M. R. Pinsky · L. Brochard · J. Mancebo · G. Hedenstierna (Eds.)

Applied Physiology in Intensive Care Medicine

Applied Physiology in Intensive Care Medicine

123

With 155 Figures and 27 Tables

second edition

M. R. Pinsky · L. Brochard · J. Mancebo G. hedenstierna (eds.)

3550 Terrace streetPittsburgh, Pa 15261 France

The articles in this book appeared in the journal  „intensive care Medicine“  

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MichaeL R. Pinsky, MD

JoRDi ManceBo, MD

LaURenT BRochaRD, MD

GÖRAN HEDENSTIERNA, MD

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The practice of  intensive care medicine  is at  the very  forefront of  titration of  treatment and monitoring  response.   The substrate of  this  care  is  the critically  ill patient who, by definition, is at the limits of his or her physiologic reserve.  such patients need immediate, aggressive but balanced life-altering interventions to minimize the detrimental aspects of acute illness and hasten recovery.  Treatment decisions and response to therapy are usually assessed  by  measures  of  physiologic  function,  such  as  assessed  by  cardio-respiratory monitoring.  however,  how  one  uses  such  information  is  often  unclear  and  rarely supported by prospective clinical trials.   in reality, the bedside clinician is forced to rely primarily on physiologic principles  in determining  the best  treatments and response  to therapy.  however, the physiologic foundation present in practicing physicians is uneven and occasionally supported more by habit or prior training than science.

a  series  of  short  papers  published  in  intensive  care  Medicine  since  2002  under  the heading Physiologic notes attempts to capture the essence of the physiologic perspectives 

of applied physiology and underscore what is known and how measures and monitoring interact with organ system function and response to therapy.  This collection of physiologic 

represent  an  up-to-date  and  invaluable  compendium  of  practical  bedside  knowledge essential to the effective delivery of acute care medicine.  although this text can be read from cover to cover, the reader is encouraged to use this text as a reference source reading individual Physiologic notes and Review articles as they pertain to specific clinical issues. in that way the relevant information will have immediate practical meaning and hopefully become incorporated into routine practice.

We hope that the reader finds these papers and reviews useful in their practice and enjoy reading them as much as we enjoyed editing the original articles that it comprises.

Introduction

This volume was created  to address  this  fundamental unevenness  in our understanding the associated review articles over the same interval that also addressed these central issues.  

perspectives  and  reviews,  written  by  some  of  the  most  respected  experts  in  the  field, 

volume combines the complete list of these Physiologic notes up until February 2009 with

Michael R. Pinsky, MDLaurent Brochard, MD

Jordi Mancebo, MDGöran Hedenstierna, MD

that underpin both our understanding of disease and response to therapy.  This present 

1. Physiological Notes

1.1 Pulmonary

1.1.1 Respiratory Mechanics

Intrinsic (or auto-) positive end-expiratory pressure during controlled mechanical ventilation    .  .  .  .  .  .  .  .  .   3Laurent Brochard

Intrinsic (or auto-) positive end-expiratory pressure during spontaneous or assisted ventilation   .  .  .  .  .  .  .  .   7Laurent Brochard

Work of breathing    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    11

Interpretation of airway pressure waveforms  .  .  .  .  .  .    15

1.1.2 Gas exchange

Robert Rodríguez-Roisin, Josep Roca

Amal Jubran

I 22 I 2

Björn Jonson, Laurent Brochard

1.2. Cardiovascular:

Pulmonary vascular resistance: A meaningless

Robert Naeije

Clinical significance of pulmonary artery occlusion

Ventricular interdependence: how does it impact

Cyclic changes in arterial pressure during

François Jardin 

Contents

PETER D. WAGNER

THEODOROS VASSILAKOPOULOS

JUKKA TAKALA

.  .  .  .  .  .  .  .  .  .  .  .  .  .  .    17

.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    21

Dead space   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    25

.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    29

Mechanisms of hypoxemia    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    41

