Critical Care Medicine: The Essentials , 3rd Edition. By John J. Marini, M.D., and Arthur P. Wheeler, M.D. Philadelphia, Lippincott Williams & Wilkins, Inc., 2005. Pages: 664. Price: $59.95.

Now in its third edition, Critical Care Medicine: The Essentials  has undergone extensive revision and updating since the publication of the second edition in 1997. The text is directed at upper-level trainees in critical care disciplines. The book is well organized and written in a manner to promote reading and comprehension. Although individual chapters certainly serve as excellent sources of information, the strength of the two-author format lies in the consistency, flow, and brevity of the text. This is accomplished through a minimum of duplication of information and well-placed references to other sections of the text. The authors are noted clinicians, educators, and researchers in pulmonary and critical care medicine. Their years of experience are evident in the recommended approaches to the critically ill patient and the clarity of explanations of the physiologic principles of practice. Of course the two-author format allows more of their particular practice biases to come through. This also adds considerably to the enjoyment in reading the book, giving a distinct “this is how we do it and why” feel. The book was obviously structured to promote physiologic understanding as the foundation of the practice of critical care medicine. The text is user-friendly and clinically relevant. The authors take the time to explain physical findings and relate these to pertinent points in the history and their relation to diagnostic considerations, as opposed to offering a litany of associated items. Commendably, the authors accomplish this while maintaining the concise, focused nature of the text. In this way, the book allows for reflection, understanding, and synthesis on the part of the reader. This provides a nice alternative to the numerous brief handbooks and to the large multi-authored handbooks.

The text is divided into three sections: “Techniques and Methods in Critical Care,”“Medical Crises,” and “Surgical Crises.” The techniques and methods section covers hemodynamics, cardiovascular physiology, dysrhythmias, respiratory monitoring, mechanical ventilation, imaging, acid-base physiology, fluid and electrolyte management, nutrition, and transfusion, as well as the use of analgesics and paralytics. These chapters provide the lion’s share of the physiologic basics. Also covered are medication administration, general supportive care, and intensive care unit utilization. The handling of respiratory physiology, monitoring the respiratory system, and mechanical ventilation is detailed, advanced in scope, quite comprehensive, and simply outstanding. Advanced modes of ventilation, including high-frequency oscillation and airway pressure release ventilation, are reviewed. The chapter on practical problems and complications of mechanical ventilation includes an elegant discussion of mechanisms of barotrauma. Diagrams and tables are well used to supplement the discussions and serve as rapid reference points for review. The discussion on acid-base physiology reviews aspects of both the traditional Henderson-Hasselbach and the physical chemistry (Stewart) approaches. The section on general supportive care is particularly excellent and integrates a number of aspects of care addressed by the intensive care unit care team daily. Herein the discourse is global and multidisciplinary, including important topics like care documentation, prophylactic therapies, nursing issues, respiratory therapy, and communication between the team and families. Each chapter concludes with a list of key points and suggested reading.

The section on medical crises includes cardiovascular topics such as cardiopulmonary arrest, acute coronary syndromes, hypertensive emergencies, and venous thromboembolism. Respiratory items covered include hypoxemic and hypercapnic failure and adult respiratory distress syndrome. Infectious disease issues covered include common intensive care unit infections and severe sepsis. Other chapters cover thermal disorders, acute renal failure, coagulation disorders, liver failure, endocrine emergencies, and toxicology. As would be anticipated from the outstanding sections on pulmonary physiology, the sections on management of hypoxemic and hypercapnic respiratory failure are excellent. The section on severe sepsis briefly includes information on source control, goal-directed therapy, tight glucose control, and steroid therapy.

The appendix contains several useful tables, including conversion factors, important formulae, fluid composition, and temperature correction for arterial blood gases. Also included with the text are reference cards on medications commonly used in the intensive care unit.

Limitations to this text are few and far between. There are rare editorial errors in the text consisting of an occasional duplication or omission of a word and a few typographical errors that did not interfere significantly with the clarity of the text. Table 6-2 seems to be misidentified. It lists a comparison of nasal and oropharyngeal airways but is identified in the text as listing relative indications for placement of these tubes. The suggested readings provided at the end of each chapter are predominantly recent review articles of outstanding quality. It may have been useful, however, to also include a list of landmark references specifically for the convenience of the targeted audience of fellowship-level trainees. This is a minor shortcoming because these references would be easily available from the review articles cited. There was a reference included on the use of activated factor VII in both the chapter on transfusion and blood component therapy and the chapter on clotting, bleeding, and coagulation disorders, but no mention of the use of factor VIIa could be found in the text. Anesthesiologists may be surprised by a comment in the section on analgesia and sedation indicating a trend in increased usage of droperidol in the intensive care unit, especially in light of the now well-known Food and Drug Administration “black box” warning. For anesthesiologists and surgeons, the book is more focused on medical intensive care unit populations and does not provide detailed information on concerns for the postoperative surgical patient or for particular acute problems associated with specific surgical procedures. For example, the more limited utility of human recombinant activated protein c in postsurgical patients is not discussed.

Overall, this text serves as an excellent overview of critical care medicine. It meets the goal of being extremely readable and, indeed, enjoyable, while developing sound fundamental principles of practice. It is overwhelmingly clinically oriented and user friendly. Although the stated target audience of this book is advanced residents and fellows, many active practitioners and students of critical care medicine, including physicians, advanced practice nurses, physician’s assistants, medical students, and critical care nurses, will find the information approachable and immediately useful.

*Johns Hopkins University School of Medicine, Baltimore, Maryland.