Textbook of Critical Care, Fifth Edition. By Mitchell P. Fink, M.D., Edward Abraham, M.D., Jean-Louis Vincent, M.D., Ph.D., and Patrick M. Kochanek, M.D. Philadelphia, Elsevier Saunders, 2005. Pages: 2,358. Price: $199.00.

It is a particular challenge (but still a pleasure) to review this impressive textbook—2,358 pages in 265 chapters and weighing 4.7 kg or approximately 10 pounds, with 440 contributors and edited by 4 international leaders in the field. The book is well written, and the materials are nicely presented in a sufficiently uniform style to facilitate the reader's task.

It is worth mentioning from the beginning that this textbook is accompanied by a dedicated Web site. This site is updated every week by experts in the field, which keeps the chapters up-to-date by including results from relevant new research appearing in the literature. This presents a clear advantage compared to most other books. The material is never outdated and can also be used for presentations and teaching more easily, using today's electronic transfer and projection possibilities.

The scope and horizon of this text is very complete; I was unable to find an important area of my critical care practice that is missing. The first two sections of the book are particularly well chosen. The first provides short descriptions of common symptoms and derangements in the critically ill, providing an overview on “what to look for” in these frequent problems. The second section provides basic science insights in fundamental biology and physiology relevant to the field. For instance, structure and function of cells frequently involved in critical care pathology (e.g. , leukocytes) and endothelial and epithelial mechanisms of disease are superbly presented. I liked especially the chapter on lung epithelial function and its roles in acute respiratory illness such as pulmonary edema, acute lung injury, or adult respiratory distress syndrome. Furthermore, this section describes also the most important features of complex physiologic events such as coagulation and apoptosis, which have been more recently recognized as being of particular importance in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome, as well as sepsis and other serious infectious diseases.

The following dozen sections are those found classically in a textbook about intensive care medicine: specific organ dysfunction and failure, infection and sepsis, endocrine disorders, obstetric complications, toxicology, critical care procedures, trauma, and organ transplantation. Again, descriptions of mechanisms of disease, diagnostic possibilities, monitoring, and therapy are very complete and mostly easy to read.

The last two chapters merit a special mention: first, ethics and end-of-life care, and finally, organizational and educational issues of particular interest in critical care medicine. Both are thoughtful, up-to-date, and appropriate in content. As we all know, these issues will determine, more than many others, what the speciality of intensive care medicine will be tomorrow—in the eyes of society, the patient, and his or her family. Will it be a place of human caring in difficult situations and teamwork using the limited resources in the best possible way, or an estranged world of technology and heroic acharnement thérapeutique , not placing the person and his or her values and wishes in the center of the action? In a certain sense, this book gives an answer, by the quality of all its chapters, and the importance given to the last two sections. One regret: These two sections could be placed at the beginning of the textbook, just before or after basic science, to highlight even more the relevance of ethics, end-of-life care, teaching, and training for a good practice of intensive care medicine.

The editors should be congratulated for the choice of the contributors and for the style of presentation making the many, many parts fit nicely together. Repetition is kept to a minimum. This book and the corresponding Web site can be recommended as an essential reference source for the busy clinical intensivist, but also for the scientist wishing to approach basic and clinical science in intensive care medicine and to understand their connections better.

University Hospitals, Genève, Switzerland. peter.suter@medecine.unige.ch