EVIDENCE-BASED PRACTICE of CRITICAL CARE
third edition
Clifford S. Deutschman, MS, MD, FCCM
Vice Chair, Research
Department of Pediatrics
Steven and Alexandra Cohen Children’s Medical Center
New Hyde Park, New York
Professor of Pediatrics and Molecular Medicine
Hofstra-Northwell School of Medicine
Hempstead, New York
Professor of Molecular Medicine, Feinstein Institute for Medical Research and Professor, The Elmezzi Graduate School of Molecular Medicine
Manhasset, New York
Patrick J. Neligan, MA, MB, FCAI, FJFICMI
Consultant in Anaesthesia, Special Interest in Intensive Care
Medical Director, Critical Care
Galway University Hospitals
Honorary Professor of Anaesthesia and Intensive Care
National University of Ireland, Galway
Clincal Lead in Sepsis
Saolta Healthcare Group
Ireland
1600 John F. Kennedy Blvd.
Ste 1800 Philadelphia, PA 19103-2899
EVIDENCE-BASED PRACTICE OF CRITICAL CARE, THIRD EDITION
Copyright © 2020 by Elsevier, Inc. All rights reserved. Previous editions copyrighted 2016, 2010
ISBN: 978-0-323-64068-8
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To my family:
Cate, Beth, and Nicki, who make us so proud, and Chris, for truly being my better half for three and a half decades.
Clifford S. Deutschman, MS, MD
To Diane, David, Conor, and Kate and to my parents, Maurice and Dympna Neligan, for their continued support and wisdom.
Patrick J. Neligan, MA, MB, FCAI, FJFICIMI
In memory of Brian Kavanagh friend and colleague, clinician and scientist contributor to the first edition, mentor to many of the authors of this one and, too sadly, not here to be embarrassed by this dedication.
Gareth L. Ackland, PhD, FRCA, FFICM
Reader in Perioperative Medicine
Translational Medicine & Therapeutics
William Harvey Research Institute
Barts and The London School of Medicine and Dentistry, Queen Mary University of London London, United Kingdom
Adeel Rafi Ahmed, MB BCh, BAO, MRCPI, MRCP(UK), PGDip(ClinEd)
Registrar/Fellow Department of Nephrology University Hospital Galway Galway, Ireland
Djillali Annane, MD, PhD
Professor and Director, General Intensive Care Unit
Hospital Raymond Poincaré, Assistance Publique Hôpitaux de Paris
Dean, School of Medicine Simone Veil, at University of Versailles Saint Quentin en Yvelines
University Paris Saclay Garches, France
Eman Ansari, MD, MPH
Faculty Physician
Department of Medicine
Boston Children’s Hospital
Instructor of Pediatrics
Harvard Medical School Boston, Massachusetts
Hubertus Axer, MD
Professor
Hans Berger Department of Neurology Jena University Hospital
Jena, Germany
Jan Bakker, MD, PhD, FCCP, FCCM Department of Pulmonology and Critical Care
New York University and Columbia University Medical Center
New York, New York
Intensive Care, Adults
Erasmus MC University Medical Center
Rotterdam, The Netherlands
Department of Intensive Care
Pontificia Universidad Católica de Chile Santiago, Chile
Ian J. Barbash, MD, MS
Assistant Professor
Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine University of Pittsburgh Pittsburgh, Pennsylvania
John James Bates, MB, BCh, BAO, MRCPI, FCAI, FCICM, FJFICMI
Consultant in Anaesthesia & Intensive Care
Galway University Hospitals
Honorary Professor of Anaesthesia and Intensive Care
National University of Ireland, Galway Clinical Lead for Critical Care
Saolta Healthcare Group
Ireland
Michael Bauer, MD
Director, Department of Anaesthesiology and Intensive Care
Chief Executive Director, Center for Sepsis Control & Care
Jena University Hospital
Jena, Germany
Amy L. Bellinghausen, MD Fellow
Department of Pulmonary, Critical Care and Sleep Medicine
University of California San Diego San Diego, California
William S. Bender, MD, MPH Assistant Professor
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine
Emory University School of Medicine Atlanta, Georgia
Matthew R. Biery, DO
Attending Physician
Department of Critical Care and Emergency Medicine
Jefferson Health System
Assistant Clinical Professor of Emergency Medicine
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvania
Alexandra Binnie, MD, DPhil
Associate Staff Physician
Department of Critical Care
William Osler Health System
Brampton, Canada
Thomas P. Bleck, MD, MCCM, FNCS Professor of Neurology
Northwestern University Feinberg School of Medicine
Emeritus Professor of Neurological Sciences, Neurosurgery, Anesthesiology, and Medicine
Rush Medical College Chicago, Illinois
Christina Boncyk, MD
Assistant Professor Department of Anesthesiology
Vanderbilt University Medical Center Nashville, Tennessee
Jason C. Brainard, MD
Associate Professor
Department of Anesthesiology
University of Colorado School of Medicine
Aurora, Colorado
Scott C. Brakenridge, MD, FACS, MSCS Assistant Professor of Surgery and Anesthesiology
Department of Surgery, Division of Acute Care Surgery
University of Florida Gainesville, Florida
Frank Martin Brunkhorst, MD Director, Center of Clinical Studies Professor of Anaesthesiology and Intensive Care Medicine
Jena University Hospital Jena, Germany
Tara Cahill, BSc(Physio), MSc
Respiratory Physiotherapy
Galway University Hospital, Saolta University Healthcare Group
National University of Ireland Galway Galway, Ireland
Christina Campbell, Mb BCh, BAO, RCPI
Respiratory Specialist Registrar
Galway University Hospital, Saolta University Healthcare Group
National University of Ireland Galway Galway, Ireland
Jonathan Dale Casey, MD, MSCI
Assistant Professor of Medicine
Division of Allergy, Pulmonary, and Critical Care
Vanderbilt University Medical Center
Nashville, Tennessee
Jean-Marc Cavaillon, Dr.Sc
Professor Experimental Neuropathology Institut Pasteur Paris, France
Maurizio Cereda, MD
Associate Professor
Department of Anesthesiology and Critical Care
Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
David J. Cooper, BMBS, MD
Professor of Intensive Care Medicine Monash University Melbourne, Australia
Craig M. Coopersmith, MD, FACS, FCCM
Professor
Department of Surgery
Emory Critical Care Center Emory University Atlanta, Georgia
Jennifer Cruz, DO
Cardiovascular Disease Fellow
Department of Cardiovascular Disease Cooper University Camden, New Jersey
Cheston B. Cunha, MD
Medical Director, Antimicrobial Stewardship
Infectious Disease Division
Alpert School of Medicine, Brown University Providence, Rhode Island
Gerard F. Curley, MB, PhD, FCAI FJFICMI
Professor & Chair of Anaesthesiology & Critical Care
Royal College of Surgeons in Ireland Consultant in Anaesthesia & Intensive Care Beaumont Hospital Dublin, Ireland
Allison Dalton, MD
Assistant Professor
Department of Anesthesia & Critical Care University of Chicago Chicago, Illinois
Daniel De Backer, MD, PhD
Professor
Intensive Care Department
CHIREC Hospitals, Université Libre de Bruxelles Brussels, Belgium
Clifford S. Deutschman, MS, MD, MCCM
Vice Chair, Research
Department of Pediatrics
Steven and Alexandra Cohen Children’s Medical Center
New Hyde Park, New York
Professor of Pediatrics and Molecular Medicine
Hofstra-Northwell School of Medicine
Hempstead, New York
Professor of Molecular Medicine, Feinstein Institute for Medical Research and Professor, The Elmezzi
Graduate School of Molecular Medicine
Manhasset, New York
David Devlin, FRCA, MRCPI Clinical Fellow
Galway University Hospital Galway, Ireland
Claudia C. Dos Santos, MSc, MD
Associate Professor of Medicine Scientist, Institute of Medical Sciences
University of Toronto Scientist, Keenan Research Centre for Biomedical Science
St. Michael’s Hospital Toronto, Canada
Tomas Drabek, MD, PhD, FASA
Associate Professor
Department of Anesthesiology and Perioperative Medicine
Scientist
Safar Center for Resuscitation Research University of Pittsburgh Pittsburgh, Pennsylvania
Laura Dragoi, MD Fellow
Department of Critical Care Medicine Sunnybrook Health Sciences Centre Toronto, Canada
Martin Dres, MD, PhD
Sorbonne Université
Neurophysiologie Respiratoire Expérimentale et Clinique
Pneumologie, Médecine Intensive –Réanimation
La Pitié Salpêtrière Hospital Paris, France
Anne M. Drewry, MD, MSCI
Associate Professor of Anesthesiology Department of Anesthesiology
Washington University School of Medicine
St. Louis, Missouri
Stephen Duff, MD School of Medicine
University College Dublin Dublin, Ireland
Philip A. Efron, MD, FACS, FCCM Professor of Surgery
Department of Surgery, Division of Acute Care Surgery
University of Florida Gainesville, Florida
Sinéad Egan, MB, BCH, BAO, FCAI Department of Anesthesia and Intensive Care
Beaumont Hospital Dublin, Ireland
Ali A. El Solh, MD, MPH Professor
Department of Medicine, Epidemiology, and Environmental Health
Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions
University at Buffalo Associate Chief of Staff for Research VA Western New York Healthcare System Buffalo, New York
E. Wesley Ely, MD, MPH
Grant Liddle Honorary Chair, Professor of Medicine
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center
Assoc. Director of Aging Research, VA Tennessee Valley GRECC Vanderbilt University Medical Center Nashville, Tennessee
Laura Evans, MD, MSc Associate Professor
Departments of Pulmonary, Critical Care, and Sleep Medicine
New York University School of Medicine
New York, New York
Jessica Falco-Walter, MD Clinical Assistant Professor
Department of Neurology and Neurological Sciences
Stanford University Palo Alto, California
Jonathan K. Frogel, MD
Senior Anesthestiologist
Sheba Medical Center
Department of Anesthesiology
Ramat Gan, Israel
Niall D. Ferguson, MD, MSc Professor
Interdepartmental Division of Critical Care Medicine
University of Toronto Head, Critical Care Medicine
University Health Network and Sinai Health System Toronto, Ontario, Canada
Joseph S. Fernandez-Moure, MD, MS Instructor Department of Surgery Division of Traumatology, Critical Care, and Emergency Surgery University of Pennsylvania Philadelphia, Pennsylvania
Jakub Furmaga, MD
Assistant Professor of Emergency Medicine University of Texas Southwestern Medical Center Dallas, Texas
David Foster Gaieski, MD Professor Department of Emergency Medicine
Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania
Ognjen Gajic, MD Professor of Medicine Division of Pulmonary and Critical Care Mayo Clinic Rochester, Minnesota
Alice Gallo De Moraes, MD, FACP Assistant Professor of Medicine Department of Medicine, Division of Pulmonary and Critical Care Mayo Clinic Rochester, Minnesota
Kelly R. Genga, MD, PhD Center for Heart Lung Innovation University of British Columbia Vancouver, British Columbia, Canada
Pierce Geoghegan, MB, BCh, BAO, BA Specialist Registrar
Departments of Anaesthesia, Intensive Care and Pain Medicine
St. Vincent’s University Hospital Dublin, Ireland
Evangelos J. Giamarellos-Bourboulis, MD, PhD
4th Department of Internal Medicine
National and Kapodistrian University of Athens, Medical School Athens, Greece
Rick Gill, MD
Assistant Professor Department of Neurology
Loyola University Chicago Chicago, Illinois
Ewan C. Goligher, MD, PhD
Department of Medicine, Division of Respirology
University Health Network
Assistant Professor of Medicine
Interdepartmental Division of Critical Care Medicine
University of Toronto Scientist
Toronto General Hospital Research Institute Toronto, Canada
Emily K. Gordon, MD, MSEd
Associate Professor of Clinical Anesthesiology and Critical Care Department of Anesthesiology and Critical Care
Perelman School of Medicine at the University Hospital of Pennsylvania Philadelphia, Pennsylvania
W. Robert Grabenkort, PA, MMSc, FCCM
Physician Assistant Emory Healthcare Atlanta, Georgia
Garima Gupta, DO, MPH Clinical Fellow Department of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
Jacob T. Gutsche, MD Associate Professor
Cardiothoracic and Vascular Section; Anesthesiology and Critical Care
The Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
Goksel Guven, MD Department of Intensive Care Erasmus Medical Center, Erasmus University of Rotterdam Rotterdam, The Netherlands Department of Translational Physiology Academic Medical Center, University of Amsterdam Amsterdam, The Netherlands
Paige Guyatt
Research Assistant
Department of Health Research Methods, Evidence, and Impact
McMaster University Hamilton, Canada
Nicholas Heming, MD General Intensive Care Unit
Raymond Poincaré Hospital (AP-HP) University of Versailles SQY Laboratory of Inflammation and Infection U1173 INSERM Garches, France
Cheralyn J. Hendrix, MD Resident
Department of Surgery
George Washington University Hospital Washington, D.C.
McKenzie K. Hollen, BA Department of Surgery, Division of Acute Care Surgery
University of Florida Gainesville, Florida
Steven M. Hollenberg, MD Professor of Medicine
Hackensack Meridian Medical School at Seton Hall
Associate Director, Cardiothoracic Intensive Care Unit
Hackensack Meridian University Hospital Hackensack, New Jersey
Vivien Hong Tuan Ha, MD Assistant Specialist Intensive Care
Raymond Poincaré University Hospital Garches, France
Shahd Horie, BSc, MSc, PhD Lung Biology Group
Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices
National University of Ireland Galway Galway, Ireland
Catherine L. Hough, MD, MSc Professor of Medicine
University of Washington Seattle, Washington
Can Ince, PhD
Professor
Department of Intensive Care
Erasmus Medical Center
University Medical Center Rotterdam, The Netherlands
Theodore J. Iwashyna, MD, PhD
Director of Health Services Research Pulmonary and Critical Care Medicine
University of Michigan
Ann Arbor, Michigan
Judith Jacobi, PharmD, FCCP, MCCM, BCCCP
Critical Care Clinical Pharmacist Indiana University Health Methodist Hospital Indianapolis, Indiana
Marc Jeschke, MD, PhD, FACS, FCCM, FRCS(C) Professor
Department of Surgery, Division of Plastic Surgery, Department of Immunology University of Toronto Chair in Burn Research
Ross Tilley Burn Centre
Sunnybrook Health Sciences Centre Senior Scientist Sunnybrook Research Institute Toronto, Canada
Nicholas J. Johnson, MD Assistant Professor Department of Emergency Medicine
Adjunct Assistant Professor Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine University of Washington/Harborview Medical Center
Seattle, Washington
Jeremy M. Kahn, MD, MS Professor and Vice Chair Department of Critical Care Medicine University of Pittsburgh Pittsburgh, Pennsylvania
Lewis J. Kaplan, MD, FACS, FCCM, FCCP Professor of Surgery Department of Surgery; Division of Trauma, Surgical Critical Care and Emergency Surgery
Perelman School of Medicine, University of Pennsylvania
Section Chief, Surgical Critical Care Department of Surgery
Corporal Michael J Crescenz VA Medical Center Philadelphia, Pennsylvania
Mark T. Keegan, MB, MRCPI, D.ABA, MSc, FCCM
Professor of Anesthesiology Division of Critical Care, Department of Anesthesiology and Perioperative Medicine
Mayo Clinic and Mayo Clinic College of Medicine and Science Rochester, Minnesota
Jordan Anthony Kempker, MD, MSc Assisstant Professor
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine
Emory University
Atlanta, Georgia
Leo G. Kevin, MD, FCARCSI Department of Intensive Care
University Hospital Galway Galway, Ireland
Yasin A. Khan, MD
Clinical Fellow
Interdepartmental Division of Critical Care University of Toronto Toronto, Ontario, Canada
Ruth Kleinpell, PhD, RN, AG-ACNP, FCCM
Assistant Dean for Clinical Scholarship Professor
Vanderbilt University School of Nursing Nashville, Tennessee
Kurt Kleinschmidt, MD Professor of Emergency Medicine Division Chief, Medical Toxicology
University of Texas Southwestern Medical Center Dallas, Texas
Michael Klompas, MD, MPH Professor of Population Medicine
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Healthcare Institute Hospital Epidemiologist
Brigham and Women’s Hospital Boston, Massachusetts
Patrick M. Kochanek, MD, MCCM
Ake N. Grenvik Professor in Critical Care Medicine
Professor and Vice Chair, Critical Care Medicine
Professor of Anesthesiology, Pediatrics, Bioengineering, and Clinical and Translational Science
Director, Safar Center for Resuscitation Research
University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
W. Andrew Kofke, MD, MBA, FCCM, FNCS
Professor, Director of Neuroscience in Anesthesiology and Critical Care Program
Co-Director, Neurocritical Care
Co-Director, Perioperative Medicine and Pain Clinical Research Unit
Departments of Anesthesiology and Critical Care and Neurosurgery
University of Pennsylvania Philadelphia, Pennsylvania
Benjamin Kohl, MD, FCCM Chief, Critical Care
Professor of Anesthesiology
Department of Anesthesiology
Thomas Jefferson University Philadelphia, Pennsylvania
Andreas Kortgen, MD
Department of Anaesthesiology and Critical Care Medicine
Center for Sepsis Control and Care
Jena University Hospital
Jena, Germany
David Kung, MD
Assistant Professor Department of Neurosurgery
University of Pennsylvania Philadelphia, Pennsylvania
John G. Laffey, MD, MA, FCAI, FJFICMI Professor, Anaesthesia and Intensive Care Medicine, Vice-Dean Research, College of Medicine, Nursing and Health Sciences
NUI Galway
Consultant, Anaesthesia and Intensive Care Medicine
Galway University Hospitals
Galway, Ireland
Joel Lage, BS
Vila Real de Santo Antonio, Portugal
David William Lappin, MB, PhD, FRCPI Consultant Nephrologist
Galway University Hospitals
Honorary Personal Professor of Nephrology and Hypertension Department of Medicine