Pulse oximetry  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    45

Effects of body temperature on blood gases    .  .  .  .  .  .    49

Venous oximetry    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    53

   .  .  .  .  .  .  .  .  .  .    57

.  .  .  .  .  .    61

variable?  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    65

Pulmonary artery occlusion pressure    .  .  .  .  .  .  .  .  .  .  .    69

pressure   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    73

Pulmonary capillary pressure    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    77

on hemodynamic evaluation in clinical practice?    .  .  .    81

mechanical ventilation   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    85

Measurement of respiratory system resistance during mechanical ventilation

Umberto Lucangelo, luis Blanch 

in mechanically ventilated COPD patients using the Campbell diagram

The multiple inert gas elimination technique (MIGET)

influence of cardiac output on oxygenation

Understanding wasted/ineffective efforts

CLAUDE GUERIN, JEAN-CHRISTOPHE RICHARD

A T

Alveolar ventilation and pulmonary blood flow. : .

Evans R. Fern rez, Rolf D. HubmayrÁ É

/F O ratio and F O :.  .  .  .  .  .  .  . 

the V /Q concept  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    37

Relation between PaO

Hypoxemia due to increased venous admixture:

a mathematical description J ÉRÔM E

Michael R. Pinsky

Michael R. Pinsky

ndez-P

 Aboab, Bruno Louis, 

Frank Bloos, Konrad Reinhart

Andreas Bacher

Belen Cabello, Jordi Mancebo

Jukka Takala

François Jardin

Enrico Calzia, Peter Radermacher 

ContentsViii

2. Physiological Reviews

2.1. Measurement techniques

Fluid responsiveness in mechanically ventilated

Karim Bendjelid, Jacques-André Romand

Different techniques to measure intra-abdominal

Manu L. N. G. Malbrain

Tissue capnometry: does the answer lie

Alexandre Toledo Maciel, Jacques Creteur, Jean-Louis Vincent 

Alexandre Lima, Jan Bakker 

2.2. Physiological processes

SAiram Parthasarathy, Martin J. Tobin 

Magnesium in critical illness: metabolism,

Luis J.  Noronha, George M. Matuschak 

Pulmonary endothelium in acute lung injury:

Pulmonary and cardiac sequelae of subarachnoid

Carol S. A. Macmillan, 

Paul McLoughlin, Brian P. Kavanagh

Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic

Antoine Vieillard-Baron

Acute right ventricular failure – from

Alexandre Mebazaa, Peter Karpati, Estelle Renaud, Lars Algotsson 

Michael Piagnerelli, Karim Zouaoui-Boudjeltia, Michel Vanhaeverbeek, Jean-Louis Vincent 

Hypotension during intermittent hemodialysis:

Frédérique Schortgen 

1.4. Cerebral Function

Peter J. D. Andrews  

Peter J. D. Andrews, Giuseppe Citerio

Ultrasonographic examination of the venae cavae   .  .   Antoine Vieillard-Baron, François Jardin 

.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 

1.3. Metabolism and Renal Function

Daniel De Backer

Rinaldo Bellomo, John A. Kellum, Claudio Ronco 

Lactic acidosis   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    89

new insights into an old problem  .  .  .  .  .  .  .  .  .  .  .  .  .  .    99

and basic concepts  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .   105

and technology   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .   109

 .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  113

 .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  123

patients: a review of indices used in intensive care   .  .   133

blood flow monitoring

and microdialysis  .

