PREFACE

Abstract

Critical care medicine is a relatively new specialty. The oldest noncoronary ICUs have just turned 25, and subspecialty examinations have only been administered for the past 10 years. Unlike other subspecialties, critical care medicine is extraordinarily multidisciplinary. It is the only subspecialty recognized by surgery, medicine, anesthesiology, and pediatrics. Given its young age and multidisciplinary nature, disagreement about some of the most fundamental concepts in critical care medicine is common. This has resulted in a Society of Critical Care Medicine-sponsored lecture series that has procon debate as its focus, and now this issue that extends the same format to print.I owe the idea for this issue to my teacher and friend, Dr. Thomas Iberti, who died prematurely 3 years ago. His driving passion for the practice of critical care medicine and desire to disagree with even the most obvious of facts always impressed me. State the obvious and Tom was always willing to disagree, and often could convince you that you were wrong all along. This attitude spurred me to higher understanding and prevented me from readily accepting anything as fact.It is my goal for this issue to stimulate disagreement about common controversies in critical care medicine so that each of us may come to the understanding that Dr. Iberti had; that is, there are only shades of the truth, but no absolute black and white. The beauty of medicine, particularly critical care medicine, is in the appreciation of the shades, not in the acceptance of black and white.To this goal, I have assembled 18 articles focusing on nine issues that each of us face daily in our practice of critical care medicine. Hemodynamic support of subarachnoid hemorrhage, invasive and noninvasive monitoring, severity scoring, renal dose dopamine, pushing oxygen delivery, problems resulting from mechanical ventilation, nutrition in the ICU, and even the need for fulltime intensivists are all expertly reviewed by authors with opposite viewpoints, while usually relying on a common literature.I hope this makes for stimulating reading, changes a few minds, and at least makes all of us question some of our fundamental beliefs in at least one of these areas. Critical care medicine is a relatively new specialty. The oldest noncoronary ICUs have just turned 25, and subspecialty examinations have only been administered for the past 10 years. Unlike other subspecialties, critical care medicine is extraordinarily multidisciplinary. It is the only subspecialty recognized by surgery, medicine, anesthesiology, and pediatrics. Given its young age and multidisciplinary nature, disagreement about some of the most fundamental concepts in critical care medicine is common. This has resulted in a Society of Critical Care Medicine-sponsored lecture series that has procon debate as its focus, and now this issue that extends the same format to print. I owe the idea for this issue to my teacher and friend, Dr. Thomas Iberti, who died prematurely 3 years ago. His driving passion for the practice of critical care medicine and desire to disagree with even the most obvious of facts always impressed me. State the obvious and Tom was always willing to disagree, and often could convince you that you were wrong all along. This attitude spurred me to higher understanding and prevented me from readily accepting anything as fact. It is my goal for this issue to stimulate disagreement about common controversies in critical care medicine so that each of us may come to the understanding that Dr. Iberti had; that is, there are only shades of the truth, but no absolute black and white. The beauty of medicine, particularly critical care medicine, is in the appreciation of the shades, not in the acceptance of black and white. To this goal, I have assembled 18 articles focusing on nine issues that each of us face daily in our practice of critical care medicine. Hemodynamic support of subarachnoid hemorrhage, invasive and noninvasive monitoring, severity scoring, renal dose dopamine, pushing oxygen delivery, problems resulting from mechanical ventilation, nutrition in the ICU, and even the need for fulltime intensivists are all expertly reviewed by authors with opposite viewpoints, while usually relying on a common literature. I hope this makes for stimulating reading, changes a few minds, and at least makes all of us question some of our fundamental beliefs in at least one of these areas.