National University of Ireland, Galway Galway, Ireland
Francois Lamontagne, MD, MSc
Professor
Université de Sherbrooke
Scientist
Centre de Recherche du CHU de Sherbrooke
Intensivist
Centre Intégré Universitaire de Santé et de Services Sociaux Sherbrooke
Sherbrooke, Quebec, Canada
Daniel E. Leisman, BS
Visting Scholar
Department of Pediatrics
Feinstein Institute for Medical Research
Manhasset, New York
Icahn School of Medicine at Mount Sinai New York, New York
Ron Leong, MD Fellow
Department of Anesthesiology Hospital of the University of Pennsylvania Philadelphia, Pennsylvania
Joshua M. Levine, MD
Associate Professor
Departments of Neurology, Neurosurgery, and Anesthesiology & Critical Care
Chief, Division of Neurocritical Care Department of Neurology
Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
Andrew T. Levinson, MD, MPH
Assistant Professor of Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine
Warren Alpert School of Medicine, Brown University Providence, Rhode Island
Mitchell M. Levy, MD Professor of Medicine
The Warren Alpert Medical School of Brown University
Chief, Division of Pulmonary, Critical Care, and Sleep Medicine
Director, Medical Intensive Care Unit Rhode Island Hospital Providence, Rhode Island
Ariane Lewis, MD
Associate Professor Department of Neurology and Neurosurgery
New York University Langone Medical Center
New York, New York
Ariel Tamara Slavin, MD
Resident Physician
Department of Obstetrics & Gynecology Drexel University Philadelphia, Pennsylvania
Olivier Lheureux, MD
Department of Intensive Care CUB Erasme Hospital Brussels, Belgium
Vincent X. Liu, MD, MSc
Research Scientist Division of Research
Kaiser Permanente
Oakland, California
Craig Lyons, MB, MCAI
Specialist Registrar in Anaesthesia Department of Anaesthesia and Intensive Care Medicine
Galway University Hospitals Galway, Ireland
Jason H. Maley, MD Fellow
Division of Pulmonary and Critical Care Medicine
Massachusetts General Hospital Division of Pulmonary, Critical Care, and Sleep Medicine
Beth Israel Deaconess Medical Center Boston, Massachusetts
Atul Malhotra, MD
Peter C. Farrell Presidential Chair in Respiratory Medicine
Research Chief of Pulmonary, Critical Care and Sleep Medicine
University of California, San Diego School of Medicine
La Jolla, California
Joshua A. Marks, MD, FACS
Assistant Professor of Surgery
Program Director, Surgical Critical Care Fellowship
Medical Director, Surgical Intensive Care Unit
Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania
Greg S. Martin, MD, MSc Professor of Medicine
Executive Associate Division Director
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine
Emory University
Grady Memorial Hospital Atlanta, Georgia
Niels D. Martin, MD, FACS, FCCM
Section Chief of Surgical Critical Care
Division of Traumatology, Surgical Critical Care & Emergency Surgery
Department of Surgery
Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
Claire Masterson, BSc, MSc, PhD
Post Doctoral Researcher, Lung Biology Group
Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices
National University of Ireland Galway Galway, Ireland
Yunis Mayasi, MD, MS
Division of Neurosciences Critical Care
Departments of Anesthesia and Critical Care Medicine and Neurology
Johns Hopkins University Baltimore, Maryland
Virginie Maxime, MD Réanimation Médicale Assistance Publique-Hôpitaux de Paris Garches, Frances
Bairbre Aine McNicholas, BSc, MB, BCh, MRCPI, PhD, FJFICMI
Department of Anaesthesia and Intensive Care Medicine
Galway University Hospitals Galway, Ireland
Jakob McSparron, MD Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine
University of Michigan Ann Arbor, Michigan
Maureen O. Meade, MD, MSc Professor
Departments of Medicine and Health Research Methods, Evidence and Impact McMaster University Hamilton, Ontario, Canada
Mark E. Mikkelsen, MD, MSCE Associate Professor of Medicine
Pulmonary, Allergy, and Critical Care Division
Perelman School of Medicine at the University Hospital of Pennsylvania Philadelphia, Pennsylvania
Alicia M. Mohr, MD, FACS, FCCM Professor of Surgery
Department of Surgery, Division of Acute Care Surgery
University of Florida Gainesville, Florida
Peter Moran, MB, BCh, BAO, MRCPI, FCAI, FJFICMI, EDIC
Specialist Registrar in Intensive Care Medicine
Intensive Care
University Hospital Galway Galway, Ireland
Stephanie Royer Moss, MD Associate Staff
Department of Hospital Medicine, Medicine Institute
Department of Pediatric Hospital
Medicine, Pediatrics Institute Cleveland Clinic Foundation Cleveland, Ohio
Patrick T. Murray, MD, FASN, FRCPI, FJFICMI School of Medicine University College Dublin Dublin, Ireland
Patrick J. Neligan, MA, MB, FCAI, FJFICMI
Consultant in Anaesthesia, Special Interest in Intensive Care
Medical Director, Critical Care
Galway University Hospitals
Honorary Professor of Anaesthesia and Intensive Care
National University of Ireland, Galway Clincal Lead in Sepsis
Saolta Healthcare Group Ireland
Larry X. Nguyen, DO, FACOI Faculty Intensivist
Department of Critical Care Medicine Jefferson Health Northeast Philadelphia, Pennsylvania
Alistair D. Nichol, MB BCh, BAO, FCICM, FCARCSI, JFICMI, PhD Professor of Critical Care University College Dublin, NUI Consultant in Anaesthesia and Intensive Care
St. Vincent’s University Hospitals Dublin, Ireland
Katherine Lyn Nugent, MD Assistant Professor
Department of Emergency Medicine Emory Critical Care Center
Emory University School of Medicine Atlanta, Georgia
Mark E. Nunnally, MD, FCCM Professor
Departments of Anesthesiology, Perioperative Care & Pain Medicine, Neurology, Surgery & Medicine
New York University Langone Health
New York, New York
Michael F. O’Connor, MD Professor
Department of Anesthesia and Critical Care, Department of Medicine
University of Chicago Chicago, Illinois
Yewande Odeyemi, MBBS, MS
Senior Associate Consultant
Assistant Professor
Department of Pulmonary and Critical Care Medicine
Mayo Clinic Rochester, Minnesota
Steven M. Opal, MD
Clinical Professor of Medicine
Department of Medicine
The Alpert Medical School of Brown University
Infectious Disease Division
Rhode Island Hospital Providence, Rhode Island
Anthony O’Regan, MD, FRCPI Professor
Department of Medicine
Consultant in Respiratory Medicine
Chief Academic Officer
Saolta University Health Care Group Professor (personal) of Medicine
National University of Ireland Galway Galway, Ireland
John O’Regan, MD
Nephrology Division University Hospital Galway Galway, Ireland
Michelle O’Shaughnessy, MB, BCh, MRCPI, MS, FASN
Clinical Assistant Professor of Medicine
Division of Nephrology, Department of Medicine
Stanford University School of Medicine Palo Alto, California
Robert L. Owens, MD
Associate Professor of Medicine
Department of Pulmonary, Critical Care and Sleep Medicine
University of California San Diego La Jolla, California
Pratik Pandharipande, MD, MSCI
Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center
Vanderbilt University Nashville, Tennessee
Ithan D. Peltan, MD, MSc
Clinician Investigator
Division of Pulmonary and Critical Care
Medicine
Intermountain Medical Center
Murray, Utah
Adjunct Assistant Professor
Division of Pulmonary and Critical Care
Medicine
University of Utah School of Medicine
Salt Lake City, Utah
Anders Perner, MD, PhD Professor
Department of Intensive Care
Rigshospitalet
Copenhagen, Denmark
Michael R. Pinsky, MD, CM, Dr hc, MCCM
Professor of Critical Care Medicine
University of Pittsburgh Pittsburgh, Pennsylvania
Greta Piper, MD
Assistant Professor of Surgery
Department of Surgery
New York University Langone Health
New York, New York
Lauren A. Plante, MD, MPH, FACOG Professor
Departments of Obstetrics & Gynecology and Anesthesiology
Drexel University College of Medicine Philadelphia, Pennsylvania
Ariella Pratzer, MD
Department of Internal Medicine
New York University
New York, New York
Jean-Charles Preiser, MD, PhD Professor
Intensive Care Unit
Erasme University Hospital
Université libre de Bruxelles
Brussels, Belgium
Hallie C. Prescott, MD, MSc
Assistant Professor of Internal Medicine
University of Michigan
Investigator, VA Center for Clinical Management Research
VA Ann Arbor Healthcare System
Ann Arbor, Michigan
Megan T. Quintana, MD
Trauma and Critical Care
R. Adams Cowley Shock Trauma Center
University of Maryland Medical Center
Baltimore, Maryland
Lindsay Raab, MD
Resident Physician Department of Neurology
Hospital of the University of Pennsylvania Philadelphia, Pennsylvania
Jason S. Radowsky, MD Trauma and Critical Care
R. Adams Cowley Shock Trauma Center University of Maryland Medical Center Baltimore, Maryland
