Pharmacology of the Critically Ill.

Abstract

Mayo Clinic, Jacksonville, Florida. murray.michael@mayo.eduPharmacology of the Critically Ill. By Gilbert Park, Maire Shelly. London, BMJ Publishing Group, 2001. Pages: 189. Price $49.95.Pharmacology of the Critically Ill is a relatively brief textbook (179 pages) written primarily by anesthetists from the United Kingdom, although there are authors from several other countries as well. As stated in the preface, the book was not written to describe how critically ill patients should be treated but, rather, how critically ill patients respond to the drugs that they are given. The authors believe that there is a need for such a book because the care of critically ill patients is becoming more complex and their treatments are becoming equally more sophisticated. I could not agree more.The book has several chapters describing the basic principles of pharmacodynamics and pharmacokinetics of drugs given to critically ill patients. There are six chapters dealing with how specific organ injury affects pharmacokinetics and pharmacodynamics (although the chapter on brain failure is more of a chapter on how one should treat patients with closed head injury). The final two chapters discuss pharmacology for children who are critically ill and safe drug prescribing for the critically ill patient.The book is very well written and easy to read, and overall it provides an excellent review of the pharmacokinetics, pharmacodynamics, and effects of multiple organ dysfunction syndrome on the pharmacology of drugs given to critically ill patients. Certain chapters stand out, such as the chapters on drug action and renal failure. Throughout the book there are excellent discussions of the effects of critical illness on the cytochrome P450 enzymes and the effects of critical illness on receptors within specific organs (e.g. , the heart). The references for each of the chapters are excellent. As the authors often point out, extensive studies involving critically ill patients are lacking, and often information must be extrapolated from human studies conducted in the operating room, from animal studies, and from cell studies.Overall, Pharmacology of the Critically Ill provides an excellent review of an important topic, and I would recommend it for anesthesiologists who work in an intensive care unit and for pharmacists who work with them. Those looking for extensive insights into specific drugs, such as sedatives and neuromuscular blocking agents or antibiotics, given to patients in an intensive care unit will be disappointed. There are very few studies of drug metabolism in critically ill patients, which, in and of itself, is equally disappointing. This textbook appropriately addresses how multiple organ dysfunction syndrome can potentially affect any drug on the basis of the degree of renal, hepatic, gastrointestinal, cardiac, or pulmonary dysfunction. At $49.95, the book should be within the purview of anyone working in an intensive care unit.