Oh’s Intensive Care Manual, 5th edition . Edited by Andrew D. Bersten, Neil Soni. Burlington, MA, Butterworth Heinemann, 2003. Pages: 1,173. Price: $79.95.

Critical care textbooks seem to cohort themselves into pocket “quickie” references, soft-cover manuals, and exhaustive tomes. The fifth edition of Oh’s Intensive Care Manual  breaks the mold by combining elements of all three. Although Professor Teik Oh turns the major editing efforts of this edition over to the able hands of Professor Bersten and Dr. Soni, the basic principles of this expanded soft-cover text are closely maintained. As promised, the authors and editors provide “… lucid and easily read information that will assist in the practical management of diseases and problems in the intensive care unit.” The latest edition has been significantly revamped with 16 new chapters that address advances and evolving challenges in critical care medicine, such as biologic terrorism, broader coverage of the various causes of shock, and care of compromised parturients and children.

The Intensive Care Manual  is somewhat uniquely divided into 17 sections ranging from basic organizational aspects of critical care through organ-specific discussions to specialized topics such as pharmacology, transplantation (although there are no specific comments on kidney or pancreas transplantation), and pediatrics. Eighty-nine experts predominantly from Australia, Hong Kong, and the United Kingdom supply state-of-the-art commentary in 104 chapters that average approximately 10 pages (range, 6–50 pages) with approximately 25–75 references each. References as recent as early 2002 are presented but are not meant to be exhaustive and tend to include select sentinel pieces, state-of-the-art commentaries, and those that support recent advances or discuss evolving or controversial topics. Radiographs, figures, and tables are of high quality and fine resolution, and the index is adequate. The book also has eight helpful appendices that cover the gamut from normal laboratory values and therapeutic parameters to physiologic equations to severity of illness scores. Appendix 5, which has the entertaining title Plasma Drug Concentrations and American Nomenclature, facilitates bilingual translation for those purchasing the text here or abroad. Interestingly, Appendix 8 includes tables of several recognized outcome scoring systems, but Acute Physiology and Chronic Health Evaluation and Injury Severity Scores are not included and are discussed only within the text. Some of the terminology used in this book will not be familiar to the American reader, and some topics unique to the U.S. trainee or practitioner such as Health Information Portability and Accountability Act regulations guiding confidentiality and personal health information are not covered.

The chapters in which I knew little or have forgotten much educated me, whereas the chapters that covered areas of day-to-day practice tended to be concise, with a common-sense approach to pathophysiology, diagnosis, and therapeutic interventions. For example, the chapter on acute myocardial infarction was well written, with a clear discussion of the evolution of ischemia/plaque rupture (including diagnostic nomenclature) buttressed by informative graphics, logical therapeutic algorithms, and evidence-based tables. The chapters that contained topics within my areas of greatest experience/expertise were, for the most part, also well done. Surprisingly, the chapter on sedation, analgesia, and neuromuscular blockade did not include the most cogent recent guidelines from the Society of Critical Care Medicine1,2and did not address characteristics of specific agents such as the indications/contraindications to suxamethonium (American translation: succinylcholine). Furthermore, suxamethonium is not listed in the index, nor is the use of this drug directly addressed in the chapter on burns. The chapter on meningitis did not include the latest information on the use of steroids in adult patients with bacterial meningitis,3and the airway chapter would have benefited from inclusion of the American Society of Anesthesiologists difficult airway algorithm and Web site reference.4However, some of the newer additions, particularly the expanded chapter on echocardiography and discussions of bioterrorism and multiple organ dysfunction syndrome were quite worthwhile.

Suggestions for future editions include a bit tighter line editing (there are a fair number of misspellings), inclusion of a table of abbreviations at the beginning of some chapters (particularly the chapter on mechanical ventilation), the addition of an individual chapter on genomics, and an expanded chapter on general radiography in the critically ill that could be readily combined with the fine new presentation on chest radiology. Finally, to keep the text up to date between editions, consideration should be given to on-line access of new and updated references presenting cutting-edge material.5 

Despite some shortcomings, this is an excellent book that I would recommend as an addition to the library of students, trainees, and practitioners. In fact, reviewing this text has kindled our interest in comparing student impressions and poststudy knowledge base after reading various popular intensive care unit manuals. Presentations in the Intensive Care Manual  are basic enough to educate the student new to the complex intensive care unit world but of sufficient breadth and depth to be worthwhile for the busy experienced clinician.

University of Wisconsin, Madison, Wisconsin. dcoursin@facstaff.wisc.edu

Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD, Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists (ASHP), American College of Chest Physicians: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30:119–41
Murray MJ, Cowen J, DeBlock H, Erstad B, Gray AW Jr, Tescher AN, McGee WT, Prielipp RC, Susla G, Jacobi J, Nasraway SA Jr, Lumb PD, Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists, American College of Chest Physicians: Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 2002; 30:142–56
De Gans J, van de Beek D: Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347:1549–56
American Society of Anesthesiologists Task Force on Management of the Difficult Airway: Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology 2003; 98:1269–77
Wenzel V: A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 2004; 350:105–113