Critical Care Medicine: The Essentials, Fourth Edition. By John J. Marini, M.D., and Arthur P. Wheeler, M.D. Philadelphia, Lippincott Williams & Wilkins, 2010. Pages: 708. Price: $69.95.
The practice of critical care medicine requires an understanding of the complex physiologic principles at the foundation of this practice and mastery of an ever-increasing body of basic and clinical science studies.
The authors of Critical Care Medicine: The Essentials have undertaken the formidable task of synthesizing in a concise yet comprehensive format the underlying theoretical concepts of critical illness and their clinical applications. Whenever possible, they base their discussion on the underlying pathophysiology—a practice that is increasingly rare in evidence-based medical texts.
The text is the product of a two-author collaboration. This approach contributes to uniformity in writing style and topic discussions. The current state of medical knowledge in the field of critical care is well-represented and landmark studies are incorporated into the text. The authors themselves are both international leaders in critical care and possess a deep insight into state-of-the-art practices.
The book is organized into two sections. The first section, “Techniques and Methods in Critical Care,” reviews the basics of management in critical illness. The discussion covers the entire range of physiology and pathophysiology of the cardiovascular, pulmonary, and hematologic systems as well as acid-base and fluid and electrolyte disorders. A focused review of the relevant pharmacology is presented in two chapters.
The essential techniques and principles of hemodynamic and respiratory monitoring, arrhythmia control, airway management, and mechanical ventilation are reviewed cogently and comprehensively. Discussions of ventilatory support address an extensive array of issues from initiation of mechanical ventilation to its discontinuation, including practical problems and complications, various modalities, and weaning techniques. The authors emphasize the contemporary understanding of ventilatory management and refer extensively to the relevant literature.
In the section on transfusion medicine, the authors discuss transfusion thresholds in light of the available medical evidence. The first section is rounded out with chapters on intensive care imaging, general supportive care, quality improvement, and cost control.
The second section of the book, “Medical and Surgical Emergencies,” includes discussions of a wide range of topics involving clinical syndromes and events encountered in the intensive care practice. The chapter on sepsis provides an excellent synopsis of the current medical knowledge and clinical practice. The discussion of acute kidney injury includes an excellent and useful review of the modes of renal replacement therapy.
The infectious complications of critical illness are an increasingly recognized and studied complication of the intensive care unit. The discussions of intensive care unit–related infection, including ventilator-associated pneumonia and catheter-related bloodstream infections, are terrific synopses of these areas.
Each chapter begins with a list of key points. The book is consistently illustrated with essential figures, graphs, and tables. Each chapter concludes with a succinct list of the key references.
Critical Care Medicine: The Essentials is aptly titled. The authors present an eminently concise and readable text. Medical students, residents, and fellows will love this book because it summarizes state-of-the-art practices concisely and in a manner that is not available from other sources. Nonintensivist anesthesiologists will find it a lucid, thoughtful, highly informative explication. However, they might also be frustrated by the paucity of images in the chapter on imaging, which discusses newer modalities and the key findings associated with important diagnoses. For other readers who are interested in more detailed, exhaustive reviews, I recommend seeking one of the tomes of critical care—or they may wish to sate their appetites with offerings from the peer-reviewed literature.
As an introduction to critical care, however, it is my belief that this text is without equal. A copy should be present in every anesthesia and intensive care library.
University of Chicago, Chicago, Illinois. zzafirova@dacc.uchicago.edu
