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Pediatric Critical Care: The Essentials

Greeley, William J. MD

doi: 10.1213/00000539-200002000-00065
Book and Multimedia Reviews

Department of Anesthesiology and Critical Care Medicine The Children’s Hospital of Philadelphia University of Pennsylvania Philadelphia, PA 19104

Pediatric Critical Care: The EssentialsJoseph D. Tobias, ed. Armonk, NY: Futura Publishing, 1999, ISBN 0-87993-428-X, 169 pp, $75.00.

The half-life of medical information is approximately 3 yr. The direct implication of this statement is that half of the medical knowledge we learned 3 yr ago is now obsolete. This is particularly true in the fields of medicine in which new technology, new drug therapy, or complex medical/surgical treatments are deployed. For all these reasons, pediatric critical care medicine is one such example of rapid turnover of medical information. Thus, the timeliness of new information is important to all practitioners who care for critically ill children.

The context in which critically ill children are cared for within a health system is also dramatically changing. Because of the very nature of the discipline, patient care often requires a multidisciplinary approach. Therefore, pediatricians, anesthesiologists, family practitioners, internists, and surgeons not formally trained in pediatric critical care medicine may be involved in the care of such patients. Indeed, these physicians may be the providers during the initial stabilization.

In Pediatric Critical Care: The Essentials, the editor and authors provide an overview and an introduction to critical care medicine. The medical information is new, and the intent of the book is segmented such that it is aimed at specific audiences. The editor’s approach is one of overview and a reference as an introductory text. This is not intended to be a comprehensive text of pediatric critical care medicine; more comprehensive textbooks exist elsewhere. The book’s primary objective is to provide a useful, practical reference that can be used during the initial stabilization and management of critically ill children by physicians not formally trained in pediatric critical care medicine.

The book does an adequate job of covering certain disease processes, technical approaches, as well as situational management of medical events likely encountered in a child with a critical illness. Major organ system failure, e.g., heart, lung, brain, are comprehensively discussed in this text. For example, in several chapters, the authors address acute respiratory distress syndrome, airway management, mechanical ventilation, as well as alternative modes of respiratory support including extracorporeal membrane oxygenation. Thus, from the stand point of the respiratory system, the situational, technical, and patient care management aspects are comprehensively covered. Likewise, the treatment of congenital heart disease, arrhythmias, and the postoperative care of the cardiac surgical patient are addressed in several chapters. Other system issues, such as fluid and electrolyte maintenance, and nutrition in the critically ill patient are adequately discussed. The chapter on the use of sedatives/analgesics and neuromuscular blockading agents in children in the pediatric intensive care unit is excellent. The author comprehensively describes the issues and treatment options of the various sedatives/analgesics and neuromuscular blockading agents. The book concludes with the management of some of the common causes from which a child is likely to be critically injured: poisoning and trauma.

This is an multiauthored text; many of the chapter authors are national authorities in their respective fields. This textbook does suffer from the lack of uniform approach chapter to chapter as a result of the different styles of the various authors. This, however, represents only a minor distraction. The topics and treatment information are current, and the references are up to date. Another weakness in this book is that more tables and figures could have been included to illustrate the pathophysiology and treatment.

Pediatric Critical Care: The Essentials is an excellent textbook as a reference for physicians who may be involved in the care of critically ill children on a consultative or initial/stabilizing basis. This is especially true for the busy anesthesiologists who may encounter critically ill children in their practice. In addition, this reviewer believes this textbook would be invaluable for medical students, residents, and fellows who work in a pediatric intensive care unit. A comprehensive reading of this text by students and residents over a period of time would certainly educate them on the major issues and treatment likely to be encountered in pediatric critical care environment. This textbook should facilitate the care of children who have critical illness and require complex medical and surgical intervention.

© 2000 International Anesthesia Research Society