Passive leg raising

pressure (IAP): time for a critical re-appraisal   .  .  .  .  .     143

under the tongue?   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  159

Noninvasive monitoring of peripheral perfusion    .  .  .  169

181

185

Sleep in the intensive care unit     .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  191

assessment, and treatment   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  201

from basic science to the critically ill  .  .  .  .  .  .  .  .  .  .  .  .  215

haemorrhage: time for active management?   .  .  .  .  .    229

ventilatory strategies    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  241

subsets to respirator settings  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  251

pathophysiology to new treatments   .  .  .  .  .  .  .  .  .  .  .  261

Red blood cell rheology in sepsis    .  .  .  .  .  .  .  .  .  .  .  .  .    273

XAVIER MONNET AND JEAN-LOUIS TEBOUL

ANUJ BHATIA, ARUN KUMAR GUPTA

ANUJ BHATIA, ARUN KUMAR GUPTA

Part one: Intracranial pressure and cerebral

Part two: Cerebral oxygenation monitoring

Defining renal failure: physiological principles  .  .  .  .  .    93

Intracranial pressure. Part one: Historical overview

Intracranial pressure. Part two: Clinical applications

Giuseppe Citerio, 

Neuromonitoring in the intensive care unit.

Neuromonitoring in the intensive care unit.

Ian S. Grant, Peter J. D. Andrews

John G. Laffey, Donal  O’Croinin, l

 François Jardin, 

stylianos E. Orfanos, Irene Mavrommati, 

Permissive hypercapnia – role in protective lung

Io nna  Korovesi, Charis Roussos a

Contents iX

Diaphragmatic fatigue during sepsis

Sophie Lanone, Camille Taillé, Jorge Boczkowski, Michel Aubier 

Jean-Roger Le Gall 

jean-Louis Vincent, Daniel De Backer 

Suveer Singh, Timothy W. Evans 

Ventilator-induced lung injury: from the bench

Lorraine N. Tremblay, Arthur S. Slutsky 

Remembrance of Weaning Past:

Martin J. Tobin3. Seminal Studies in Intensive Care

Manipulating afterload for the treatment of acute

pressure into mechanical ventilation:

Konrad J. Falke 

Elastic pressure-volume curves in acute lung injury and acute respiratory distress syndrome Björn Jonson 

Luciano Gattinoni, Antonio Pesenti 

The effects of anesthesia and muscle paralysis on

Göran Hedenstierna, Lennart Edmark 

.  .  .  ..

Normalizing physiological variables in acute illness:

Brian P. Kavanagh, L. Joanne Meyer

SHANE M. TIBBY, ANDREW DURWARD

THEODOROS VASSILAKOPOULOS

Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain

Ioanna Dimopoulou, Stylianos Tsagarakis 

Matching total body oxygen consumption and

Pierre Squara

Stress-hyperglycemia, insulin and

Paul E. Marik, Murugan Ragavanh 

gradient across a pulmonary artery band Interpretation of the echocardiographic pressure

in the setting of a univentricular heart

Ventilator-induced diaphragm dysfunction: the clinical relevance of animal models

Understanding organ dysfunction in hemophagocytic lymphohistiocytosis

Interactions between respiration and systemic hemodynamics. Part I: basic concepts

Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care

immunomodulation in sepsis    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    283

injury    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .     293

delivery: a crucial objective?    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    303

five reasons for caution  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .     313

 .  .  .  .  .  .  .  .  .     321

 .  .  .  .  .  .  .  .     327

 .  .  .  .  .  .  .     337

a retrospective    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    363

.  .  .  .  .  .  .  .     367

The concept of “baby lung”   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    375

the respiratory system    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    385

and septic shock    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    395

The use of severity scores in the intensive care  .  .  .  .     403

  409

Organ dysfunction during sepsis    .  .  .  .  .  .  .  .  .  .  .  .  .    417

to the bedside   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .     429

the Seminal Studies    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    439

.  .  .  .  .  .  .  .  .    449

  459

  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    467

CAROLINE CRÉPUT, LIONEL GALICIER, SOPHIE BUYSE ELIE AZOULAY

FRANÇOIS FEIHL , ALAIN F. BROCCARD

Subject Index 

FRANÇOIS FEIHL , ALAIN F. BROCCARD

Nosocomial pneumonia    .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .    355

