Critical Care Medicine: The Essentials

Abstract

Critical Care Medicine: Th e Essentials is already in its fourth edition. What are the essentials? Th e essentials are a mixture of sound physiology and ground knowledge on diseases and established therapies. Why should we read Th e Essentials? All patients do not behave the same, therefore physicians have to decide patient management using clinical judgment based on clinical signs, on core physiology and on patient response to disease and interventions. Most of the attractiveness of this book comes from the fact that it is written by clinicians for clinicians. It describes a lot of clinical signs, (patho)physiological patterns, X-ray aspects, and other small tricks that guide the physician to rapidly diagnose at the bedside what the patient may present or to better set up ventilatory support. Th is book is separated into two parts: the fi rst relates to techniques and methods, while the second relates to diseases. Th e separation is sometimes artifactual, as mecha nical ventilation has to be discussed as a technique but also for the management of ventilatory failure. Nevertheless, this separation does not impede reading because there is no overlap and because this book is not a handbook. Chapters have to be read cautiously, taking time to under stand the details of physiological principles or the interaction between disease processes and interventions. Th e book covers most aspects of intensive care practice, including a rapid description of the diseases that may be encountered in critically ill patients, the specifi cities of critically ill patients, and the therapeutic interventions and monitoring techniques that may be used. Th e quality of the diff erent sections is quite heterogeneous. Th e cardiovascular sections are excellent and the respiratory sections are really astonishing. Even physicians with excellent knowledge in respiratory medicine will learn by reading these parts. Th e sections describe all types of respiratory failure and discuss their specifi c management. Respiratory patterns and ventilatory support are reported extensively. Th e section on hemodynamic monitoring is attractive – including a large part on the interpretation of pulmonary artery tracings (which is particularly useful in present times when physicians are more reluctant to insert pulmo nary artery catheters and may sometimes lack some of the basic knowledge required to interpret the tracings), but also excellent parts related to non-invasive monitoring including echocardiography. Imaging techniques are well reported, with a lot of attention paid to visualization of lines and tubings. One can nevertheless regret that noncardiac echography is not discussed. Th e chapters on analysis of acid–base status and interpretation of blood gas and electrolyte disorders are also very good. Some chapters are defi nitively weaker. Th e chapters on renal epuration, especially hemofi ltration, and on sepsis are oversimplifi ed. Th e book also includes several appendices, including physiological equations (mostly respiratory and cardiovascular formulas) and some physical correction factors. In summary, Critical Care Medicine: Th e Essentials is very attractive for physicians involved in the care of critically ill patients and for physicians who need to train or to perfect their knowledge, especially in the fi eld of thoracic and cardiovascular medicine.