Hepatic Critical Care

Abstract

Rahul Nanchal and Ram Subramanian, 2 highly respected specialists in the field of hepatic critical care, are editors of a new book on the topic. The liver plays a pivotal role in many metabolic processes; it performs complex functions of synthesizing and metabolizing carbohydrates, protein, and lipids. The liver also plays a significant role in modification of proteins and drugs to their biologically active form, as well as detoxification and excretion of drugs out of the body. Limitations of hepatic function would have detrimental effects on various physiological systems, which could compromise circulatory, respiratory, gastrointestinal, renal, and cerebrovascular functions. Because the liver is a vital metabolic organ, it is susceptible to various conditions that can affect any of its many functions that can potentially lead to critical illness. This is well described in the first part of the book. Over 75 pages, the authors give an extensive and yet easily fathomable overview of various pathophysiological mechanisms involved in liver diseases. The second part of the book is clinically oriented, focusing on manifestations of liver-related problems in critically ill patients and their management. With 230 pages, it is more extensive than the first part, indicating their clinical relevance and significance. The first chapters of this section follow the same structure of the first part, in reviewing cerebral, cardiovascular, gastrointestinal, respiratory, renal and hematological consequences of hepatic insufficiency and their clinical applications. This is followed by chapters discussing special issues like pharmacological considerations, liver trauma, extracorporeal liver support, liver transplantation, and anesthetic considerations. All chapters start with an abstract, keywords, and learning objectives and end with a summary and recommendations section that is then followed by questions and answers. This structure clearly shows the intention of the authors to write a comprehensive textbook for educational purposes, a goal they seem to have well achieved. Such a didactic approach increases knowledge transfer and combines efficient means of swiftly grasping the essential information and retaining essential knowledge for future practice. Authors of single chapters are respected experts with a strong academic and/or clinical experience in the field. The text is easily comprehensible and appears to a large extent very homogeneous in style. Forty-one well-designed figures and a large number of tables help the reader to better understand complex interrelations. This book is appropriate for physicians who are looking for a broad overview of this topic, whether first-time residents or experienced physicians and researchers. In addition, this book can also be considered a quick reference for swift access to specific issues. For example, the excellent chapter on perioperative management should be commended because it gives clear practical clinical recommendations in a concise succinct fashion. In conclusion, Nanchal and Subramanian wrote an excellent textbook on hepatic insufficiency in the intensive care. This book provides an overview of both the pathophysiological background of liver disease and its effects on other systems. It offers background knowledge and clinical management. It has an admirable didactic approach that is comprehensive enough to provide all essential information, while succinct enough to still be considered concise. This book is recommended for those in the medical field who are involved in the management of patients with hepatic insufficiency in the intensive care and wish to establish, deepen, or refresh their knowledge. ACKNOWLEDGMENTS The authors thank Eugenia Lamont, their medical English editor, for streamlining and language editing of the manuscript. Ashraf A. Dahaba, MD, MSc, PhDHelmar Bornemann-Cimenti, MD, DMedSci, MScDepartment of Anaesthesiology and Intensive Care MedicineMedical University of GrazGraz, Austria[email protected]