In an inspiring and imaginative editorial titled “Visit to intensive care of 2050,” Einav, O'Connor, and Chavez, intensivists and clinical epidemiologists, outlined a vision of critical care medicine in the year 2050.1 Computerized systems will integrate patient data, hospital resources, and physician expertise to help predict survivability, responsiveness to treatment, and the appropriate critical care unit for patients based on specific health needs. Patients with organ dysfunction will have individualized organs created via 3- dimensional printing or using a patient-specific “decellularized organ scaffold.” Although not mentioned in the editorial, we are certain that the educational resources available to practitioners will complement the technological advances of this future vision. Undoubtedly, Dr Marino’s acclaimed and condensed version of his critical care textbook, The Little ICU Book, will be installed in every critical care practitioner’s electronic pocket device.
In the second edition of this text, the goals of the book are clearly outlined in the preface, the ultimate of which is to create a “distilled version” of the parent textbook with an emphasis on evidence-based guidelines and recommendations. The book accomplishes this objective by creating an easy to read, comprehensive text. With a total of 904 pages (compared to the 781 pages of the first edition) and 47 chapters with 17 total sections including an appendix, the book’s organization is intuitive.
The first 6 chapters cover monitoring, monitoring devices, and preventative practices. Chapter 1, “Central Venous Access,” provides a detailed review of central venous catheters (CVCs), which includes proper infection control of CVCs, types and nomenclature of these devices, the optimal positioning of patients, and associated complications related to the insertion of CVCs. Following this layout, health care providers of all levels can use this text to obtain a basic overview of CVCs and basic anatomy or receive the latest published guidelines for antimicrobial-coated CVCs.
The clinically oriented chapters follow an organ systems–based order. Cardiac emergencies and pulmonary, renal, pelvic, and abdominal disorders are each discussed separately. Each chapter is accompanied by easy-to-follow diagrams and illustrations depicting individual disorders common to each organ system. Tables depicting the diagnostic criteria and treatments for specific diseases are also provided in concise yet comprehensible format.
This book is exceptional in emphasizing recent guidelines for leading causes of morbidity and mortality in critically ill patients. Sepsis, for example, has more than doubled in hospitalized patients in recent years, forcing clinicians and experts to reevaluate the optimal approach for rapid diagnosis and treatment.2 Clinical screening tools for sepsis such as the quick Sepsis-related Organ Failure Assessment score are recommended for identifying organ dysfunction and predicting mortality.
Although we see no obvious deficiencies in this book, we expect that future editions will include a chapter on obstetric critical care, a contemporary and increasingly pertinent issue in critical care medicine. Obstetric-related medical disease (for example, but not limited to, massive obstetric hemorrhage and sequelae of severe preeclampsia) and comorbidity during pregnancy (for example, but not limited to, maternal cardiac disease and substance abuse) are increasing, and maternal mortality has likewise increased in the United States over the past 25 years.3 The concept of the “virtual” obstetric critical care unit has recently been described, and the need for these services is only expected to increase.4 A review of obstetric physiology, critical illness, and updated guidelines would be greatly beneficial for health care practitioners with regard to this vulnerable population.
The Little ICU Book is a model tool for providing updated resources and concise and informative guidelines with instructive review of pathophysiology for health care practitioners of all backgrounds. The book surpasses its central objective of creating a “succinct and retrievable” resource for critical care medicine. The emphasis on providing updated practice guidelines from its previous version is aligned with the mission of the modern health care practitioner. Ultimately, Marino’s latest edition maintains its credibility as “the ICU book” for all providers wishing to understand the vastly changing and complex world of critical care medicine.
Cesar R. Padilla, MDJie Zhou, MD, MS, MBADepartment of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalHarvard Medical SchoolBoston, Massachusettsjzhou5@bwh.harvard.edu
1. Einav S, O’Connor M, Chavez LO. Visit to intensive care of 2050. Intensive Care Med. 2017;43:97–100.
2. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief. 2011;(62):1–8.
3. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:980–1004.
4. Leovic MP, Robbins HN, Foley MR, Starikov RS. The “virtual” obstetrical intensive care unit: providing critical care for contemporary obstetrics in nontraditional locations. Am J Obstet Gynecol. 2016;215(6):736.e1–736.e4.