Saunders Manual of Critical Care

Abstract

Saunders Manual of Critical Care is edited by three American professors, who have also written extensive contributions to it. The other invited contributors tend, in general, to be colleagues with the same affiliations as the editors; namely at Detroit, Pittsburgh and Phoenix. The book is aimed at ‘intensivists and other acute care practitioners…including trainees and nurses’. The intention of the authors is to provide a ‘distillation of practical information required for bedside management’, and a brief and concise overview of the many diverse conditions encountered on the intensive care unit (ICU). Indeed, readers wanting in-depth explanations of pathophysiology or current controversies are directed elsewhere. The book does not cover paediatric issues at all, and is limited in respect of adult specialities such as cardiothoracic and neurosurgical critical care. As a bench-book for general adult critical care areas, the design is excellent. Chapters are organized into six main sections: common ICU problems, medical and surgical disorders (by far the largest), pharmacology, procedures and monitoring. A final section covers mechanical ventilation, which will be warmly welcomed by many non-anaesthetic clinicians working on ICU. There are three extra indexes on the inside covers, with alphabetical lists of topics covered in the ‘disorders’, ‘pharmacology’ and ‘procedures and monitoring’ sections, facilitating rapid access to the relevant chapters in the middle of the night. The indexes refer to chapter numbers rather than actual pages, so some minor additional searching may be required. Chapters are short and divided into methodological and consistent subsections (definition, aetiology, clinical features, differential diagnosis, and treatment). Bulleted lists are also included, following the book's ‘key’ motif—‘key findings’ or ‘key treatment’ are valid and useful headings, whereas ‘key prognosis’ and ‘key pathogenesis’ do not transfer easily into British English. Another example of the UK/US language divide is the use of the word ‘inhomogeneity’ as opposed to ‘heterogeneity’ when describing respiratory units in ARDS. Occasional points are given prominence as ‘pearls’ and whilst many are so, others are just stating the obvious. The medical disorders section, which spans over half the book, is extensive, covering routine ICU problems such as status asthmaticus and supraventricular tachycardia, as well as less-common conditions such as tumour lysis syndrome and care of the post-craniotomy patient. Algorithmic diagrams are included which give a clear and easily followed management plan. Readers may have reservations about some of the management priorities—when treating a patient with unstable angina, one might be expected to give oxygen before i.v. morphine, and not appear to limit its use only to those patients with signs of hypoxaemia. Furthermore, supplemental oxygen and chest physiotherapy are described as ‘not routine’ therapies for adult pneumonia. An example of inconsistent cross-referencing is the absence of recommendations on the use of succinylcholine in the section on burns management, with a passing comment only noted much later in the book in the section about tracheal intubation. The section on the management of spinal cord compression does deal adequately with this problem however. The procedures section of the book clearly explains common ICU interventions such as central venous cannulation and placement of chest drains (but not percutaneous tracheostomy). It does not mention, however, the use of ultrasound technologies to aid such procedures. Clear and easily followed descriptions are offered that are supplemented by good diagrams. Novice intensivists will find these chapters invaluable when learning these procedures. Similarly, the pharmacology section briefly explains the indications, contraindications and typical dosing for commonly used ICU drugs. There is much to recommend about this book. The format is excellent for clarity of reading, and a lot of thought has gone into providing easy access to relevant sections. Despite some minor reservations about treatment priorities, it represents good value and should not be out of place in any adult critical care area.