Critical Care of Infants and Children. Edited by I. David Todres, M.D. and John H Fugate, M.D. Boston, Little, Brown and Company, 1996. Pages: 752. Price:$99.00.

This review must open with a pair of disclaimers! First, I am a long-time friend one of the editors, David Todres. Second, although indirect concerned and certainly very interested, I have not been directly responsible for the care of children in the pediatric intensive care unit (PICU) for many years. To compensate for my own lack of current credentials in hands-on PICU work, I had sections of the book examined by members of our cardiothoracic PICU attending staff, Drs. Keith Kocis and Margaret Schwartz, and by one of our PICU fellows, Dr. Niurka Rivero.

The earliest pediatric intensive care units were established as a result of the pioneering efforts of pediatric anesthesiologists, such as Jack Downes in Philadelphia and Alan Conn in Toronto. Since those early days, the staffing of the PICU has changed and a new subspecialist, the pediatric intensivist, has emerged. David Todres is one of the few trained anesthesiologists who were in at the start and have survived these years of increasing specialization in the PICU. This is significant because the editors bring to this book the practical down-to-earth yet comprehensive approach that might be expected from an anesthesiologist/intensivist.

In 752 pages Drs. Todres and Fugate have assembled, the work of 88 contributors from 17 of the United States and one foreign country (Israel). The contributors are drawn from those who work every day in the PICU, many of them having trained with Dr. Todres. The book has a practical direct approach and is well illustrated with line drawings, photographs, algorithms, tables, and charts. The style between chapters is uniform, despite the many authors.

The initial chapters describe cardiopulmonary resuscitation; trauma care; transportation; basic airway and vascular access techniques; and pulmonary, cardiac, and renal procedures. These subjects are covered in a basic practical manner, clearly illustrated, and enhance the value of the book, especially for the beginner in pediatric critical care. The subsequent chapters are organized to discuss pediatric critical care by body system, and there are additional chapters describing surgically related conditions, the chronically ill child, and ethical and organizational issues. The book is concise, direct, and practical and provides a solid foundation of important background knowledge on which the reader can build by using the comprehensive and current bibliography. The sections on the respiratory, cardiovascular, and renal systems are particularly strong and will be useful not only to intensivists but also to many other physicians, including the pediatric anesthesiologist.

The knowledge base that may be expected of the pediatric intensivist today is very extensive; no single book could possibly cover every detail of the specialty. Thus the informed reader may become frustrated that some subjects within the book must be dealt with in a somewhat superficial manner. Some sections of this book are indeed more superficial, such as Antimicrobial Treatment of Sepsis and Critical Upper Airway Obstruction. However, in such instances the basic essentials are well documented, and there is ample direction to further reading. The chapter on poisonings could be more comprehensive and include some of the less common but quite challenging situations, such as organophosphate or hydrocarbon ingestions. The difficult topics-ethical aspects, communication with families, and psychiatric aspects of pediatric intensive care-are well handled in a sensible and concise manner.

I recommend this book as an excellent resource for those training in a PICU fellowship program, and also for pediatric residents during their PICU rotation. Pediatricians attending in the PICU will find the book a source of useful data and references. Anesthesiologists with any extensive pediatric practice, especially those in tertiary care institutions, should look to this as a useful addition to their library. There is much useful information here that could be applied to pediatric perioperative care. I intend to keep my copy close by! The cost at $99 is considered reasonable for a book that will become the corner-stone of PICU training for many physicians.

David J. Steward, M.B., F.R.C.P.C.

Director of Anesthesiology; Childrens Hospital of Los Angeles; Professor of Anesthesiology; University of Southern California; 4650 Sunset Boulevard; Los Angeles, California 90027