Mohan Gurjar (ed)
India: Jaypee Brothers Medical Publishers (P) Ltd
Pp 738, ISBN: 9789351524229
In a world of rapid technological advances, the Intensive Care Unit (ICU) is no stranger. Even in the (relatively) short time I have been practising there have been many changes; a good example is the use of ultrasound. Once the radiologists domain, ultrasound is now wielded by many intensivists to aid an ever expanding list of procedures in addition to guiding diagnosis and management with more complex techniques such as focused echocardiography. As such (and as alluded to by the editor in the preface of this book) books offering the latest list and description of procedural skills may become quickly outdated. However, the ‘Manual of ICU Procedures’ offers the reader a thorough look at many key procedures from first principles - easily extrapolated and expanded upon for the future reader.
The first impression of this book was its size. At just over 700 pages in length and weighing in at 1.16 kg it is certainly not a pocket reference. It is logically divided into five sections: Airway and Respiratory; Vascular and Cardiac; Neurological; Gastrointestinal, Abdominal, Genitourinary; and, Miscellaneous. Together these contain the description of a very comprehensive 61 procedural skills chapters ranging from the exceedingly basic (bag and mask ventilation, peripheral venous cannulation and nasogastric tube placement) to more complex procedures (percutaneous tracheostomy, pericardiocentesis and pulmonary artery catheter insertion). Some of the included procedures (cranial burr hole, bedside laparoscopy, nerve and muscle biopsy) are not commonly performed by intensivists in the UK, in my experience. However, knowledge of the intricacies of such procedures is useful to the intensivist in the management of the ICU patient before and after such interventions.
The format of each of the 61 chapters is fairly similar and typically runs through a brief introduction to the skill (including some interesting historical trivia), indications and contraindications, applied anatomy, technique and equipment (including advantages and disadvantages of the various approaches or techniques), preparation, steps of the procedure, post procedure care and potential complications. The text is easy to read and gives a reassuringly detailed account. The chapters are beautifully illustrated with colour photographs, anatomical diagrams and radiological images, all of which are clear and certainly enhance the reader's understanding of the procedure, anatomy and equipment.
The book, however, is not without its problems. Many of the chapters are word-heavy, occasionally repetitive and could benefit from some grammatical polishing. I would have preferred procedural techniques to have adhered more closely to the recommendations and guidelines from the ‘Difficult Airway Society’ (DAS); scalpel cricothyroidotomy as the preferred ‘plan D’ technique for a ‘Can’t Intubate, Can’t Ventilate’ scenario, for example. A chapter on the physics and clinical applications of ultrasound and process of consent or assent for procedures in ICU would also have been useful.
All in all, the book does deliver a good step-by-step guide to procedures carried out on the intensive care unit. I would recommend it to anaesthetists and intensivists looking to improve their procedural skills and knowledge, particularly useful for those sitting postgraduate examinations.
Dr Emma Temple
Specialist Trainee in Anaesthesia and Intensive Care Medicine
Queen's Medical Centre