The Handbook of Critical Care Drug Therapy. By Gregory M. Susla, Henry Masur, Robert E. Cunnion, Anthony F. Suffredini, Frederick P. Ognibene, William D. Hoffman, James H. Shelhamer. Baltimore, Williams & Wilkins, 1998. Pages: 436. Price: $24.95.

Critical care is a multidisciplinary activity that encompasses all major organ systems and medical specialties. Staying current with the pharmacology used in critical care has become increasingly difficult because of the continued development of new drugs. This handbook was designed to be a readily available reference to provide the necessary information to select an appropriate drug and dosage for a specific situation. The book consists of 13 chapters (acute resuscitation; anesthesia; cardiovascular therapies; pulmonary therapies; renal, electrolyte, and acid-base disturbances; endocrine; gastroenterology; hematology; neurology and psychiatric therapeutics; infectious disease; allergy; poisonings; drug monitoring) and three appendices (intravenous medication administration guidelines; intravenous to oral conversions; oral drug doses). As can be seen by the chapter titles, the book discusses all areas of pharmacology relevant to critical care. Unfortunately, the book sometimes loses sight of its basic focus on drugs, so it lists tables that have little direct pharmacologic implications, such as tension pneumothorax, tamponade, tracheal intubation techniques, tumor lysis syndrome, nutrition, blood component therapy, and transfusion reactions. In addition, some of the tables appear to be relevant primarily to patients outside of the intensive care unit (ICU); the book may be particularly valuable for the new specialty of hospitalists.

The format of the book consists of tables of two types: one lists drugs and their indications and the other lists diseases and the available drugs. Because it is difficult to discuss drug therapy outside of the context of specific diseases, the complementary presentation of drugs in both types of tables is extremely useful. For example, one Table lists the available antiarrhythmic agents and a second Table providesa listing of drugs according to the specific arrhythmia. The major issue in critical care pharmacology frequently involves deciding the best choice among multiple available drugs. Unfortunately, the authors do not always prioritize the available drugs and frequently do not state whether the list is actually a prioritized list. For example, the table "Seizures: Urgent Management" provides what appears to be a prioritized list (thiamine, dextrose, diazepam, phenytoin, among others), but the table "Seizures: Maintenance Therapy" on the adjacent page lists 11 anticonvulsants in alphabetical order.

The tables frequently have extensive comments that are invaluable. For example, comments on adenosine therapy include the decrease in required dose when administered via a central venous catheter and the increased and decreased effects in patients receiving dipyridamole and theophylline, respectively. The multiple drugs and comments result in crowded tables, and the authors have chosen a type font (approximately size 8) that preserves readability while allowing tables to fit within the width of a single 4.5-inch page. The index is excellent, allowing the reader to find all references to a specific drug. However, because many drugs have more than 20 citations, a notation as to which pages focus on that particular drug would be a helpful addition.

The authors either are or have been associated with the Critical Care Medicine Department of the National Institutes of Health, Bethesda, Maryland. By their nature, handbooks tend to have an institutional bias and this is particularly common when multiple possible therapeutic alternatives exist. However, the authors appear to have provided a balanced presentation throughout the book (or else we share the same biases).

To determine the usefulness of the handbook, I carried it with me during my most recent ICU rotation. The book readily provided information for almost all drugs, and the list of drug doses and the adjustments for renal and hepatic dysfunction were valuable. The listing of drugs was comprehensive, with only some minor omissions (ethacrynic acid from the diuretic category; inclusion of tranexamic acid but not aprotinin for prevention or treatment of anticoagulation). For vancomycin-resistant Enterococcus the book not only listed approved drugs, but also provided the phone number to contact for the investigational drug Synercid (Rhone-Poulenc Rorer, Collegeville, PA). However, the book did not clearly differentiate among the available fluoroquinolones, even though the different agents have specific indications. Atrial fibrillation is the most common dysrhythmia in the ICU. The book provides a list of antiarrhythmic drugs and a separate page with a prioritized list for initial treatment and prevention of recurrence. For the management of hypertension, a common problem in the ICU, one Table listed available drugs, one Table listed drugs of choice in different settings, and two appendices discussed oral drugs. However, I was not convinced that the physician who did not already have an approach to the treatment of perioperative hypertension would be able to choose an initial drug and then convert to oral therapy on a subsequent day. Similar to many other textbooks, the handbook provides the standard tables regarding vasoactive therapy. Unfortunately hemodynamic treatment for septic shock, a leading cause of death in the ICU, was discussed in a single sentence, stating that the treatment is dopamine up to 20 [micro sign]g [middle dot] kg (-1) [middle dot] min-1followed by norepinephrine. Other agents such as epinephrine, dobutamine, phenylephrine, and milrinone were not mentioned in this section, nor was there discussion regarding the need to maintain cardiac output.

This second edition of the handbook is almost twice the length of the first edition. In general, the two editions discuss the identical topics and have many tables with no or only minor changes. The increased length of the second edition is a combination of the increased number of available drugs and the use of a larger type size and other formatting changes. A comparison of the two editions demonstrates the significant advances that have occurred in critical care pharmacology, and the second edition is extremely up-to-date.

In summary, this handbook succeeds in presenting a wealth of information regarding critical care pharmacology in a relatively inexpensive, compact format. It is equally useful on the reference shelf and in one's pocket.

Ronald G. Pearl, M.D.

Department of Anesthesiology; Stanford University School of Medicine; Stanford, California 94305

(Accepted for publication February 3, 1999.)