CLAUDE PERRET, JEAN-FRANÇOIS ENRICO

Waldemar G. Johanson, Lisa L. Dever 

The introduction of positive endexpiratory

controversy  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .Oxygen transport—the oxygen delivery

heart failure. A historical summary   .  .  .  .  .  .  .  .  .  .  .  .    351

Jérôme AboabRéanimation Médicalehôpital henri Mondorcréteil, France

Lars AlgotssonDepartment of anaesthesiology– heart-Lung DivisionUniversity hospital of Lund,22185 Lund, sweden

Peter J. D. AndrewsDepartment of anaesthetics, intensive care and Pain MedicineUniversity of edinburgh, Western General hospitalcrewe Road, eh4 2XU edinburgh, scotland, Uk

Michel AubierinseRM U 700 and iFR 02, Facult Xavier Bichat16 rue henri huchard, 75018 Paris, France

Andreas BacherDepartment of anesthesiology and General intensive careMedical University of Vienna, akhWähringer Gürtel 18–20, 1090 Vienna, austria

Jan BakkerDepartment of intensive care, erasmus McUniversity Medical center RotterdamP.o. Box 2040, 3000 ca Rotterdam, The netherlands

Rinaldo BellomoDepartment of intensive care and Division of surgeryaustin & Repatriation Medical centre3084 heidelberg, Melbourne, Victoria, australia

Karim Bendjelidsurgical intensive care Division, Geneva University hospitals1211 Geneva 14, switzerland

critical care center hospital de sabadellParc Taulis/n, 08208 sabadell, spain

Frank Bloosklinik für anästhesiologie und intensivtherapieklinikum der Friedrich-schiller-Universitäterlanger allee 101, 07747 Jena, Germany

Jorge BoczkowskiinseRM U 700 and iFR 02, Facult  Xavier Bichat16 rue henri huchard, 75018 Paris, France

Laurent Brochard Réanimation Médicalehôpital henri Mondor, Université Paris 12, inseRM U651, 94010 créteil, France

Contributors

Department of Clinical Immunology, and Hôpital Saint-Louis, Medical ICU, AP--HP, -University Paris-7 Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France

Elie Azoulay

Department of Anaesthesia, Addenbrooke’s Hospital, Hills Road, CB2 2QQ Cambridge, UK

Anuj Bhatia

Medical Intensive Care Unit, Regions Hospital Pulmonary and Critical Care Division,

MN 55101-2595, USA

Alain F. Broccard

Regions Hospital, St Paul,

Department of Clinical Immunology, and Hôpital Saint-Louis, Medical ICU, AP---HP, University Paris-7 Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France

Sophie Buyse

Luis Blanch

ContributorsXii

Lisa L. DeverUMDnJ-new Jersey Medical school, Va new Jersey health care system385 Tremont, east orange, nJ 07018, Usa

Ioanna Dimopoulousecond Department of critical care Medicine, attikon hospital, Medical school national and kapodistrian University of athens2 Pesmazoglou street, 14561 kifissia, athens, Greece

Lennart EdmarkDepartment of anesthesia and intensive carecentral hospital72335 Vasteras, sweden

Jean-François EnricoFormer chief of intensive care Unithôpital des cadolles,neuchâtel, switzerland

Timothy W. Evansimperial college school of MedicineDepartment of intensive care MedicineRoyal Brompton hospital, London, Uk

Konrad J. Falkeklinik für anaesthesiology und operative intensivmedizin Berlincampus Virchow klinikum,charite, Berlin, Germany

Evans R. Fernández PérezMayo clinic college of Medicine 

Jean-Roger Le GallDepartment of intensive care Medicinesaint-Louis University hospital, Paris, France

Luciano Gattinoniistituto di anestesia e RianimazioneFondazione iRccs ospedale Maggiore PoliclinicoMangiagalli, Regina elena di Milano, Università degli studiVia Francesco sforza 35, 20122 Milan, italy

Ian S. GrantDepartment of anaesthesia, University of edinburgh,Western General hospital, edinburgh,  scotland, Uk

