The ICU Book, 3rd Edition. By Paul L. Marino, M.D., Ph.D., F.C.C.M. Philadelphia, Lippincott Williams & Wilkins, 2007. Pages: 1,088. Price: $79.95.

The third edition of The ICU Book  by Paul L. Marino offers a comprehensive update of this single-authored critical care text, which has over the course of its previous editions become popular among residents, fellows, and staff physicians as well as other practitioners caring for the critically ill. Since its first edition in 1990, the overall concept of The ICU Book , to serve as a general textbook for adult intensive care while omitting some highly specialized areas, has been maintained. Most chapters of this new edition have been extensively updated or were entirely rewritten. Figures were either updated or completely redesigned. The overall appearance and print quality of this new edition is improved as well.

The current edition of The ICU Book  starts off with a concise review of circulatory and respiratory physiology. The chapters headlined “Preventive Practices in the Critically Ill” introduce largely evidence-based concepts geared toward the prevention of complications. Here, daily management strategies commonly referred to as “line bundle” and “ventilator bundle” are outlined. The addition of these chapters offers an evidence-based approach that is useful in daily patient management and forms an integral part of a contemporary critical care practice. It has shifted the focus away from previous chapters in the second edition that largely emphasized theoretical concepts of tissue injury, such as oxidative stress, which have not been translated into clinical success despite substantial efforts.

The bulk of the chapters, with a few exceptions, continue to use a problem-based rather than a disease-oriented approach. Dr. Marino states in his foreword that the problem-based approach mimics the workings of the intensive care unit (ICU) because it focuses on practical solutions to medical problems that arise in the ICU setting, e.g. , resuscitating a patient with a gastrointestinal bleed rather than actually locating the bleeding site. This statement clearly highlights the inherent limitations of a concise problem-based textbook. It points toward the intended readership as those who have early exposure to the ICU environment and those who execute ICU orders on the frontline, as opposed to senior-level intensivists involved in comprehensive and expectant patient management.

Nevertheless, many important current concepts introduced into clinical practice since the last edition (low-tidal-volume mechanical ventilation strategy, recent recommendations for resuscitation of patients with sepsis, early antibiotic therapy in sepsis, and a possible role of steroids in sepsis) have found their way into the new ICU Book . The omission or restricted discussion of other current topics (glucose management) is a limitation in a textbook that attempts to give an overview of current practice.

Most chapters end with a “final word” section, offering a summary of concepts discussed in the chapter and putting them into a clinical context. As much as these paragraphs introduce another level of bias, they are highly instructive, at times entertaining, and offer clear insight into the thought processes involved in critical care decision making and summarize the essence of the chapter. The hands-on approach to ICU care that is presented in The ICU Book  is also evidenced by refreshing discussions of topics that stir up heated debate among critical care practitioners, such as the eternal debate over optimal resuscitation fluids.

Keeping a textbook up-to-date that attempts to cover adult critical care as broadly as this ICU book is a daunting task. Dr. Marino—with the help of Kenneth M. Sutin, M.D., F.C.C.M., who authored the final chapters—was able to achieve this in the current edition. Considering the wide range of disciplines involved in critical care and the enormous pace of developments in diagnostics and treatment in the critically ill especially during the past few years, the update of The ICU Book  is successful.

The third edition of The ICU Book  is well referenced within the limitations of a concise paperback text. The scope of references is at times more comprehensive and less biased than the tone of the text, making the references a useful starting point for in-depth reading. The fact that it is authored by a two-author team ensures that the text stays readable, and it limits repetition, overlap of chapters, and contradicting recommendations. It can be read front to back without need for adjustment to different presentation styles.

In summary, the third edition of The ICU Book  is an excellent, well-readable text for anybody starting out in the intensive care unit. Being largely single authored makes it a relatively easy read, which is its greatest advantage overall over more extensive multiauthored textbooks.

Mayo Clinic College of Medicine, Rochester, Minnesota.