennsylvania School California,San Francisco School of Medicine;Director,Clinical
of Medicine,Division of Hematology,The Children’s Hospital of Services,Division of Nephrology,University of California,
Philadelphia,Philadelphia [41] San Francisco Medical Center,San Francisco [37,38]
LINDSEY R.BADEN,MD RAPHAEL DOLIN,MD
Assistant Professor of Medicine,Harvard Medical School, Maxwell Finland Professor of Medicine (Microbiology and
Boston [43] Molecular Genetics);Dean for Academic and Clinical Programs,
Harvard Medical School,Boston [13,14,43]
JOHN R.BALMES,MD
Professor of Medicine,University of California,San Francisco; NEIL J.DOUGLAS,MD
Chief,Division of Occupational and Environmental Medicine, Professor of Respiratory and Sleep Medicine,University of
San Francisco General Hospital;Professor of Environmental Health Edinburgh;Honorary Consultant Physician,Royal Infirmary of
Sciences,School of Public Health,University of California, Edinburgh,United Kingdom [23]
Berkeley [10]
THOMAS D.DuBOSE,JR.,MD
PETER J.BARNES,MA,DM,DSc Tinsley R.Harrison Professor and Chair of Internal Medicine;
Professor and Head of Thoracic Medicine,National Heart & Lung Professor of Physiology and Pharmacology,Wake Forest University
Institute;Head of Respiratory Medicine,Imperial College London; School of Medicine,Winston-Salem [40]
Honorary Consultant Physician,Royal Brompton Hospital,
London [8] JANICE P.DUTCHER,MD
Professor,New York Medical College;Associate Director,
GERALD BLOOMFIELD,MD,MPH Our Lady of Mercy Cancer Center,Bronx [45]
Department of Internal Medicine,The Johns Hopkins University
School of Medicine,Baltimore [Review and Self-Assessment] JOHN E.EDWARDS,JR.,MD
Chief,Division of Infectious Diseases,Harbor/University of
RICHARD C.BOUCHER,JR.,MD California,Los Angeles Medical Center;Professor of Medicine,
William Rand Kenan Professor of Medicine,University of North David Geffen School of Medicine at the University of California,
Carolina at Chapel Hill;Director,University of Carolina Cystic Los Angeles,Torrance [44]
Fibrosis Center,Chapel Hill [17]
ROBERT FINBERG,MD
EUGENE BRAUNWALD,MD,MA (Hon),ScD (Hon) Professor and Chair,Department of Medicine,University
Distinguished Hersey Professor of Medicine,Harvard Medical of Massachusetts Medical School,Worcester [25]
School;Chairman,TIMI Study Group,Brigham and Women’s
Hospital,Boston [4,33,34] JOYCE FINGEROTH,MD
Associate Professor of Medicine,Harvard Medical School,
BARRY M.BRENNER,MD,AM,DSc(Hon),DMSc(Hon), Boston [25]
Dipl(Hon)
Samuel A.Levine Professor of Medicine,Harvard Medical School; DANIEL J.FINK,†MD,MPH
Director Emeritus,Renal Division,Brigham and Women’s Hospital, Associate Professor of Clinical Pathology,College of Physicians and
Boston [39] Surgeons,Columbia University,New York [Appendix]
CYNTHIA D.BROWN,MD SAMUEL Z.GOLDHABER,MD
Department of Internal Medicine,The Johns Hopkins University Professor of Medicine,Harvard Medical School;Director,Venous
School of Medicine,Baltimore [Review and Self-Assessment] Thromboembolism Research Group,Director,Anticoagulation
Service,and Senior Staff Cardiologist,Department of Medicine,
CHRISTOPHER P.CANNON,MD Brigham and Women’s Hospital,Boston [20]
Associate Professor of Medicine,Harvard Medical School;Associate
Physician,Cardiovascular Division,Senior Investigator,TIMI Study RASIM GUCALP,MD
Group,Brigham and Women’s Hospital,Boston [33,34] Professor of Clinical Medicine,Albert Einstein College of Medicine,
Montefiore Medical Center,Bronx [45]
†Deceased.