Jesse M. Raiten, MD
Associate Professor
Anesthesiology and Critical Care University of Pennsylvania Health System Philadelphia, Pennsylvania
Bryan T. G. Reidy, MB, BAO, BCh, FCAI
Specialist Registrar Anaesthesia and Critical Care Medicine
Department of Anaesthesia University Hospital Galway Galway, Ireland
Patrick M. Reilly, MD, FACS Professor of Surgery Department of Surgery
Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
Kenneth E. Remy, MD, MHSc, MSCI
Assistant Professor of Pediatrics and Internal Medicine
Washington University in St. Louis, School of Medicine
Barnes-Jewish Hospital
St. Louis Children’s Hospital St. Louis, Missouri
Emanuele Rezoagli, MD Lung Biology Group
Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices
National University of Ireland Galway Department of Anesthesia and Intensive Care Medicine
Galway University Hospitals
SAOLTA University Health Group Galway, Ireland
Department of Medicine and Surgery
University of Milan-Bicocca Monza, Italy
Zaccaria Ricci, MD
Department of Cardiology and Cardiac Surgery
Pediatric Cardiac Intensive Care Unit
Bambino Gesù Children’s Hospital Rome, Italy
Lisbi Rivas, MD
Resident Physician
Department of Surgery
George Washington University Washington, DC
Bram Rochwerg, MD, MSc, FRCPC
Assistant Professor
Department of Medicine
McMaster University Hamilton, Ontario, Canada
Kristen Carey Rock, MD
Assistant Professor
Anesthesia and Critical Care Medicine
University of Pennsylvania Philadelphia, Pennsylvania
Claudio Ronco, MD
Professor of Nephrology
Department of Medicine
Università degli Studi di Padova Director, Department of Nephrology, Dialysis and Transplantation
International Renal Research Institute (IRRIV)
San Bortolo Hospital Vicenza, Italy
James A. Russell, MD
Centre for Heart Lung Innovation Division of Critical Care Medicine, Department of Medicine
St. Paul’s Hospital and University of British Columbia Vancouver, British Columbia, Canada
Danielle K. Sandsmark, MD, PhD Assistant Professor
Departments of Neurology, Neurosurgery, and Anesthesiology/Critical Care Hospital of the University of Pennsylvania Philadelphia, Pennsylvania
Joshua Iokepa Santos, MD
Anesthesiology Critical Care Fellow Department of Anesthesiology & Critical Care
University of Colorado School of Medicine Aurora, Colorado
Babak Sarani, MD, FACS, FCCM Professor of Surgery and Emergency Medicine
Director, Center for Trauma and Critical Care
Director, George Washington Patient Logistics Center
George Washington University Washington, DC
Damon C. Scales, MD, PhD
Professor
Interdepartmental Division of Critical Care
Medicine and Department of Medicine
University of Toronto
Staff Intensivist and Clinician Scientist Department of Critical Care Medicine
Sunnybrook Health Sciences Centre and Sunnybrook Research Institute Toronto, Canada
Michael Scully, MB BCh, MD, FRCA, MRCPI, FCICM, FJFICMI
Senior Lecturer in Critical Care
National University of Ireland, Galway, Consultant in Anaesthesia & Intensive Care
Galway University Hospitals Galway, Ireland
Jon Sevransky, MD, MHS Professor of Medicine
Emory University Atlanta, Georgia
Sam D. Shemie, MD
Department of Pediatric Critical Care
Montreal Children’s Hospital, McGill University and Health Centre Montreal, Canada
Carrie A. Sims, MD, PhD, FACS
Associate Professor of Surgery and Director of Research
Section Chief, Geriatric Acute Care Surgery Division of Trauma, Surgical Critical Care, and Emergency Surgery University of Pennsylvania Philadelphia, Pennsylvania
Brian P. Smith, MD
Assistant Professor of Surgery Department of Surgery
The Hospital of the University of Pennsylvania Philadelphia, Pennsylvania
Audrey E. Spelde, MD
Resident Physician Department of Anesthesiology and Critical Care
The University of Pennsylvania Philadelphia, Pennsylvania
Robert David Stevens, MD, FCCM
Associate Professor
Department of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and Radiology
Johns Hopkins University School of Medicine
Baltimore, Maryland
B. Taylor Thompson, MD
Division Pulmonary and Critical Care Medicine
Massachusetts General Hospital Professor of Medicine Harvard Medical School Boston, Massachusetts
Samuel A. Tisherman, MD, FACS, FCCM
Professor Department of Surgery and the Program in Trauma University of Maryland School of Medicine Baltimore, Maryland
Mark Trinder, MSC Centre for Heart Lung Innovation Experimental Medicine Program University of British Columbia Vancouver, British Columbia, Canada
Isaiah R. Turnbull, MD, PhD Assistant Professor Department of Surgery
Washington University School of Medicine St. Louis, Missouri
Ida-Fong Ukor, MBBS, FCICM, FANZCA, BMed Sci
Centre for Heart Lung Innovation and Division of Critical Care Medicine University of British Columbia Vancouver, British Columbia, Canada
Tom van der Poll, MD, PhD Professor
Division of Infectious Diseases & Center of Experimental and Molecular Medicine
Amsterdam UMC, Academic Medical Center, University of Amsterdam Amsterdam, The Netherlands
Tjitske S.R. van Engelen, MD, MSc Center for Experimental Molecular Medicine and Department of Internal Medicine
Amsterdam University Medical Centers University of Amsterdam Amsterdam, The Netherlands
Charles R. Vasquez, MD
Surgical Resident
Division of Traumatology, Surgical Critical Care & Emergency Surgery Department of Surgery
Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
Michael A. Vella, MD, MBA Instructor in Surgery
Division of Traumatology, Surgical Critical Care & Emergency Surgery
Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
William J. Vernick, MD
Assistant Professor
Department of Anesthesiology and Critical Care
The Perelman School of Medicine at the University Hospital of Pennsylvania Philadelphia, Pennsylvania
Gianluca Villa, MD
Department of Health Science, Section of Anaesthesiology, Intensive Care and Pain Medicine
University of Florence Department of Anaesthesia and Intensive Care, Section of Oncological Anaesthesia and Intensive Care Unit
Azienda Ospedaliero Universitaria Careggi Florence, Italy
Jean-Louis Vincent, MD, PhD
Professor of Intensive Care Medicine
Department of Intensive Care
Erasme Hospital, Université libre de Bruxelles Brussels, Belgium
Amy C. Walker, BSc, MD
Resident Physician
Department of Emergency Medicine
University of Washington Seattle, Washington
Keith R. Walley, MD
Professor of Medicine
University of British Columbia Vancouver, British Columbia, Canada
Lorraine B. Ware, MD Professor of Medicine
Division of Allergy, Pulmonary and Critical Care Medicine
Department of Medicine
Department of Pathology, Microbiology and Immunology
Vanderbilt University School of Medicine
Nashville, Tennessee
Stuart J. Weiss, MD, PhD
Associate Professor
Chief, Division of Cardiac Anesthesiology
Department of Anesthesiology and Critical Care
University of Pennsylvania Philadelphia, Pennsylvania
Anna E. Garcia Whitlock, MD
Resident in General Surgery University of Pennsylvania Philadelphia, Pennsylvania
Pauline Whyte, MB BCh, FRCAI
Consultant in Anaesthesia & Intensive Care
Galway University Hospitals Galway, Ireland
We are delighted to present this third edition of EvidenceBased Practice of Critical Care. Critical care is a fast moving field with an abundance of new publications that result in subtle but frequent changes in our thinking. To produce a state of the art book that covers the full spectrum of our specialty has required the participation of a large number of experts and their mentees. We are truly grateful for their participation. We would like to thank the many critical care practitioners who have purchased the prior editions of the book and complimented us on its value and content. This edition is not an updated facsimile of the second. We have significantly revised the content:
• Some of the basic principles we highlighted previously have stood the test of time—at least of the last few years. These successes reinforce our belief that care of the critically ill patient will continue to improve.
• Evidence continues to support the value of consistently applying proven interventions (Chapters 1, 2, 8, 38). However, while we may now have a better sense of which individual approaches carry the most profound benefit (Chapters 9, 16, 18, 24, 34), we are profoundly aware that many may not (Chapters 25, 48) and that, in most cases, the evidence remains equivocal (Chapters 7, 8, 18, 20, 26, 57, 73, 84).
• We have a better understanding of some aspects of the pathobiology of critical illness (Chapters 14, 17, 25, 29, 38, 40, 41, 62, 63, 69), but a great deal remains elusive (Chapters 5, 32, 33, 38, 69).