Jacques CreteurDepartment of intensive care, erasme University hospital, Free University of BrusselsRoute de Lennik 808, 1070 Brussels, Belgium

Enrico Calziasektion anästhesiologische Pathophysiologie und Verfahrensentwicklung Universitätsklinik für anästhesiologie, Universität UlmParkstrasse 11, 89070 Ulm, Germany

Giuseppe Citerioneurorianimazione, Dipartimento di anestesia e Rianimazionenuovo ospedale san GerardoVia Donizetti 106, 20052 Monza, italy

Belen Cabellohospital santa creu i sant Pau, servicio de Medicina intensivaav/ sant antoni Maria claret 167, cP 08025 Barcelona, spain

and Hôpital Saint-Louis, Medical ICU, AP--HP, -University Paris-7 Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France

Caroline Créput Department of Clinical Immunology,

Evelina Children’s Hospital, Guy’s and Saint Thomas’ NHS Trust, Paediatric Intensive Care Unit, SE1 7EH London, UK

Andrew Durward

1011 Lausanne, Switzerland

University Hospital (CHUV) and Lausanne University (UNIL),

François Feihl Division of Clinical Pathophysiology,

Department of Clinical Immunology, and Hôpital Saint-Louis, Medical ICU, AP--HP, -University Paris-7 Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France

Lionel Galicier Daniel De BackerDepartment of intensive care, erasme University hospitalFree University of BrusselsRoute de Lennik 808, 1070 Brussels, Belgium

55905 Mn ,  UsaRochester,  

Contributors Xiii

Bruno Louisinserm Unit 651Department of Medecine Paris 12créteil, France

Umberto LucangeloDepartment of Perioperative Medicine,intensive care and emergency, cattinara hospital, Trieste University school of Medicine34139 Trieste, italy

Jordi Mancebohospital santa creu i sant Pau, servicio de Medicina intensivaav/ sant antoni Maria claret 167, cP 08025 Barcelona, spain

Alexandre Toledo MacielDepartment of intensive care, erasme University hospital, Free University of BrusselsRoute de Lennik 808, 1070 Brussels, Belgium

Carol S. A. MacmillanUniversity of Dundee, Department of anaesthesianinewells hospital, Dundee DD1 9sy, Uk

Brian P. KavanaghDepartment of critical care Medicine, hospital for sick children555 University avenue, Toronto, onT, M5G 1X8, canada

John A. KellumDivision of critical care Medicine, scaife hallUniversity of Pittsburgh Medial centre,Terrace street, Pittsburgh, Pa 15260, Usa

Peter KarpatiDepartment of anaesthesiology and critical care Medicinehopital Lariboisie`re, 2 Rue ambroise Pare75475 Paris cedex 10, France

Waldemar G. Johanson †UMDnJ-new Jersey Medical school185 south orange, newark, nJ 07018, Usa

Björn JonsonDepartment of clinical PhysiologyUniversity hospital of Lund22185 Lund, sweden

Amal JubranDivision of Pulmonary and critical care Medicine edward hines Jr. Veterans affairs hospitalRoute 111 n, hines, iL, 60141, Usa

John G. LaffeyDepartment of anaesthesia, University college hospitalGalway and clinical sciences institute, national University of ireland, Galway, ireland

Sophie LanoneinseRM U 700 and iFR 02, Facult  Xavier Bichat16 rue henri huchard, 75018 Paris, France

Alexandre LimaDepartment of intensive care, erasmus McUniversity Medical center RotterdamP.o. Box 2040, 3000 ca Rotterdam, The netherlands

Ioanna KorovesiDepartment of critical care & Pulmonary Medicine and “M. simou” LaboratoryMedical school, University of athens, evangelismos hospital45–47 ipsilandou st., 10675 athens, Greece

Göran Hedenstiernaclinical Physiology, Department of Medical sciences, University hospital75185 Uppsala, sweden

Rolf D. HubmayrMayo clinic college of Medicine 

François Jardinhôpital ambroise Paré,service de Réanimation Médicale,9 avenue charles de Gaulle, 92104 Boulogne, France