vii
viii Contributors
JESSE B.HALL,MD BRUCE D.LEVY,MD
Professor of Medicine,Anesthesia & Critical Care;Section Chief, Associate Professor of Medicine,Harvard Medical School;
Pulmonary and Critical Care Medicine,University of Chicago, Pulmonary and Critical Care Medicine,Brigham and Women’s
Chicago [26] Hospital,Boston [30]
J.CLAUDE HEMPHILL,III,MD,MAS RICHARD W.LIGHT,MD
Associate Professor of Clinical Neurology and Neurological Surgery, Professor of Medicine,Vanderbilt University,Nashville [21]
University of California,San Francisco;Director,Neurocritical Care
Program,San Francisco General Hospital,San Francisco [36] DAVID A.LIPSON,MD
Assistant Professor of Medicine,Pulmonary,Allergy & Critical Care
KATHERINE A.HIGH,MD Division,University of Pennsylvania Medical Center,
William H.Bennett Professor of Pediatrics,University of King of Prussia [1,3]
Pennsylvania School of Medicine;Investigator,Howard Hughes
Medical Institute,The Children’s Hospital of Philadelphia, KATHLEEN D.LIU,MD,PhD,MCR
Philadelphia [41] Assistant Professor,Division of Nephrology,San Francisco [37,38]
JUDITH S.HOCHMAN,MD RONALD V.MAIER,MD
Harold Synder Family Professor of Cardiology;Clinical Chief,the Jane and Donald D.Trunkey Professor and Vice Chair,Surgery,
Leon H.Charney Division of Cardiology;New York University University of Washington;Surgeon-in-Chief,Harborview Medical
School of Medicine;Director,Cardiovascular Clinical Research, Center,Seattle [28]
New York [31]
SCOTT MANAKER,MD,PhD
GARY W.HUNNINGHAKE,MD Associate Professor of Medicine and Pharmacology,Pulmonary and
Sterba Professor of Medicine;Director,Division of Pulmonary, Critical Care Division,Department of Medicine,University of
Critical Care and Occupational Medicine;Director,Institute for Pennsylvania,Philadelphia [6]
Clinical and Translational Science;Director,Graduate Program in
LIONEL A.MANDELL,MD
Translational Biomedicine;Senior Associate Dean for Clinical and
Professor of Medicine,McMaster University,Hamilton,Ontario [11]
Translational Science,Iowa City [9]
ROBERT S.MUNFORD,MD
DAVID H.INGBAR,MD
Jan and Henri Bromberg Chair in Internal Medicine,University
Professor of Medicine,Physiology & Pediatrics;Director,Pulmonary,
of Texas Southwestern Medical Center,Dallas [29]
Allergy,Critical Care & Sleep Division;Executive Director,Center
for Lung Science & Health,University of Minnesota School of
ROBERT J.MYERBURG,MD
Medicine;Co-Director,Medical ICU & Respiratory Care,
Professor of Medicine and Physiology;AHA Chair in Cardiovascular
University of Minnesota Medical Center,Fairview [31]
Research,University of Miami Miller School of Medicine,
Miami [32]
EDWARD P.INGENITO,MD,PhD
Assistant Professor,Harvard Medical School,Boston [27]
RICHARD J.O’BRIEN,MD
Head of Scientific Evaluation,Foundation for Innovative
TALMADGE E.KING,JR.,MD
New Diagnostics,Geneva,Switzerland [12]
Constance B.Wofsy Distinguished Professor and Interim Chair,
Department of Medicine,University of California,San Francisco,
MICHAEL A.PESCE,PhD
San Francisco [19]
Clinical Professor of Pathology,Columbia University College of
Physicians and Surgeons;Director of Specialty Laboratory,New York
JOEL N.KLINE,MD,MSC
Presbyterian Hospital,Columbia University Medical Center,
Professor,Internal Medicine and Occupational & Environmental
New York [Appendix]
Health;Director,University of Iowa Asthma Center,Iowa City [9]
ELIOT A.PHILLIPSON,MD
ALEXANDER KRATZ,MD,PhD,MPH
Professor,Department of Medicine,University of Toronto,
Assistant Professor of Clinical Pathology,Columbia University
Toronto [22]
College of Physicians and Surgeons;Associate Director,Core
Laboratory,Columbia University Medical Center,New York-