• The use of large datasets to identify disorders has increased (Chapters 1, 2, 3, 5, 13, 21, 31, 34, 37, 38), mostly to the benefit of critically ill patients. Data-based approaches have aided in the early identification of disorders of profound importance, for example, sepsis (Chapter 31). The impact of comorbidities as well as preexisting and predisposing conditions is now clearer (Chapters 5, 11, 15, 21,79), but controversy remains (Chapter 27).
• Critical illness does not end with discharge from the ICU; in fact, some unfortunate patients never fully recover (Chapters 3, 22, 40). A pathobiologic understanding is only just emerging (Chapters 3, 4, 12, 40, 41) and identification/validation of therapeutic approaches is limited (Chapter 4, 22).
• Definitions for sepsis, acute respiratory distress syndrome (ARDS), and ventilator-associated pneumonia have been revised (Chapters 13, 30, 47). It is now appreciated that a definition (“what a thing is”) differs from the clinical criteria used to identify a disorder (Chapters 13, 30, 31, 47) because there are few gold standards that can be used to unequivocally identify most diagnoses that underlie critical illness. Critical criteria to identify patients with sepsis and
ARDS have been derived and validated using large datasets (Chapters 13, 31). There remains a pressing need to develop and validate evidence-driven consensus criteria for other disorders (e.g., brain death, Chapter 87).
• Many aspects of critical care practice remain poorly understood, controversial, or unproven (Chapters 25, 26, 32, 33, 39, 57, 68, 73). And while some of the things we do may be bad (Chapters 6, 10, 24, 60, 61), we continue to do them.
• Early identification of several disorders, especially those involving infection, trauma, or the vasculature, is of paramount importance (Chapters 34, 38, 46, 52, 53, 54, 64, 65, 66, 67, 74, 75, 77, 80).
• Determining if outcomes from critical illness have improved, or if interventions have been effective, remains problematic (Chapters 2, 5, 17, 18, 19, 20, 21, 22, 37, 38, 39, 47, 68, 73). And we continue to search for the elusive “better way” (Chapter 84).
• Critical care practice has long been recognized as a “team sport.” We recognize that the critical care team is composed of diversely educated coequals; while each member may have a specific area of expertise, we also support and learn from each other (Chapters 85, 86).
• The results of many studies continue to be negative or equivocal. But we have increasingly come to recognize that this result is virtually unavoidable when we globally apply a specific therapy to all patients with a given disorder. A major challenge for future critical care practitioners will be to identify those specific patients in whom a therapeutic approach is most likely to work. Genetics or other aspects of the host response will be major determinants (Chapters 5, 32, 33, 40, 41, 46, 63), but so will the characteristics of the disorder, for example, the importance of the specific infecting agent that precipitates sepsis remains virtually unexplored (Chapter 43).
• Finally, critical care practice has become more patientcentric (Chapters 2, 3, 4, 5, 84, 86, 88), and this trend must continue.
Reading, writing, and editing the chapters in this book has been hugely enjoyable and thought provoking. In particular, we would like to commend the individuals who are contributing for the first time, having not participated in the first two editions. It is gratifying to recognize that their enthusiasm for critical care equals our own, and that their understanding of our field exceeds our own. These individuals represent the future of critical care—and the field is in good hands.
Clifford S. Deutschman
Patrick J. Neligan March 2019
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[114] Voyez l’explication de notre planche 6.7.
[115] HORAPOLLON, liv. Ier, Hiéroglyphe 20.
[116] Suprà, planche 6.6, no 2.
[117] Description de l’Égypte, Antiquités, vol. I, bas-relief du portique d’Esné.
[118] Voyez Recherchespourserviràl’histoiredel’Egypte,etc.par M. Letronne, pages 341 et 480.
[119] Idem, page 361.
[120] HORAPOLLON, liv. I, hierogl. 11.
[121] Grand manuscrit hiéroglyphique, gravé dans la Description de l’Égypte, Antiq., vol. II, pl. 72.
[122] Manuscrit hiératique, publié à Vienne, par MM. Fontana et de Hammer, 1822.
[123] Voyages, Rechercheset Découvertes de BELZONI enEgypte et enNubie, atlas, pl. 3.
[124] Idem, même planche.
[125] Idem, planche 17.
[126] HORAPOLLON, Hiéroglyph., lib. I, § II, page 22.
[127] Texte grec, ligne 36.
[128] Texte hiéroglyphique, ligne 5, à la fin.
[129] Ce bas-relief est gravé en entier dans la Description de l’Égypte, A, tome II.
[130] Supprimée dans notre planche.
[131] Voyez l’explication de nos planches 6 et 6.3.
[132] EUSÈBE, Préparat.Evangel.liv. III, chap. 11.
[133] IAMBLICH., deMysteriis, sect. VIII, cap. 8.
[134] Ce nom divin est en effet écrit Ⲡⲧⲁϩ dans les textes coptes thébains.
[135] DIOGÈNE LAERCE, De vitis Philos., Proœmium.
[136] Voyez ma LettreàM.Dacierrelativeàl’AlphabetPhonétique.
[137] HESYCHIUS, au mot Πααμυλης.
[138] Voyez la Description de l’Égypte, Antiq. vol. II, pl. 65; et les bas-reliefs du tombeau royal découvert par Belzoni.
[139] Inscript. de Rosette Démotique, ligne 2, grec, ligne 3.
[140] Idem, texte hiérogly. lig. 6, 12 et 14.
[141] Idem, texte hiérogly. lig. 9, grec, lig. 44.
[142] Idem. Dans le texte hiéroglyphique, le pschent est exprimé par sa propre image (ligne 9), reproduite une seconde fois à la fin de la même ligne, là où le grec porte: προειρημένον βασίλειον, lasusdite couronne.
[143] Idem, ibidem.
[144] Idem, texte démot. lig. 1 et 2, grec, lig. 2 et 3.
[145] Idem, texte hiérogly. lig. 10, démot. lig. 27, grec, lig. 46.
[146] Livre I, §. 13.
[147] Idem, §. 10.
[148] Dans des légendes royales d’Épiphane, dessinées à Philæ et à Thèbes, par M. Huyot; et à Dendérah, par la commission d’Égypte.
[149] HORAPOLLON, liv. I, no 10.
[150] IAMBLICH., deMysteriis, sect. VII, cap. 2.
[151] Idem.
[152] Voyez la Description de l’Égypte, Antiq. vol. II, pl. 73 et 75.
[153] Idem, pl. 75, col. 36, 56 et 59.
[154] Idem, pl. 75, entre les colonnes 132 et 133.
[155] Hiéroglyphiq., liv. I, §. 10.
[156] Descript. de l’Égypte, Ant. vol. II, pl. 75, col. 135.
[157] Idem, col. 127 et 128.
[158] AMMIEN MARCELIN, liv. XVII, ch. 4.
[159] Panth. Ægypt. lib. III, cap. I.
[160] LunamÆgyptiimysticèDEUM dicunt.
[161] Καὶ γὰρ εἰ
[162] Panth. Ægypt. lib. I, III, §. 6, pag. 64.
etc.
[163] Descr. de l’Égypte. A. vol. II, pl. 13, No 1. Voyeznotre pl. 14, No 4.
[164] Idem. A. vol. III, pl. 32, No 4. A. vol. III, pl. 67, No 2. A. vol. I, pl. 43, No 19. Id.pl. 95, No 8., en face d’Ammongénérateur. Voyeznotre pl.
[165] Voyeznotre pl. 14, Nos 6 et 8; et Descr. de l’Égypt. A. vol. II, pl. 36, No 5.
[166] Idem.A. vol. II, pl. 35, No 3.
[167] Idem.A. vol. IV, pl. 22, No 1.
[168] Σελήνης
Porphyrius apud Euseb. Præparat. Evangelic. lib. III, cap. 13, pag. 117, Edit. Viger.
[169] Descr. de l’Égypte. A. vol. IV, pl. 21.
[170] Σελήνην
les Égyptiens voulant écrire LA LUNE tracent la figure D’UN CROISSANT. Stromat. liv. V, pag. 657. Édit. Potter.
[171] Hiéroglyphicor. lib. I, §. 4.
[172] Idem.Ibidem.
[173] Voyez Descript. del’Egypte. A. vol. II, pl. 7, au-dessus des colonnes 21 à 39. Id.MSS. hiératique, pl. 70.
[174] Texte hiéroglyphique, ligne 7, au commencement. Ce groupe répond au mot Θεραπεύειν de la 40e ligne du texte grec.
[175] Horapollon. Hiéroglyph. lib. I, §. 15.
[176] Idem.Ibidem.
[177] HÉRODOTE, liv. II, § XXIII.
[178] Voyez ci-dessus l’article Ammon-Cnouphis.
[179] Dialogued’Isis, voy. STOBÆI Eclogar . Physicar., lib. I, cap. LII, p. 1076; IAMBLIQUE, deAnima, ap. Euseb. Præp. evangelic.
