Case Studies in Pediatric Critical Care. Edited by Peter J. Murray, M.B., Ch.B., D.A., F.R.C.A., Stephen C. Marriage, F.R.C.P., and Peter J. Davis, M.D., F.A.A.P. Cambridge, United Kingdom, Cambridge University Press, 2009. Pages: 335. Price: $70.00.
As the old saying goes, “there is no substitute for experience.” This is certainly true in the specialized field of pediatric critical care, where the clinical reasoning and management skills characteristic of an expert intensivist are the product of extensive experience overlaid on a strong grounding in physiology, pharmacology, and evidence-based medicine. Case Studies in Pediatric Critical Care , with its concise, practically oriented chapters, provides the intensivist-in-training (or practicing intensivist) with expert insight into the diagnosis and management of a variety of important problems in pediatric critical care.
Each of the book's 27 chapters, written by an international group of experts, leads with a brief introduction, followed by a case history detailing the presentation, symptomatology, results of investigations, decision-making approaches, and management of the patient in the intensive care unit and beyond. The case mix strikes a good balance between pathologies that are common (e.g. , respiratory syncytial virus bronchiolitis, diabetic ketoacidosis, and sepsis in the bone marrow transplant recipient) and unusual (e.g. , dengue hemorrhagic fever, management of the patient with a failing Fontan repair, and refractory narrow complex tachycardia in infancy). Each case presentation is followed by a discussion of the approach to workup and management (which includes perioperative considerations for surgical cases), a brief conclusion, a list of essential learning points, and key references.
What distinguishes this book is its reader-friendly format and a consistent emphasis on imparting practical knowledge in the context of examples and evidence. Because the authors clearly explain the rationale for their management decisions (e.g. , for transfusion, choice of ventilator settings, or the decision to institute and later withdraw extracorporeal membrane oxygenation), each case history creates a memorable, vivid example to help guide the reader's own decision-making. The discussion sections bolster this framework for decision-making with epidemiologic data, information about prognostic factors, and succinct summaries of recent evidence. Another unique feature of this book is the longitudinal perspective imparted by following the course of each critically ill child from intensive care unit admission through discharge, and sometimes for several months thereafter. This perspective provides a more realistic view of the “highs and lows” that often characterize the course of recovery from critical illness.
One suggestion for the next edition would be to present the cases in a logical progression, perhaps organized by primary organ system dysfunction (e.g. , the five cases involving management of patients with congenital heart disease might be grouped together), with greater coordination of content across chapters. Another suggestion would be to minimize the overlap between cases, such as that in Chapter 11, “Critical Care for a Child with 80% Burns,” and that in Chapter 23, “The Child with Thermal Injury and Smoke Inhalation,” by consolidating information relevant to both cases in an appendix or in a shared introductory section. Similarly, some repetition of topics and tables presented in both Chapter 5, “Child with a Head Injury,” and Chapter 24, “A Child with Multiple Trauma,” could be eliminated. Overall, the book makes excellent use of figures and tables, but several chapters could benefit from greater use of graphics to highlight salient aspects of the case, pathophysiology, workup, and management. Finally, the scope of each chapter could be more uniform because the discussion sections (most of which run approximately 5 pages) range from 3 to 14 pages. These relatively minor suggestions do not significantly diminish the overall quality of the book.
Overall, this text offers the reader a strong framework for approaching the complex diagnostic, therapeutic, and even ethical challenges in pediatric critical care. It is refreshing to read a text that is so accessible and so deftly addresses the technical and humanistic challenges of caring for critically ill children. Case Studies in Pediatric Critical Care is an excellent resource for the intensivist-in-training, as well as for the fully trained practitioner interested in viewing the management of important intensive care unit problems from the vantage point of well-constructed case studies.
*Massachusetts General Hospital, Boston, Massachusetts. ebittner@partners.org
