Current Therapy in Critical Care Medicine. 3rd ed

Abstract

Current Therapy in Critical Care Medicine. 3rd ed. J. E. Parrillo, editor. St. Louis, MO: Mosby-Year Book Inc., 1997, ISBN 0-8151-7327-X, 430 pp, $81.95. This multi-authored text focuses primarily on management of the critically ill patient. Unlike most standard texts, the clinical presentations and pathophysiology sections in this text are limited to that which is necessary to provide a rational framework for therapy. There are 74 chapters arranged into the following sections: diagnostic and therapeutic techniques; cardiovascular therapeutics; pulmonary therapeutics; therapeutics for infectious disease; neurologic therapeutics; renal, gastrointestinal, hematologic and metabolic therapeutics; therapeutics for physical injury; and social, ethical, psychiatric, and cost considerations. This format allows for initial consideration of elements of therapy often applied to many critically ill patients before focusing on specific organ systems and their dysfunction and management. The contents embrace all the important aspects of critical care medicine. The 100 authors are well known critical care physicians from the United States, Europe, and Israel. Most of the chapters discuss the standard accepted therapeutic options extremely well; in many instances, in considerable detail. The text is well supported with both appropriate figures and tables. Each chapter concludes with a list of recommended reading, which includes the important and more current relevant references. The reviewers particularly enjoyed the section on cardiovascular therapeutics. One of the problems authors and editors of critical care medicine therapy texts face is what of new, or as yet not universally accepted, treatments should be included. This book focuses on current therapy, and, therefore, less attention to newer and more experimental modes of therapy is appropriate. However, sections in some chapters that address newer ideas are not as comprehensive as they might be. For example, there is no consideration of techniques of hemofiltration and mixed venous oximetry is reduced to an entry in a Table ofderived values from pulmonary artery catheters. Similarly, brain protection and the use of calcium channel blockers in the management of intracranial hypertension are omitted. When addressing mechanical ventilatory support of patients with adult respiratory depression syndrome, consideration is given to nonventilatory methods of carbon dioxide removal, such as ECCO2 removal, to oxygenation with intravascular oxygenators, and to use of partial liquid ventilation. However, the authors do not address alternative modes of mechanical ventilatory support that have application in this particular patient population, namely, airway pressure release ventilation, proportional assist ventilation, and transtracheal oxygen insufflation. As is often the case with multi-authored books, there is some redundancy of information, particularly with respect to intracranial hypertension, fluid and electrolyte management, and mechanical ventilation. In addition to redundancy, some topics, such as mechanical ventilation, are broken up through several chapters that address disease-specific application of mechanical ventilation. Despite these minor criticisms, this book does a good job of compiling well accepted elements of the management of critically ill patients into an eminently readable format. For all critical care practitioners-be they resident, nurse, occasional critical care medicine practitioner, or intensive-this text provides an excellent overview of critical care medicine therapeutics. Roy D. Cane, MBBCh Zoltan Hevesi, MD Department of Anesthesiology; University of South Florida; Tampa, FL 33612