Intensive Care Medicine, 4th edition. Volumes I and II . By Richard S. Irwin, Frank B. Cerra, James M. Rippe. Philadelphia, Lippincott–Raven, 1999. Pages: 2,520. Price: $239.00.

This textbook is the fourth edition of one of the well-known reference publications in the specialty of intensive care medicine. The two volumes are divided into 24 sections that contain material from more than 300 contributors, most of whom live in Boston and the surrounding area. We may conclude that the intention of the editors was not to produce an international book or to represent several different schools of critical care medicine, but rather to focus on a North American, more specifically an East coast, point of view. It is this reviewer's opinion that this is an advantage for the book because it would have been much more difficult to produce such a well-unified text had there been several contributors from around the world representing completely different schools of critical care medicine. Generally speaking, such an international grouping of contributors often leads to the chance that contradictory statements will exist between the texts of the various authors, and this usually only confuses the reader. Therefore, the editors’ choice to have contributors who practice in one geographic area actually makes this book rather exemplary in its format. Although there are some chapters that clearly do refer to local psychologic, moral, and cultural attitudes, these chapters do have some value for international readers despite the fact that most non-US readers will have to refer to other books that take into account their own local aspects of these problems. Fortunately, most of these chapters are located in the last two sections of volume II.

In the judgment of this reviewer, whose mother language is not American English, the text is written in a way that makes it easy to read and understand. The segmentation of the chapters into subchapters is done logically. The font size is relatively small but still acceptable. No special features from a didactic or layout point of view are used. Everything is black and white, and highlighted texts are used to identify important information. This rather conservative way of presentation is more suitable for a standard textbook that is mainly used only as reference guide for a quick read about one specific problem. If you intend to read more than 10 pages of this book in one sitting, you had better have a lot of enthusiasm and concentration. There are a fair amount of figures used to supplement the text, most of which are not superb but are presented with an acceptable standard of quality. However, a couple of them are clearly below today's reproductive quality, e.g. , figure 48-1 on page 529 and figure 38-1 on page 379. Overall, there is no question that the book would have profited from a few more illustrations of slightly better quality. The same is true for the tables. The quality is fair, but no special attempt was made to make them more interesting to catch the reader's attention.

These statements regarding the presentation fortunately do not reflect the contents; they simply say that the presentation of the contents does not help make reading interesting and definitely does not increase one's hunger for more reading than is absolutely necessary to cover a particular subject at any one time. However, the professional content of the various chapters is good and complete, although I must admit that I could not read the entire book from cover to cover before writing this review. Nonetheless, my overall impression of the book is that the reader will be able to find a reasonable answer to many questions that may arise during daily practice in an adult medical, surgical, or mixed intensive care unit. In addition, there is an extensive reference list that is available at the end of each chapter that can help to identify sources of more specific information for those who would like to know more about a particular subject. However, because this fourth edition of the book was published in 1999, one can expect to find that most references are only current up to 1996 and, in a few instances, to 1997.

In conclusion, I recommend buying this textbook to use as a standard intensive care medicine resource. It will serve as a ready reference for more experienced intensivists who search for explanations of specific problems that one can encounter in daily practice, as a pathophysiologic clarification, and as a good source of references. When compared with other books of the same type, I think it is one of the best. However, I believe that it is not the best book for first-year residents in critical care medicine who are looking for a text that will give them a good overview of the important problems related to this specialty. I suggest that they consider another more concise book that gives a basic overview of intensive care and that has a modern approach to presentation and didactic methods. However, if after having read such a book they are still willing to continue their medical education in critical care, choosing this book as a comprehensive reference would be a good investment.