Department of Anaesthesia, Addenbrooke’s Hospital, Hills Road, CB2 2QQ Cambridge, UK

Neuroscience Critical Care Unit, Addenbrooke’s Hospital, Hills Road, CB2 2QQ Cambridge, UK

Arun Kumar Gupta

and

Hôpital de la Croix Rousse and Université de Lyon, Service de Réanimation Médicale, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France

Claude Guerin

55905 Mn ,  UsaRochester,  

ContributorsXiV

Stylianos E. Orfanos2nd Department of critical care, University of athens Medical school, attikon hospital1, Rimini st., 12462 haidari (athens), Greece

Sairam ParthasarathyDivision of Pulmonary and critical care, Medicine edward hines Jr.Veterans administrative hospital, Loyola University of chicago stritch school of MedicineRoute 111 n, hines, iL 60141, Usa

Michael PiagnerelliDepartment of intensive care, erasme University hospitalFree University of Brussels808 route de Lennik, 1070 Brussels, Belgium

Claude PerretFormer chief of intensive care DepartmentUniversity hospital of Lausanne, switzerlandRuelle des halles 4, ch-1095 Lutry, switzerland

Antonio PesentiDipartimento di Medicina Perioperatoria e Terapia intensiva a.o. ospedale s.GerardoMonza, Università degli studiMilan-Bicocca, italy

Robert Naeije Department of Physiology,Faculty of Medicine of the Free University of Brussels, erasme campus808 Route de Lennik, cP 604, 1070 Brussels, Belgium

Luis J. NoronhaDivision of Pulmonary, critical care and occupational MedicineDepartments of internal Medicine and Pharmacological and Physiological scienceschool of Medicinesaint Louis University, 3635 Vista ave., saint Louis, Mo 63110-0250, Usa

O’CroininDepartment of Physiology, University college DublinDublin, ireland

Paul McLoughlinDepartment of Physiology, University college DublinDublin, ireland

Alexandre MebazaaDepartment of anaesthesiology and critical care Medicinehopital Lariboisière, 2 Rue ambroise Pare75475 Paris cedex 10, France

L. Joanne MeyerDepartment of Medicine, st. Joseph’s hospitalToronto, canada

Paul E. MarikDepartment of critical care MedicineUniversity of Pittsburgh Medical center640a scaife hall, 3550 Terrace street, Pittsburgh, Pa, 15261, Usa

George M. MatuschakDivision of Pulmonary, critical care and occupational MedicineDepartments of internal Medicine and Pharmacological and Physiological scienceschool of Medicinesaint Louis University, 3635 Vista ave., saint Louis, Mo 63110-0250, Usa

Irene MavrommatiDepartment of critical care & Pulmonary Medicine and “M. simou” LaboratoryMedical school, University of athens, evangelismos hospital45–47 ipsilandou st., 10675 athens, Greece

Hôpital de Bicêtre, AP-HP, Service de réanimation médicale, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France

Université Paris-Sud, Equipe d’accueil EA 4046, Faculté de Médecine Paris-Sud, 94270 Le Kremlin-Bicêtre, France

Xavier Monnet

and

Manu L. N. G. MalbrainMedical intensive care Unit, acZa campus stuivenbergLange Beeldekensstraat 267, B-2060 antwerpen, Belgium

Donall

XV

Camille TailléinseRM U 700 and iFR 02, Facult  Xavier Bichat16 rue henri huchard, 75018 Paris, France

Arthur S. SlutskyQueen Wing, st. Michael’s hospital30 Bond st., Toronto, onT, M5B 1W8, canada

Pierre SquaraceRic clinique ambroise Pare27 Boulevard Victor hugo, 92200 neuilly-sur-seine, France

Claudio RoncoDivisione di nefrologia, ospedale san BortoloVia Ridolfi, 36100 Vicenza, italy

Frédérique SchortgenRéanimation Médicale et infectieusehôpital Bichat-claude Bernard75018 Paris, France