RONALD E.POLK,PharmD
Presbyterian Hospital;Director,Allen Pavilion Laboratory,New York
Chair,Department of Pharmacy,Professor of Pharmacy and
[Appendix]
Medicine,School of Pharmacy,Virginia Commonwealth University,
Richmond [42]
JOHN P.KRESS,MD
Associate Professor of Medicine,Section of Pulmonary and Critical
MARIO C.RAVIGLIONE,MD
Care,University of Chicago,Chicago [26]
Director,StopTB Department,World Health Organization,
Geneva [12]
PATRICIA A.KRITEK,MD,EdM
Instructor in Medicine,Harvard Medical School;Co-Director,
JOHN J.REILLY,JR.,MD
Harvard Pulmonary and Critical Care Medicine Fellowship,
Associate Professor of Medicine,Harvard Medical School;
Brigham and Women’s Hospital,Boston [7]
Vice Chairman,Integrative Services,Department of Medicine,
Brigham and Women’s Hospital,Boston [7,18]
Contributors ix
ALLAN H.ROPPER,MD FRANK E.SPEIZER,MD
Executive Vice-Chair,Department of Neurology,Brigham and Edward H.Kass Professor of Medicine,Harvard Medical School,
Women’s Hospital,Harvard Medical School,Boston [35] Channing Laboratory,Department of Medicine,Brigham and
Women’s Hospital,Boston [10]
ILENE M.ROSEN,MD,MSC
Associate Director,Internal Medical Residency Program;Assistant ADAM SPIVAK,MD
Professor of Clinical Medicine,University of Pennsylvania School of Department of Internal Medicine,The Johns Hopkins University
Medicine,Philadelphia [5] School of Medicine,Baltimore [Review and Self-Assessment]
JOSHUA SCHIFFER,MD GREGORY TINO,MD
Department of Internal Medicine,The Johns Hopkins University Associate Professor of Medicine,University of Pennsylvania School
School of Medicine,Baltimore [Review and Self-Assessment] of Medicine;Chief,Pulmonary Clinical Service Hospital of the
University of Pennsylvania,Philadelphia [16]
RICHARD M.SCHWARTZSTEIN,MD
Professor of Medicine,Harvard Medical School; ELBERT P.TRULOCK,MD
Associate Chair,Pulmonary and Critical Care Medicine; Professor of Medicine,Rosemary and I.Jerome Flance Professor of
Vice-President for Education,Beth Israel Deaconess Pulmonary Medicine,Washington University School of Medicine,
Medical Center,Boston [2] St.Louis [24]
STEVEN D.SHAPIRO,MD PETER D.WALZER,MD,MSC
Jack D.Myers Professor and Chair,University of Pittsburgh, Associate Chief of Staff for Research,Cincinnati VA Medical Center;
Pittsburgh [18,30] Professor of Medicine,University of Cincinnati College of
Medicine,Cincinnati [15]
EDWIN K.SILVERMAN,MD,PhD
Associate Professor of Medicine,Harvard Medical School, STEVEN E.WEINBERGER,MD
Brigham and Women’s Hospital,Boston [18] Senior Vice President for Medical Education Division,American
College of Physicians;Senior Lecturer on Medicine,Harvard
GARY G.SINGER,MD Medical School;Adjunct Professor of Medicine,University of
Assistant Professor of Clinical Medicine,Washington University Pennsylvania School of Medicine,Philadelphia [1,3,5,6,16]
School of Medicine,St.Louis [39]
CHARLES WIENER,MD
WADE S.SMITH,MD,PhD Professor of Medicine and Physiology;Vice Chair,Department of
Professor of Neurology,Daryl R.Gress Endowed Chair Medicine;Director,Osler Medical Training Program,The Johns
of Neurocritical Care and Stroke;Director,University of Hopkins University School of Medicine,Baltimore [Review and
California,San Francisco Neurovascular Service, Self-Assessment]
San Francisco [36]
RICHARD WUNDERINK,MD
A.GEORGE SMULIAN,MB,BCh Professor,Division of Pulmonary and Critical Care,Department of
Associate Professor,University of Cincinnati College of Medicine; Medicine,Northwestern University Feinberg School of Medicine;
Chief,Infectious Disease Section,Cincinnati VA Medical Center, Director,Medical Intensive Care Unit,Northwestern Memorial
Cincinnati [15] Hospital,Chicago [11]