Pharmacology of the critically ill

Report

This book, with 16 authors from around the world, discusses how critically ill patients respond to some of the drugs they are given. Its aim is to give knowledge and understanding of the underlying principles of pharmacology as applied to the critically ill. The authors provide insight into why there may be differences between the expected response to a drug, or a class of drug, between critically ill patients and other types of patient.

The book is divided into 11 chapters covering different aspects of pharmacology as applied to critically ill patients. The first three chapters concern basic pharmacology, pharmacokinetics, pharmacodynamics and drug action. The next six chapters specifically address problems that may be encountered when failure of a specific organ system may be present, namely renal failure, hepatic failure, heart failure, gut failure, brain failure and respiratory failure. There is a chapter specifically concerning pharmacology in critically ill children. The final chapter gives excellent guidelines for safe prescribing in the critically ill. Each chapter is written by an expert (or experts) in their field. Gilbert Park and Maire Shelly have edited the book in such a way that it is comprehensive, understandable and logical to read.

Modern intensive care is often much more complex than providing support for failure of a single organ system. Thus, those of us who are engaged in the care of critically ill patients are increasingly called upon to have a comprehensive understanding of many different organ systems and of the pharmacology of treatment for failure of that organ system. Whereas in the past patients may have received a few drugs to support single organ failure, nowadays it is not uncommon for patients to be receiving more than 10 drugs simultaneously to support their various organ dysfunctions. This myriad of drug therapies requires not only a comprehensive knowledge of each drug and its actions, but also an appreciation of interactions and potential interactions, as well as of how these drugs may not perform as expected in the critically ill patient.

This book is clearly not intended for the trainee trying to pass their postgraduate examinations; they need a book that gives clear and concise information regarding what a drug will be expected to do in the normal patient. Rather, it is intended for specialists in critical care medicine who need to know what will happen when they use familiar drugs in an unfamiliar situation, or in patients who, by virtue of their critical illness, do not have a normal physiology. The editors make it clear that each chapter does not necessarily deal with every single situation that may occur with every single drug in the critically ill patient. The chapters describe the principles of changes in pharmacology with organ failure, and although each chapter has many examples these are intended to illustrate concepts rather than to provide comprehensive regimens.

I like this book. It is some years since Gilbert Park wrote a similar book [1] and much has changed. New research has led to a much better understanding of many of the problems. New drugs have brought with them a whole host of new problems. This book addresses both. It is clearly intended for the practising intensivist and it meets the needs of the intended audiences well. I learned a lot of new information that I will be able to use in my daily work, and I hope that other readers will too.

Book details

Gilbert Park, Maire Shelly (Eds): Pharmacology of the Critically Ill:Fundamentals of Anaesthesia and Acute Medicine. Series editors Jones RM, Aitkenhead AR, Foex P. London: BMJ Books; 2001. 189 pp. ISBN 0-7279-1221-6 (Pbk)