Intended for healthcare professionals

Book Book

Intensive Care Medicine

BMJ 1999; 319 doi: (Published 02 October 1999) Cite this as: BMJ 1999;319:927
  1. Ian Barker, consultant anaesthetist
  1. Sheffield Children's Hospital

    Ed Julian F Bion

    BMJ Books, £45, pp 456

    ISBN 0 7279 1076 0

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    Anaesthesia has its roots in the basic sciences and interfaces with every branch of medical practice. The specialty thus seems particularly suited to the publication of series of books that are more than journals but, individually, are not comprehensive textbooks.

    Intensive Care Medicine is the latest in the BMJ's series Anaesthesia and Acute Medicine. The editor is a recognised authority in the specialty, the book consists of 32 monographs by 52 authors, mostly from Britain but including some from continental Europe, Australia, and north America. It is refreshing that some of the contributors are trainees; the book cannot be regarded as merely the idiosyncratic musings of a self selected group of crusty old consultants.

    The book is divided into three sections, the first being a historical introduction, necessarily brief because intensive care has only been around for four decades. Secondly, four essays on the pathogenesis of critical illness set the scientific scene. Thirdly, the main body of the book comprises 25 chapters covering many clinical problems as they manifest in intensive care.

    Each chapter is some 12 pages long, easy to read, and well referenced The highlights are the chapters on acute lung injury and ventilatory failure, which should be compulsory reading for all who work in an intensive care unit, even the cleaner. They present well referenced, clearly summarised advice on some of the commonest problems presenting in every intensive care.

    Three other chapters are particularly worthy of attention. “Ethical Legal Issues” provides an authoritative review of consent in the management of adults and children, withholding and withdrawing intensive care, and the ethics surrounding research in the specialty. Its author, described modestly as “barrister at law,” was, in a previous career, one of the country's foremost authorities on cardiothoracic intensive care and anaesthesia. “Tissue Hypoxia and Ischaemia—Reperfusion Injury” is the uninspiring title of a clearly explained, logical discussion of the mechanisms underlying cell damage during and after shock. It emphasises the role of free radicals and the place of antioxidants These mechanisms are relevant to so many disease processes that all of us should have an appreciation of this science. “Obstetric Critical Illness” describes, in some detail, the presentation and current management of uncommon but potentially disastrous complications of pregnancy—HELLP syndrome, eclampsia, amniotic fluid embolism, and acute fatty liver of pregnancy.

    There is also a down side to the book. I was baffled by abbreviations in the chapter on cytokines: in one sentence the letters “TNF” appear six times. The chapter on the surgical abdomen summarises itself towards the end with the phrase “request a surgical consultation,” reminding me of a now retired colleague who gave a lecture to the FRCS course on anaesthesia by saying “Leave it to the experts” and departing the room. The chapter on the critically ill child paints a picture using the only photographs of patients in the book, but it is overshadowed by the book Paediatric Intensive Care in the same series. I was disappointed by the omissions. Perhaps budget holders will be pleased that protein C managed only one line. I could find little practical advice the on the rational choice of inotropes and vasoactive drugs. Most worrying of all, there was nothing on septic shock in spite of recent outbreaks of meningococcaemia in teenage and student populations.

    Anyone who reads this book cannot fail to appreciate the growth of intensive care from the “iron lung” ventilator to the scientifically based multidisciplinary management of some of our sickest patients. Who knows what the next 40 years will bring.

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