Critical Care Focus, 10: Inflammation and Immunity
H. F. Galley (ed)
BMJ Publishing Group: London, UK, 2003, 106 pp; indexed, illustrated
ISBN: 0–7279–1689–0; Price £14.95
Busy intensivists can often find themselves in a mindset where it seems simply impossible to keep up to date with the latest information on their speciality. This is exacerbated by the fact that many of them have become wary of the latest ‘fads’ and so-called advances in management. Who has not had their hands burnt by miracle cures such as highdose steroids or monoclonal antibodies? This healthy scepticism often imperceptibly spills over into cynicism and this can seriously undermine the introduction of newer techniques that actually do have patient benefit. BMA Books and Helen Galley are continuing to produce a magnificent series of monographs on those topics in the practice of intensive care that are constantly being updated and re-focused. In particular, they are presented in digestible chunks where the intensivist is able to keep up without too much effort. However, do they contain information that will seriously challenge present practice or do they just tantalize the intensivist that some wonderful development is just around the corner … yet never seeming to materialize?
Number 10 in the series considers Inflammation and Immunity and sets out to make the intensivist aware of the latest developments in this area. There are seven chapters including Immunoparalysis, Apoptosis, Virus interaction with host immunity, The role of the neutrophil, T cell immunity and sepsis, Metalloproteinases and inflammation and finally, Glucocorticoid therapy in sepsis.
I especially enjoyed the chapter on apoptosis, in particular making the point that it is pronounced apo- and -ptosis (as in the eye, with a silent ‘p’). The review of the neutrophil and its ability to both benefit the patient and contribute to reperfusion injury was masterly. However, perhaps the most thoughtprovoking chapter was the last one on Glucocorticoid Therapy in Septic Shock. It is now beginning to emerge that, whereas short high-dose glucocorticoid therapy is harmful, there is a subset of inotropedependent patients in whom a small dose of steroids for a longer period may restore vascular sensitivity and improve haemodynamics. It could be possible, therefore, to actually select patients in the intensive care unit who respond to low-dose steroid therapy, hopefully with an improvement in outcome.
Those of us who have started to collect this series will have no need to hesitate in making the next purchase. However, I would also implore that copies are kept in the intensive care unit, readily available on the shelf, for the inquisitive trainee intensivist who has a spare moment to keep up to date with the latest developments.
D. W. Green