[180] Voy. le grand mss. hiéroglyphique gravé dans la Descrip. de l’Egypte, Ant., vol. II, pl. 72.
[181] Dialogue d’Isis, déja cité.
[182] Voyez l’explication de notre planche précédente.
[183] HORAPOLLON, Hieroglyph., lib. I, cap. VII.
[184] Voyez pl. 20.2, 20.3, etc.
[185] Id., pl. 20.
[186] Planches précédentes, passim.
[187] Voyez pl. 8, no 3 et 4.
[188] Pl. 24, no 1.
[189] Précis du système hiéroglyphique, tableau général des signes, nos 234 et 234 a.
[190] HORAPOLLON, Hiéroglyph., liv. I, § 14.
[191] Ἐκ τῆς ἰδίας φύσεως αἱμάσσεται, idem, § 14.
[192] HORAPOLLON, Hiéroglyph., liv. I, § 14.
[193] Hist.nat., lib. VIII, cap. LIV.
[194] Voyez notre planche 14.2.
[195] Une momie de Cynocéphale, appartenant à feu Belzoni, et deux autres, faisant partie de la collection Drovetti, prouvent ce que nous avançons ici.
[196] Voyez l’explication de notre planche no 3.
[197] Τὸ
Euseb., Præparat.Evangelic., lib. III, cap. XII.
[198] Descript.del’Egypte, A, vol. I, pl. 59, no 5.
[199] Voyez l’explication de notre planche 14, et la note 6.
[200] Voyez notre planche 14.4, lég. no 1, et son explication.
[201] PrécisduSystèmehiéroglyphique, chap. V, pag. 104 et 105.
[202] Ἀκαθαρσίαν
HORAPOLLON, Hieroglyph., livre I, § 49.
[203] HORAPOLLON, Hiéroglyph., livre I, § 6, 7, 8, etc.
[204] Præparatio evangelica, lib. III, cap. XII, pag. 116; édit. de Viger.
[205]
Id., ibid.
[206] HORAPOLLON, Hiéroglyph., liv. I, § 49.
[207] Voyez planche 29.
[208] Descript. de l’Égypte. A. vol. III, pl. 34, No 1.
[209] Cette légende est très-incorrecte dans la Description de l’Égypte. Un dessin très-soigné en a été fait sur les lieux par M. Huyot, qui a bien voulu me le communiquer. Voyez, pour le règne illusoire de ce prince sur l’Égypte, l’ouvrage de mon frère, Annales desLagides, tome I, page 241 à 306.
[210] Descript. de l’Égypt. A. vol. III, pl. 34, No 1. On a, par erreur, donné sur cette planche une têted’épervier, au lieu d’une têted’Ibis, au personnage de gauche, comme le prouve la légende placée audessus de sa tête, et qui est celle d’Hermès Ibiocéphale.
[211] Idem, A. vol. II, pl. 13, No 1.
[212] Idem, A. vol. I, pl. 10, No 2.
[213] Descript. de l’Égypt. Esné, pl. 80, No 2.
[214] ManethoapudSyncell.Chronograph., page 40.
[215] ApudJ. Stobœum,EclogarumPhysicarumlib. I, cap. 52, pag. 927 et suiv.
[216] Dialogued’Isisetd’Horus, apud Stobœum, loc. cit.
[217] Voyez notre planche, légende No 2, et Description de l’Égypte, A. vol. I, pl. 10, No 2.
[218] C’est-à-dire, Trismégiste. Le second Hermès à tête d’Ibis ne porte habituellement dans les inscriptions que le titre de deux fois Grand. (Voyezles légendes inscrites au-dessus de son image dans les papyrus funéraires.) C’est ce titre du second Hermès que le texte grec de l’inscription de Rosette exprime (lig. 19), par les mots μέγας καὶ μέγας, grandetgrand(deux fois grand).
[219] Voyezl’explication de notre planche 3.3.
[220] CICERO, DenaturâDeorum, lib. III, § XXII.
[221] (Mercurius) quem colunt Pheneatæ, qui et Argum dicitur interemisse ob eamque causam Ægyptum profugisse atque Ægyptiis leges et litteras tradidisse. Hunc Ægyptii Thoythappellant; eodemque nomine anni primus mensis apud eos vocatur. (CIC. loc. cit.)
[222] JAMBLIQUE, deMysteriis, sec. VIII, cap. III.
[223] Encyclopædia Britannica, supplément, vol. IV, part. I, pag. 55 et 56.
[224] Description de l’Égypte, A. vol. IV, pl. 23, No 3.
[225] Hieroglyphica, lib. I, §. 37.
[226] Description de l’Égypte, A. vol. III, pl. 34, No 1.
[227] Idem.A. vol. III, pl. 50, No 2.
[228] Voyeznotre planche 6.5, et son explication.
[229] Description de l’Égypte. A. vol. I, pl. 41, No 4.
[230] Idem.A. vol. III, pl. 59.
[231] Idem.A. vol. III, pl. 34, No 1.
[232] Voyeznotre planche 15, lég. No 1.
[233] Idem, pl. 15 B, Nos 1 et 2.
[234] Description de l’Égypte, A. vol. IV, pl. 33, Nos 2 et 4.
[235] Idem, A. vol. I, pl. 57, No 1.
[236] Voyez ci-dessus planche 9, et Descript. de l’Égypte, Ant. vol. II, pl. 73, col. 45 et 46.
[237] Suprà, pl. 2.2.
[238] Description de l’Égypte, Ant. vol. II, pl. 75, col. 28 et 29. Idem, MSS. hiératique, pl. 71.
[239] Inscript. de Rosette, texte grec, lignes 36 et 47, texte hiéroglyph. lign. 6 et 10.
[240] Idem, texte démot. lig. 1, 7, 9, 19; texte grec, lig. 1, 11, 33 et 36.
[241] Voyez ci-dessus, pl. 8, no 6, et pl. 9.
[242] Idem, pl. 13 et son explication. Le dieu est parfois représenté par un Nilomètre, auquel sont adaptés deux bras humains tenant les insignes de la divinité (voyez la Description de l’Égypte, Ant. vol. II, pl. 84, no 5.). Nous verrons dans la suite qu’Osiris fut aussi figuré, comme Phtah, sous la forme d’un Nilomètre; les légendes seulement distinguent alors ces dieux l’un de l’autre.
[243] DAMASCIUS, cité dans le PantheonÆgyptiorumde Jablonski, liv. I, chap. I, pag. 19 et 20.
[244] Suprà, pl. 1, explication.
[245] ORION, dans l’l’Etymologic.Magn.au mot Αθυρ.
[246] ÆLIEN. Hist. des Animaux, liv. XI, chap. 27.—HESYCHIUS, au mot Αθυρ. STRABON, liv. XVII.
[247] DeIsideetOsiride.
[248] HORAPOLLON. Hiérogl. liv. I, §. 8.
[249] Id.Hierogl. liv. II, §. 26.
[250] Voyez l’explication de notre planche 17.4, et la planche 17.2, no 3.
[251] Descript. de l’Égypte, Ant. I, pl. 21.
[252] Idem, pl. 36.
[253] Idem, Ant. IV, pl. 15.
[254] Voyages, RecherchesetDécouvertesdeG.Belzoni; atlas, pl. 18.
[255] Idem.
[256] Voyez notre planche 14.4.
[257] Dans l’intérieur du pronaos, sur le mur de la cella.
[258] C’est-à-dire Chonsl’Horusquidilatelecœur.
[259] C’est-à-dire l’Horussoutiendumondeterrestre.
[260] Philæ, temple d’Hathor, côté gauche intérieur du pronaos.
[261] Ὅτι
[262] Ὄφις
De Iside et Osiride.
Idem, ibidem.
[263] Indiquée, par erreur, sous le no 17.4 dans le texte explicatif de la pl. 17.2.
[264] Description de l’Égypte, Antiq. vol. V, Memphis.
[265] Voyezl’Explication de notre planche 13.
[266] Voyez la planche no 18.
[267] Voyez l’explication de la planche 17.
[268] Description de l’Égypte, A., vol. II, pl. 34, nos 7 et 8.
[269] Description de l’Égypte, A., vol. IV, pl. 11, nos 1 et 2.
[270] Description de l’Égypte, A., vol. II, pl. 34; vol. IV, pl. 13, nos 1 et 3; pl. 15, pl. 17; pl. 22, no 1; pl. 25, nos 1 et 2, etc., etc.
[271] Recherchespour servir à l’histoire del’Egypte, etc., par M. LETRONNE, pages 341 et 480.
[272] Idem, page 361.
[273] Ce monument colorié représente huit magistrats qualifiés d’auditeursdansleprétoiredejustice, adressant leurs supplications à quatre divinités, Phtha, Chnouphis-Chnoumis, Satéet Anouké.
[274] Descriptiondel’Egypte, Antiquités, vol. I, pl. 16, no 1.
[275] Idem, pl. 37, no 2.
[276] Idem, pl. 37, no 1.
[277] Idem, pl. 16, no 1.
