Critical Care Handbook of the Massachusetts General Hospital, 4th Edition. By Luca M. Bigatello, M.D. Philadelphia, Lippincott Williams & Wilkins, 2006. Pages: 887. Price: $49.95.

The new and improved version of the well-recognized Critical Care Handbook of the Massachusetts General Hospital  is now available. This anticipated update is presented to the medical audience at in a time when the critical care specialty is flourishing. Since the previous edition in 2000, the practice of critical care has evolved to an even more evidence-outcome–based approach, and this progress is reflected in this edition. A variety of trainees will find this to be a critical resource.

Dr. Luca M. Bigatello takes the lead as a senior editor and provides a slightly different albeit traditional structure and organization. As he states in the preface, “While individual intensive care units may focus their practice on selected patient populations—surgical, medical, cardiac units, etc—the basis of critical illness are universal,” the handbook follows a physiologic approach to the care of the critically ill. This characteristic makes it suitable for trainees of various backgrounds. This unifying approach to critical care is the basis for rewriting, expanding, and reorganizing the handbook. The previous organization in three parts is now remodeled into two extended sections: Critical Care Principles and Special Considerations (merging the medical and surgical considerations of the previous edition). With this reorganization, all chapters have been modified to some degree. Some have been merged (sedation, analgesia, and neuromuscular blockade), and some have been considerably expanded. One good example is the chapter on hemodynamic monitoring, which is now divided into two parts, including concepts such as systolic blood pressure variation, fluid responsiveness, and a more detailed description of the role of echocardiography in the intensive care unit. Other characteristics of this version include the appearance of new chapters featuring evidence-based medicine, critical care aspects of obesity and bariatric surgery, neurologic trauma, discontinuation of mechanical ventilation, fluids, electrolytes and acid–base balance, and prophylaxis. On the other hand, some chapters have been eliminated or incorporated into a broader category. These include intraaortic balloon counter pulsation, extracorporeal membrane oxygenation, pacemakers and implantable defibrillators, and neonatal intensive care.

The addition of an evidence-based medicine chapter underlines the direction of the specialty, with 15 pages describing how to evaluate the literature, explaining the different study designs, and describing how to apply this in the intensive care unit. Moreover, an entire chapter is dedicated to obesity and bariatric surgery, emphasizing the importance of this epidemic and its impact on critical care, starting with the physiologic changes associated with obesity, description of the surgical procedures, and finally, associated complications.

One of the most useful topics of previous editions is the chapter on mechanical ventilation. In this edition, the section on discontinuation of mechanical ventilation now constitutes a separate chapter that includes evidence-based guidelines, pathophysiology of ventilator dependency, weaning parameters and strategies, and the role of long-term facilities. This expanded version of the topic is improved and easy to read.

Despite these substantive changes, Dr. Bigatello is faithful to the style and tradition of the previous edition led by William Hurford M.D., F.C.C.M. (Professor and Chairman, Department of Anesthesia, University of Cincinnati College of Medicine, Cincinnati, Ohio). It is molded to provide a practical but complete multidisciplinary guide to the care of the critically ill and thus meets expectations and fulfills its purpose. As the body of medical literature continues to explode, those providing critical care services face daily challenges in applying this knowledge to an incredibly diverse set of clinical settings, and this type of aid is increasingly important. With its portable size, user-friendly outline, and high-quality content, this book is a good companion for trainees of various backgrounds, including nurses, respiratory therapists, medical students, residents (from medicine to surgery and anesthesia), and fellows in the intensive care unit environment.

Mayo Clinic College of Medicine, Rochester, Minnesota.