Textbook of Critical Care, 5th Ed. Fink MP, Abraham E, Vincent J-L, Kochanek PM Philadelphia, PA: Elsevier Saunders, 2005. ISBN 0-7216-0335-1. 2538 pages, $199.00 for book only and $299.00 for references on CD-ROM and Web site access.
In agreeing to review Textbook of Critical Care, this reviewer expected, if nothing else, that in the 3 months allotted for the review, he would receive a comprehensive review of critical care medicine and gain a list of recent references. The expectations were not met. The text is over 2,300 pages long, with 265 chapters and over 440 authors. The majority of the authors have an internal medicine or surgical background; less than 5% are anesthesiologists. The book would have been even longer, but the majority of the references have been included in an accompanying CD (for an additional price).
There are some differences from the 4th edition; the editors have included more international authors, but in reality, most are American or northern European. In the 5th edition, key points have been included at the beginning of every chapter, but because these are brief and not highlighted within the text, if the key point is not readily understood, there is no mechanism for identifying it in the text in order to gain additional insight. Paying the higher price gains one Internet access and the ability to download PowerPoint slides, which is a very big plus for the text. Although the overall quality of the tables is excellent, there is some variability and some are clearly deficient.
The editors have added 27 chapters at the beginning of the book that deal with common problems within the intensive care unit (ICU). Here again there is much variability between chapters. For example, the chapter on respiratory failure in this introductory section is only 2 pages long, whereas the chapter on acid-base balance is 12 pages long, and neither recommended additional reading. The sedation chapter is overall a good one, but there is no discussion of dexmedetomidine. The chapter on glucose management is also of note. Anesthesiologist-intensivists will be able to tell that a patient in the holding area, or in the ICU for that matter, is not hypoglycemic if the blood glucose is not less than 40 mg percent unless the patient is also symptomatic. Since two thirds of the patients in the ICU receive sedative agents, this definition of hypoglycemia is often not useful. In the chapter on distributive shock, vasopressors are recommended without any discussion of any specific vasopressors. While additional information is supplied later in the book, as a quick read, this chapter is not particularly helpful.
In the basic science section, again chapters are variable. The first chapter deals with the expression of gene products and notes that they are regulated at multiple steps. The second chapter in this section deals with neutrophils. There is no discussion of the immune system overall, which is critical before beginning discussions of each individual component of the immune system.
For a new textbook, some terms are already out of date such as “endotracheal” (now known as “tracheal” tubes), and the ACLS guidelines use “antidysrhythmics,” not the preferred term “antiarrhythmics.” While these are small points, they date the textbook.
The whole section on mechanical ventilation is disappointing for the same reason that the basic science section is disappointing. There is no overview of mechanical ventilation as a whole. One would have to read every chapter to have a clear understanding of the best way to ventilate a patient in the PACU or SICU. For example, there is a statement, “Extracorporeal life support should be instituted early before significant ventilator trauma developed.” One would have to consider the source, but how many of us consider extracorporeal cardiopulmonary bypass in the ICU for patients with worsening lung disease while on mechanical ventilation?
Similarly such statements as, “The presence of a difficult airway in a patient requiring prolonged mechanical ventilation is an absolute indication for a tracheostomy” would not be accepted by most anesthesiologists. To have it appear in a textbook of critical care medicine is disturbing.
In summary, this reviewer has serious concerns about the textbook, which is expensive, and though it introduces some novel concepts, the variability of the quality of the textbook makes it difficult to recommend to anesthesia residents, who might not recognize some of the deficiencies within the book, or to more experienced individuals, who would be disappointed with the overall quality.
Michael J. Murray, MD, PhD
Professor and Chair
Department of Anesthesiology