[278] Voir l’explication de notre planche 6.5.
[279] Voir notre planche 1.
[280] Voir notre planche 6.
[281] Voir notre planche 14.4
[282] Voir notre planche 17.3.
[283] Voir notre planche 2.
[284] Voir notre planche 3.
[285] Voir notre planche 19.2, sujet de cet article.
[286] Voir notre planche 20.
[287] Musée royal du Louvre, salle des Dieux, statuette en bronze, numérotée A, 137.
[288] Extraite d’un monument du Musée royal de Turin, décrit dans l’explication de la planche no 20.3.
[289] ⲥⲁⲧⲉ ou ⲥⲁϯ, Mucro, Cuspis, Telum, Sagitta. Voir le Dictionnaire de Lacroze, et la Scalamagna, page 116.
[290] Livre II, § 50.
[291] Livre I, § 13.
[292] Ces monuments sont une stèle et un bas-relief déja décrits dans l’explication de nos planches 19 et 19.2.
[293] Voir ce nom noté A dans notre pl. 19, où il a été mis par erreur, et pl. 20.3.
[294] Tirée de la stèle du comte de Belmore.
[295] Descriptiondel’Egypte, Esnéet Edfou, A, vol. I.
[296] Idem, A, vol. I, pl. 37, no 1.
[297] Idem,ibidem.
[298] Description de l’Égypte, Antiq. vol. I, pl. 79.
[299] Idem, vol. I, pl. 96, no 2.
[300] Idem, pl. X, no 1.
[301] Voyage dans la haute et la basse Égypte, pl. 129, no 4.
[302] Descriptiondel’Egypte, A, vol. I, pl. 47, le second tableau de la deuxième rangée.
[303] MonumentsdelaNubie, par M. Gau, pl. 6; idem, pl. 13, no . 9.
[304] Atlas du VoyagedanslahauteetbasseEgypte; Dendéra.
[305] Voir la planche 20.3.
[306] Voyez l’explication de la planche no 24.
[307] PantheonÆgyptorum, lib. I, cap. I, pag. 140 et 141.
[308] Voyez Georg. le Syncelle chronograp. pag. 40.
[309] MANETHO apud Euseb. Chronic. pag. 7.
[310] Bibliothec. lib. I, pag. 12.
[311] De Iside et Osiride.
[312] Voyez l’explication de notre pl. XXII.
[313] Voyez l’explication de notre planche 22.
[314] Idem.
[315] DIODORE de Sicile, Biblioth. liv. I, pag. 24.
[316] Description de l’Égypte Antiq. vol. I, pl. 36, no 3.
[317] Catalog. MM. Coptic. Mus. Borg. pag. 457.
[318] CLÉMENT d’Alexandrie, Stromat., liv. V, page 566.
[319] HORAPOLLON, liv. I, hierogl. 68, 69 et 70.
[320] Voyez la planche au signe (3).
[321] Voyez notre planche 23, lég. no. 1.
[322] Statue gravée dans le Tome VII du musée Pio-Clémentin. (Pl. A des Preuves.)
[323] HÉRODOTE, liv. II, §. CLVI.
[324] PHURNUTUS, de Natura Deorum, cap. II. PLUTARQUE, de festo Dedal.apudplatœenses.
[325] HÉRODOTE, liv. II. §. LXVII.
[326] ANTONINUS LIBERALIS, fab. 28.
[327] PLUTARQUE, Sympos., lib. IV, quæst. V.
[328] Lib. III, cap. IV.
[329] Idem.§. 8. 13.
[330] HÉRODOTE, liv. II, §. LXXXI.
[331] Voyez le musée Pio-Clémentin, tome VII. Pl. A des Preuves.
[332] Ὅν
SOPHOCLE, trachin. v. 93 et suiv.
[333] Livre II, §. CLV et CLVI.
[334] Delaulnaye, HistoiredesReligions.
[335] Voyez planches 17.2, 17.3, et leur explication.
[336] ISAIE, I, 3; texte baschmourique.
[337] IAMBLICH., deMysteriis.
[338] MANETHON, cité par Georges le Syncelle, Chronograph..
[339] HORAPOLLON, Hieroglyph.liv. I, §. 6.
[340] ÆLIAN. de Naturâ animal. lib. II, cap. 43.
[341] Idem.lib. IV, cap. 44.
[342] EUSEB. Præpar. Evangel. lib. II, §. 1.
[343] CLÉMENT d’Alexandrie, Strom. liv. V, pag. 566 d. HORAPOLLON, hiéroglyph. liv. I, §. 6.
[344] Idem.Strom. liv. V, pag. 567.
[345] HORAPOLLON, hiérog. liv. I, §. 6.
[346] HERMAPION, voy. Ammien-Marcellin, liv. XVII, ch. IV.
[347] Ἀλκῆς
Strom., lib. V, p. 671; édit. d’Oxfort.
[348] DIODORE de Sicile, Biblioth.Histor . lib, III, p. 208, C.
[349] IDEM, ibidem.
[350] Idem, p. 207, C, et 208; et lib. I, p. 21.
[351] HÉRODOTE, lib. II, §. XLIII et CXLV.
[352] IDEM, ibidem.
[353] DIODORE de Sicile, Biblioth.Histor . lib. I, p. 21, D.
[354] Idem, p. 21, A.
[355] MACROB. Saturn.lib. I, cap. 20.
[356] Description de l’Égypte, Antiq. vol. II, pl. 7, col. 81 à 79.
[357] Idem, Antiq. vol. II, pl. 91, no 2.
[358] Etymologicummagnum.
[359] HESYCHII Lexicon.
[360] PantheonÆgyptiorum, lib. II, III, p. 188.
[361] Voir la partie de ce livre sacré hiéroglyphique gravée dans la Descriptiondel’Egypte, A, vol. II, pl. 72, colonnes 21, 103, 34; pl. 73, col. 81; pl. 74, col. 33; pl. 75, col. 110, 100, 125, 97, 94.
[362] Voir la légende du dieu sur notre planche 26 et pl. 26.2, no 4.
[363] Pl. 26.2, nos 1, 2, 3; pl. 26.4, nos 3, 4 et 5.
[364] Appartenant au Musée de Turin.
[365] Voir notre planche 26.4, no 1.
[366] Idem, no 8.
[367] Idem, no 10.
[368] Idem, no 6.
[369] Voir notre planche 26.2.
[370] Voir les variantes d’orthographe de ce nom, pl. 26.2, no 5.
[371] Tableaux peints des Musées du Vatican, de Turin et de Paris.
[372] Tableaux des Musées de Paris, de Lyon et de Turin.
[373] Voir nos planches 15.3 et 15.4, ainsi que leur explication.
[374] Numéroté O, 7, dans ma Noticedescriptive des Monuments égyptiensduMuséeCharlesX.
[375] Ce texte est gravé sur notre planche 26.4, no 13.
[376] Idem., pl. 26.4, no 14.
[377] No A, 310 de ma Notice descriptive des Monuments égyptiensduMuséeCharlesX.
[378] Pl. 26.4, no 15.
[379] Manuscrit hiératique du Musée royal, pl. 26.4, nos 16 et 17.
[380] Rituels funéraires hiératiques et hiéroglyphiques des Musées de Paris et de Turin.
[381] Sur les obélisques de Louqsor et la statue de Sésostris du Musée royal de Turin.
[382] Planche 26.4, no 18.
[383] Dans AMMIEN MARCELLIN, Rerumgestarum, lib. XVII, cap. 4.
[384] Tableau numéroté A, 309, dans la Notice des Monuments égyptiensduMuséeCharlesX.
[385] Descriptiondel’Egypte, A, vol. II, pl. 83, no 1.
[386] Voir le Rituel funéraire gravé dans la Descriptiondel’Egypte, A, vol. II, pl. 74, col. 34, etc., etc.
[387] Momie notée O, 7, dans la NoticeduMuséeCharlesX.
[388] Cité par M. Niebuhr, InscriptionesNubienses.
[389] Voyez Gau, MonumentsdelaNubie;Inscriptions;Calabsché; pl. II, no 4; pl. III, nos 7, 9, 10, 14, 15, 16, 17; pl. IV, nos 20, 22, 23, et 29.
[390] Voyez, entre autres monuments, une momie de la collection de M. Cailliaud.
[391] Légende no 1 de notre planche; le dernier caractère est le signed’Espèce, DIEU.
[392] Légendes nos 2, 3 et 4, de notre planche: le no 5 est la forme hiératique de la légende no 1; voyez aussi Description de l’Egypte, Ant.; vol. III, pl. 34; idem, pl. 31; et le Voyage de M. Cailliaud à Méroé, Barkal, etc.; pl. LXXI.
[393] Ἀστὴρ
Horapollon, liv. II, § 1.
[394] Bas-relief décorant le fût de la huitième colonne de l’édifice de droite après le grand pylône.
[395] DIODORE DE SICILE, liv. I, § 12.
[396] Voyez mon ÉgyptesouslesPharaons, t. I, p. 179.
