Handbook of Pediatric Intensive Care, 3rd Edition. By Mark C. Rogers, Mark A. Helfaer. Philadelphia, Lippincott Williams & Wilkins, 1999. Pages: 1998. Price: $49.00.

Ten years have passed since the publication of the first edition of Rogers’Handbook of Intensive Care . In the current manual, an abbreviated version of Rogers’ textbook, the authors’ goal was to “cut short the discussions of pathophysiology and basic science to focus on the diagnosis and treatment of critically ill children.” The text focuses on brief discussions of disease states punctuated by user-friendly tables that highlight management principles. Four years since publication of the second edition, in which Dr. Helfaer was added as coeditor, the third edition furthers the authors’ mission while largely retaining the original format. Several new chapters have been added, accounting for an incremental 100 pages of text.

The first six chapters pertain to the respiratory system. The opening chapter about cardiopulmonary resuscitation is essentially a restatement of the corresponding sections in the “Pediatric Advanced Life Support” providers’ manual. 1A brief reference is made regarding the use of the laryngeal mask airway during cardiopulmonary resuscitation. A more detailed description of the use and limitations of this device, unfamiliar to most pediatric intensivists lacking training in anesthesiology, might be useful. The subsequent chapter about airway management is a well-written review of the basics as encountered in a variety of anesthesia texts. Several passages present essential information with which pediatric anesthesiologists are well-versed but that is underrepresented in other pediatric critical care texts. This includes discussion of reversal of neuromuscular blockade and induction agents suited to children with open globe injury, increased intracranial pressure, and hypovolemia. The ensuing chapters about small airway obstruction, adult respiratory distress syndrome, neuromuscular disease, and mechanical ventilation are thoughtfully written and thorough. The latter chapter, conspicuously absent from the second edition, is a welcome addition to this text. Interestingly, an excellent review of upper airway disease, present in the previous edition, has been dropped from the current Handbook .

The ensuing four chapters involve the circulatory system. Each chapter has the same authors and similar content as the previous edition, but all have been upgraded and reedited. The chapter about dysrhythmias has been enhanced by the condensation of text into more easily referenced tables. The chapter about postoperative care after cardiac surgery, however, retains a somewhat haphazard format and might benefit from the reorganization of cardiac lesions into a more coherent structure.

The subsequent section, devoted to the central nervous system, has several new or significantly revised chapters. The chapter about encephalopathies moves away from an emphasis on Reye syndrome, now rarely seen, and embraces a more orderly classification of etiologies. There is new, well-written material about head injury accompanying the section about spinal cord injury, and these have been appropriately placed in sequence with other chapters pertaining to the central nervous system. In the interest of brevity, enlightening but nonessential epidemiologic information has been omitted from the chapter about drowning. Valuable consideration of organ donation and withdrawal of life support has been added to the excellent review of brain death.

The section about infectious diseases retains vital chapters about the human immunodeficiency virus, overwhelming sepsis, and central nervous system infections. The chapter entitled “Specific Infectious Diseases of Interest to the Intensivist,” however, is dominated by a lengthy discussion about tetanus, which is rarely seen in the United States. A review of Rocky Mountain spotted fever follows. Conspicuously absent is a discussion of common iatrogenic infections, including prevention and treatment of central venous catheter–related sepsis.

The chapter about gastrointestinal and liver failure, retained from the second edition, provides an adequate overview. The reference to Reye syndrome is dated, however, and the discussion of hepatorenal syndrome neglects to mention its low incidence in young children. The new chapter about liver transplantation is certainly welcome. Its discussion of antirejection therapy, though, fails to distinguish between acute and chronic rejection; erroneously indicates that FK506 (now tacrolimus, or Prograf) is “typically” used as a sole agent after transplantation; and omits reference to lymphoproliferative disease, which may be fatal and for which immunosuppressive agents are often withheld.

The third edition of the Handbook  includes chapters about renal, endocrine, and hematologic disorders found in the previous edition. Chapters about poisoning, multiple trauma, and burn injuries are retained. The chapter about malignancies has been deleted. The final chapter, dedicated to sedation and analgesic therapy, is thorough and expertly composed. This new addition to the Handbook  serves to affirm the vital role of the anesthesiologist–intensivist in pediatric critical care.

In general, changes from the previous edition are welcome. The index of topics at the beginning of each chapter has been expanded to include subheadings, allowing the reader to easily identify the desired section. In addition, key points in each chapter have been separately grouped and highlighted with bullets. However, arrows and bold text directing the reader to the diagnosis and therapy for particular lesions have been eliminated from the previous edition. For those readers seeking rapid identification of these topics, the task has been rendered somewhat more difficult.

The Handbook of Intensive Care  is generally easy to read and contains a wealth of excellent tables and figures. Although each chapter begins with a detailed index, references and even suggestions for additional reading are lacking. Nevertheless, the book will serve the house officer in pediatric critical care well. Both critical care fellows and fully trained practitioners will settle for no less than the unabridged textbook version, which remains a vital and essential reference for pediatric intensivists.

Textbook of Pediatric Advanced Life Support. Edited by Chameides L, Hazinski MF. Dallas, American Heart Association, 1994