Pediatric Critical Care

Abstract

Paediatric intensive care has developed greatly since the first edition of this book in 1992, with innovations in drug therapy, advanced organ support, and gene diagnosis and treatment coupled with better understanding of pathophysiology in cardiac and respiratory disease. The authors have set out to provide in a single volume (with access to an electronic companion) a comprehensive overview of the whole speciality. It has a largely American authorship with some high profile international contributors and although the author list is very long, the editors have done well to keep the chapter formats consistent. The book is split into sections with individual chapters. The first section is on the discipline of paediatric critical care which contains section on ethics, palliative care, and transportation. This is followed by sections on organs and organ-based diseases which contain chapters on both the physiology and pharmacology, and individual disease management. There then follows a useful section on inflammation, immunity, and infection with individual chapters on sepsis, systemic inflammatory disease, and genomics. The final section covers a wide variety of miscellaneous but important topics that do not easily fit elsewhere of stand-alone subjects such as trauma, burns, and child abuse and anaesthetic topics such as airway management and sedation. Each chapter begins with a set of key points or ‘pearls’ that highlight some of the main points of the chapter. The early chapters on the ‘discipline’ were at times too broad. While these are important aspects of intensive care, the reader might do better by going straight to a more specialized textbook. However, the chapters on ethics and intensive care were very well written and concise. The cardiac and respiratory sections were excellent with appropriate and well-produced diagrams and figures that complemented the text and helped understanding of key issues. The chapter on pharmacology of cardiovascular drugs provided good basic science descriptions of catecholamines and phosphodiesterases, but fell short in the clinical areas. The authors stray into more prescriptive text on how to make up drug infusions while leaving out pharmacology and clinical evaluation of drugs such as angiotensin-converting enzyme inhibitors, calcium channel blockers, and the use of drugs such as levosimendan and calcium infusions. In the respiratory section, the colour photographs and clinical management of respiratory disease was a highlight. Overall, this book is a bold attempt to try to get everything into a single volume and, generally, it succeeds. It provides a shelf book for understanding of the building blocks of paediatric intensive care unit and a reference manual for trainees preparing for higher exams or certification. The editors should be congratulated on undertaking such a large task and maintaining the quality and consistency throughout. This is a generalist book in a very competitive field and it concentrates more on the principles and science and less on specifics of clinical management. Therefore, for some diseases, more detailed information may still need to be sought from specialized publications. The link to references, rather than a printed list of references at the end of each chapter, necessitates that the reader needs to go online in order to retrieve them. I personally did not like this, but I appreciate that this reduced text length, and that in future the electronic medium will further dominate publication practice.