[397] Idem.
[398] PLUTARQUE, Traitéd’Isisetd’Osiris.
[399] PORPHYRE, DeAbstinentiâ, lib. II.
[400] HÉRODOTE, liv. II, § XLV.
[401]
Præparat.Evangelic., lib. III, cap. XII.
[402] Planches 6, 6.5, et leur explication.
[403] Idem.
[404] IABLONSKI, PantheonÆgyptiorum, lib. III, cap. III, § 7.
[405] GAU, MonumentsdelaNubie, pl. 22.
[406] Idem, pl. 25.
[407] Descriptiondel’Egypte, A, vol. IV, pl. 17.
[408] Idem, pl. 27, no 3.
[409] Idem, A, vol. I, pl. 96.
[410] PantheonÆgyptiorum, lib. III, cap. III, § 7.
[411] DIODORE, liv. I, § 12.
[412] ORPHICA, ed. Hermann, hymne IIe, vers 12e .
[413] Voyez les planches 15, 15.2, 15.3, et leur explication.
[414] MANÉTHON, Chronogr. du Syncelle, page 40.
[415] Idem,ibidem.
[416] Diodore de Sicile, liv. I, page 14.
[417] Platon, Philebus.—Plutarque, Symposiaques, Quest. 3. Diodore de Sicile, Histor . liv. I, pages 14 et 15, etc., etc.
[418] MANÉTHON, Chronogr. du Syncelle, page 40.
[419] STRABON, liv. XVII.
[420] CLÉMENT d’Alexandrie, Stromat., lib. VI, cap. 4.
[421] Legatioprochristian., pag. 32.
[422] Transcription hiéroglyphique du titre μέγας καὶ μέγας que le texte grec de l’inscription de Rosette (ligne 19) donne à ce Dieu.
[423] MANETHO apud Syncell. Chronograph., pag. 40.
[424] CICERO, DeNaturâDeorum, lib. III, § XXII.
[425] Dialogue d’Isis et d’Horus. Voy. Joh. Stobæi Eclog., lib. I. cap. II, pag. 948.
[426] HORAPOLLON, Hiéroglyph., lib. I, § 36.
[427] Voyez mon Précis du Système hiéroglyphique, chap. IX, § VII, pag. 288 et suiv.
[428] PLUTARQUE, deIsideetOsiride.
[429] Description de l’Egypte, planches relatives aux antiquités d’Edfouet de Dendéra.
[430] ÆLIEN, Denaturâanimalium, lib. II, cap. XXXVIII.
[431] CLÉMENT d’Alexandrie, Stromat., lib. V, pag. 567.
[432] Libersacerou Dialogued’Isisetd’Horus; Ioh. Stobæi Eclog.; lib. I, cap. 52, pag. 1077 et seq.
[433] Voyez planches 29, lég. no 1; et 29.2, lég. no 1.—Caylus, tome VI, pl. a, no 2 et 3.—Grand Mss. hiérogl., Description de l’Egypte, pl. 72; Scène du Jugement, lég. du Dieu; et toutes les légendes de ThothIbiocéphalesur les cercueils de momies.
[434] Voyez mon Egyptesous lesPharaons, tome I, pages 290 et 291.
[435] Voyez nos planches no 9, 20.2, et 20.4.
[436] Voyez sur nos planches 29 et suivantes le dernier caractère de la légende no 1.
[437] Voyez le premier signe du nom du dieu Sovk, pl. 21, lég. no 1.
[438] HÉRODOTE, liv. II, § LXXVI. SAVIGNY, Histoire naturelle et mythologiquedel’Ibis, pag. 19 et suiv., 36 et suiv.
[439] CLÉMENT d’Alexandrie, Strom., lib. V. ÆLIEN, De NaturâAnimal., lib. II, cap. XXXVIII.
[440] ÆLIEN, De Natur. Animal., lib. II, cap. XXXV et XXXVIII; lib. X, cap. XXIX.
[441] Idem, lib. II, cap. XXXVIII.
[442] CLÉMENT d’Alexandrie, Stromat., lib. V.
[443] ÆLIEN, DeNatur.Animal., lib. II, cap. XXXVIII.
[444] Livre II, § LXXVI.
[445] CICÉRON, De Natur. Deor., lib. I, XXXVI. EUSÈBE, Præp. Evangel., lib. II, § 1, p. 49.
[446] TOCHON, Recherches sur les Médailles de Nomes, pag. 114 et 116.
[447] HORAPOLLON, liv. I, hiérogl. 14.
[448] ZOEGA, Catalog.Manuscript.MusæiBorgiani, pag. 235.
[449] HORAPOLLON, liv. I, hiérogl. 14, pag. 28 et 30.
[450] De pierre calcaire blanche, très-fine, et d’un excellent travail; hauteur, 1 pied 5 pouces; largeur, 1 pied.
[451] Voyez les variantes de ce caractère hiéroglyphique, dans notre planche 20.4, nos 1, 2, 3, 4.
[452] PÉTAU, Uranologium, p. 136.
[453] Voyez notre planche no 14.2.
[454] Hiéroglyphiques, liv. I, § 70; édit. de Paw.
[455] Voyez notre planche 29.2.
[456] Voyez l’explication de la planche 28.2.
[457] JABLONSKI, Pantheon Ægyptiorum, liv. II, chap. I, pag. 140 et 141.
[458] Quod vero ad RHEAM attinet, quam SATURNO et sororem et conjugem Græci adjungunt, ea Theologis Ægyptiorum, omnino incognita fuit. Idem, ibidem, page 141.
[459] Idem,ibidem.
[460] Bibliothec.histor., livre Ier, page 12.
[461] Voir JABLONSKI, PantheonÆgyptiorum, livre IV, chap. II, qui a réuni la plus grande partie des passages relatifs à Apis, tirés des auteurs grecs et latins.
[462] CLÉMENT D’ALEXANDRIE, AdmonitioadGentes, pag. 26, D.
[463] Recherches sur les médailles des nomes, par TOCHON, pages 54, 60, 73, 91, 100, 111, 117, 129, etc.
[464] Idem, pages 55, 56, 57, 63, 69, etc.
[465] Voir notre planche no 32 et son explication.
[466] DIODORE DE SICILE, liv. Ier , pag. 79, édit. de Rhodoman.—STRABON, liv. XVI, pag. 553, édit. de Is. Casaubon. MACROBE, Saturnales, liv. Ier , § 21. ÆLIEN, Histoire desAnimaux, liv. XI, chap. 10. PLUTARQUE, Traité d’Isisetd’Osiris.
[467] τῳ τε Απει
[468] Préparationévangélique, liv. III, chap. 13.
[469] MensaIsiaca.
[470] Plutarque, deIsideetOsiride.
[471]
ligne 31.
ibid.
[472] Je me suis assuré, pendant mon séjour aux ruines d’Ombos en 1829, que le champ du listel, sur lequel on a gravé cette inscription, était jadis doré, et que toutes les lettres furent remplies d’une couleur rouge éclatante.
[473] Voir les Recherches pour servir à l’histoire de l’Egypte pendant la domination des Grecs et des Romains, par M. Letronne, page 76 et suivantes.
[474] Dans l’ouvrage précité M. Letronne lit: Ἡλίωι θεῶι, μεγίστωι, au lieu d’Ἀρωήρει θεῶι μεγίστωι que porte réellement l’inscription originale; mais mon savant ami a été induit en erreur par la copie fautive de cette inscription fournie par MM. Jomard et Chabrol, qui n’ont point indiqué, comme l’a fait M. Hamilton, une fracture opérée sur une portion des lettres formant le nom ΑΡΩΗΡΕΙ. En examinant moi-même avec attention le monument original, en novembre 1829, j’ai parfaitement distingué les lettres ΩΗΡΕΙ encore trèsreconnaissables, ce qui exclut sans réplique la leçon ΗΛΙΩΙ que donnent à tort les deux membres de la commission d’Égypte.
[475] ⲱⲣ prononcé ⲱⲏⲣⲓ en suppléant les voyelles, comme le prouve l’orthographe hiéroglyphique et hiératique des noms propres égyptiens, que les Grecs ont transcrit πωηρις, οσορωηρις, Σενποηρις, πετεαρωηρις, etc., etc.
[476] Traitéd’Isisetd’Osiris, traduction d’Amyot, § XIII.
[477] Idem, Ibidem.
[478] Livre Ier .
[479] Bas-relief au fond du pronaos à droite, etc.
[480] A partir du fond du sanctuaire.
[481] Voir notre planche 33.2, sujet dessiné à Ombos.
[482] Le groupe hiéroglyphique phonétique formé du téorbe, du céraste et de la bouche, ⲛϥⲣ, répond dans tous les textes hiéroglyphiques aux deux adjectifs coptes ⲛⲟϥⲣⲉ et ⲛⲟⲩϥⲉ indistinctement.
[483] Ces titres sont sculptés à la suite du nom propre de la déesse dans les inscriptions des bas-reliefs de la seconde salle du temple d’Ombos.
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