Handbook of Drugs in Intensive Care

Abstract

The Handbook of Drugs in Intensive Care is in its fourth edition. We would argue that for a drug handbook to be useful in clinical practice, it should be a quick reference source that provides the key information needed to rapidly review the relevant pharmacologic effects of compounds of interest to the practitioner in a compact, easy-to-read format that is convenient to carry in a coat pocket. For an intensive care drug handbook to be most useful to the busy intensivist, it should be written using a simple format that allows the practitioner to rapidly access essential information regarding appropriate dosages, as well as the demographic and physiologic factors that alter dosage recommendations in critically ill patients. Given the large number of concurrent medications that are administered in the intensive care unit (ICU), information on common drug interactions and adverse side effects assumes increased importance. This handbook deals with essentially every drug used in the ICU setting. After a brief introductory section that lists indications for intensive care drugs and instructions regarding how to use the book, the primary section of the book is organized as an A–Z guide that presents the individual drugs in alphabetical order. The final section of the book includes “Short Notes” and “Appendices.” Inside the back cover of the handbook is a very detailed and highly useful drug-compatibility chart. The mechanism of action of each ICU drug is concisely described using key words. The description of the drug's primary and secondary clinical use is presented in a clear manner; however, more “in-depth” information about these drugs requires a basic pharmacologic textbook. Both registered (licensed) and “off-label” uses of these drugs are also noted. Dosage information is specified for each ICU indication, with additional information provided regarding changes required in the presence of organ system failure. The risk of misunderstandings regarding dosage alterations in patients with organ system dysfunction is minimized because of the simplified format utilized (e.g., renal or hepatic impairment: reduce dose). Tables are used in an effective, but not overwhelming manner. The detailed explanations regarding administration techniques (e.g., filter, dilution solution, storage requirements, central versus peripheral lines) minimize the risk of incorrect use of these drugs, which would lead to reduced effectiveness of the treatment. New drugs and protocols (i.e., drotrecogin) are well described. The authors have also successfully avoided excessive repetition throughout the book. The Short Notes section describes the management of the most common emergency situations in the ICU, using flow charts and key concepts, while avoiding the usual tendency in handbooks to be “superficial.” Although it can be difficult to compile a useful drug handbook in the field of intensive care medicine, Henry Paw and Rob Shulman have done a highly commendable job. Overall, there is a good mixture of basic information and helpful details regarding the clinical management of critically ill patients. Residents and ICU fellows can use the handbook to quickly review the pharmacology of drugs that are frequently used in the ICU. However, this handbook should be used to “complement” one of the basic pharmacology textbooks. Not surprisingly, the major shortcoming of the handbook relates to the rapidly changing practices in ICU medicine, which inevitably renders some of the information “outdated” (e.g., atropine, which is no longer recommended for routine use in the management of pulseless electrical activity and asystole). Appendices providing a brief discussion of the effects of various drug combinations in patients with prolonged QT intervals, as well as the pharmacologic management of myasthenic crisis, would be useful additions to the next edition of the handbook. Returning to the original thesis regarding an ideal drug manual—easy to use, highly informative, allowing the practitioner to rapidly review key drugs used in the ICU—this book comes very close. In summary, these authors have presented updated information about ICU drugs in an enjoyable and easy to read format. The book contains a wealth of concisely written information on common clinical problems (e.g., infections, prophylaxis against thromboembolic complication, anaphylaxis) with proper treatment algorithms. The Handbook of Drugs in Intensive Care can be used by all physicians involved in intensive care medicine as a brief “refresher” text and practical guide for administering drugs to critically ill patients. Rosalba Spiritoso, MD Department of Surgery and Anesthesia Sciences University of Bologna Research Unit of Anesthesia and Intensive Care Rizzoli Orthopedic Institute Bologna, Italy [email protected] Paul F. White, PhD, MD, FANZCA Research Unit of Anesthesia and Intensive Care Rizzoli Orthopedic Institute University of Bologna Bologna, Italy Department of Anesthesia Cedars-Sinai Medical Center Los Angeles, California