Suveer Singhchelsea and Westminster hospitalDepartment of intensive care Medicine369 Fulham Road, sW10 9nh London, Uk

Estelle RenaudDepartment of anaesthesiology and critical care Medicinehopital Lariboisie`re, 2 Rue ambroise Pare75475 Paris cedex 10, France

Charis RoussosDepartment of critical care & Pulmonary Medicine and “M. simou” LaboratoryMedical school, University of athens, evangelismos hospital45–47 ipsilandou st., 10675 athens, Greece

Josep Rocaservei de Pneumologia, hospital clínicinstitut d’investigaciones Biomédiques ausgust Pi i sunyer, Universitat de BarcelonaVillarroel 170, 08036 Barcelona, spain

Robert Rodríguez-Roisinservei de Pneumologia, hospital clínicinstitut d’investigaciones Biomédiques ausgust Pi i sunyer, Universitat de BarcelonaVillarroel 170, 08036 Barcelona, spain

Peter Radermachersektion anästhesiologische Pathophysiologie und Verfahrensentwicklung Universitätsklinik für anästhesiologie, Universität UlmParkstrasse 11, 89070 Ulm, Germany

Konrad Reinhartklinik für anästhesiologie und intensivtherapieklinikum der Friedrich-schiller-Universitäterlanger allee 101, 07747 Jena, Germany

Hôpital de la Croix Rousse and Université de Lyon, Service de Réanimation Médicale, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France

Jean-Christophe Richard

Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, 3010 Bern, Switzerland

Jukka Takala

Hôpital de Bicêtre, AP-HP, Service de réanimation médicale, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France

Université Paris-Sud, Equipe d’accueil EA 4046, Faculté de Médecine Paris-Sud, 94270 Le Kremlin-Bicêtre, France

Jean-Louis Teboul

and

Paediatric Intensive Care Unit, Evelina Children’s Hospital, Guy’s and Saint Thomas’ NHS Trust, SE1 7EH London, UK

Shane M. Tibby

Contributors

Murugan Raghavanconemaugh Memorial Medical centerJohnstown, Pennsylvania, Usa

Michael R. PinskyDepartment of critical care MedicineUniversity of Pittsburgh Medical center, 604 scaife, 3550 Terrace street, Pittsburgh, Pa 15261, Usa

Jacques-André Romandsurgical intensive care Division, Geneva University hospitals1211 Geneva 14, switzerland

Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital,

Critical Care Department, Evangelismos Hospital, 45---47 Ipsilandou Strasse, 10675 Athens, Greece

Department of Medicine, Division of Physiology, University of California, San Diego, 9500 Gilman Drive, Dept. 0623A, La Jolla CA 92093-0623A, USA

Peter D. Wagner

Theodoros Vassilakopoulos

and

Stylianos TsagarakisDepartment of endocrinology, athens Polyclinicathens, Greece

Michel Vanhaeverbeekexperimental Medicine Laboratory, andré Vésale hospitalMontigny-le-Tilleul, Belgium

Antoine Vieillard-BaronUniversity hospital ambroise Paré, assistance Publique hôpitaux de ParisMedical intensive care Unit9 avenue charles de Gaulle, 92104 Boulogne cedex, France

Jean-Louis VincentDepartment of intensive care, erasme University hospitalFree University of BrusselsRoute de Lennik 808, 1070 Brussels, Belgium

Karim Zouaoui-Boudjeltiaexperimental Medicine Laboratory, andré Vésale hospitalMontigny-le-Tilleul, Belgium

45---47 Ipsilandou Street, 10675 Athens, Greece

Lorraine N. TremblayDepartment of surgerysunnybrook and Women’s health sciences centerToronto, ont., canada

ContributorsXVi

Martin J. TobinDivision of Pulmonary and critical care Medicineedward hines Jr. Va hospital, 111n5th avenue and Roosevelt Roadhines, illinois 60141, Usa