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Professor and Vice Chair; Department of Anesthesia and Perioperative Care; Professor of Physiology; Director, Critical Care Medicine; University of California San Francisco School of Medicine; San Francisco, CA; gropperm{at}anesthesia.ucsf.edu
Handbook of ICU Therapy, 2nd ed.
McConachie I, ed. New York: Cambridge University Press, 2006. ISBN 0-521-68247-9. 439 pages, $60.00.
Handbook of ICU Therapy by McConachie is the second edition of a practical reference for the house officer working in the ICU. The book is based on a series of lectures organized by the editor and was originally published in 1998. Contributing authors include anesthesia intensivists, surgeons, and cardiologists. The book is divided into two sections, with the first 16 chapters covering basic principles of critical care physiology and pharmacology, and the latter 14 chapters focusing on specific clinical problems in critically ill patients.
The overall format of the book is prosaic, with listings of essential facts in each section. There are very few figures and diagrams, which is occasionally problematic in describing concepts such as cardiac dysrhythmias or hemodynamic and ventilator waveforms. Indeed, these chapters would benefit from some basic examples of these patterns to illustrate their complexity. References are as current as can be expected in a textbook, and reference to a number of ongoing clinical trials, some of which have only recently been completed, is commendable.
In the first section of the book, chapter 1 discusses cardiac function and monitoring and the indications for hemodynamic monitoring. The discussion of the uses and pitfalls of pulmonary artery catheters is excellent and helps guide the practitioner through this controversial decision. Other notable chapters include the discussions on acute respiratory failure and the basics of mechanical ventilation. These are concise and practical, identifying the important features of the differing modes of mechanical ventilation without getting bogged down in the innumerable proprietary modes of ventilation developed by the ventilator industry. The vasopressor chapter suffers from the lack of a table allowing comparison of the different inotropes and vasopressors. Perhaps the most outstanding chapter in the book deals with a very difficult topic, and is entitled "Withholding and withdrawing therapy in the ICU." This chapter includes practical examples and eloquently discusses issues such as ethics, futility, disagreements with families, and important legal decisions that have affected critical care practice. The editor is to be commended for this thoughtful discussion.
The second section of the book covers specific clinical problems in the ICU, such as trauma, sepsis, arrhythmias, and coma. These are complex topics, but the book focuses on the current state of evidence-based practice. As is inevitable in discussions of clinical syndromes, interpretation of evidence-based practice can vary. For example, the authors recommend use of low-dose steroids for late acute respiratory distress syndrome (ARDS). This recommendation is based on a single-center study (1), whereas a number of other studies, and recently the larger ARDS network trial (published only this year in NEJM) (2), have not found efficacy.
Overall, the book provides a practical, concise reference for the trainee in critical care medicine. The book has a surgical bias, which is particularly useful for the surgery or anesthesia resident first exposed to critical care. Addition of diagrams and figures might make the content more accessible, but by its nature, critical care covers nearly all areas of inpatient medicine, making it difficult to produce a reasonably sized reference. The authors have done so and have wisely emphasized the underlying physiology of critical illness.
REFERENCES
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