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A useful tool for trainees in intensive care

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Bersten AD, Soni N (Eds): Oh’s Intensive Care Manual, 5th edition. Edinburgh: Butterworth-Heinemann; 2003. 1175 pp. ISBN 0750651849

This manual is already in its 5th edition. This 1200-page intensive care manual covers most of the field of intensive care practice, including organizational aspects and pediatric intensive care. Most of the contributors originate from Australia, the UK, and Hong Kong, and have a large experience in clinical practice, research, and teaching in intensive care. This manual lies somewhere between a handbook and a textbook, with the size of a textbook and the practical presentation and conciseness of a handbook. This format is somewhat regrettable because on the one hand the book is clearly too large to be stored in the pocket but on the other hand it is not exhaustive either. Given the information presented, this book is clearly intended for physicians in training in intensive care; a more experienced audience would rather read a more in-depth intensive care medicine textbook. The principal merit of the book is that young physicians can rapidly find up-to-date practical information.

The book covers most aspects of intensive care practice, including a rapid description of the diseases that may be encountered in critically ill patients, the specifics of critically ill patients, and the therapeutic interventions and monitoring techniques that may be used. The quality of the different sections is quite heterogeneous. For example, the cardiovascular section covers the various etiologies and therapies of shock, hemodynamic monitoring, and multiple organ dysfunction. The chapter on hemodynamic monitoring is really outstanding. The information presented is not limited to the pulmonary artery catheter but also covers all the newer technologies. Transpulmonary thermodilution and its derived volumetric indices are discussed, as well as lithium dilution, esophageal Doppler and echocardiography. The limitations and advantages of each of these techniques are discussed and some decision trees are presented. Similarly, the chapter on monitoring oxygenation is very attractive. The physiological principles are briefly discussed and then the various techniques are amply discussed. Unfortunately other aspects are covered only superficially, such as causes and treatment of shock states, lactic acidosis, and multiple organ dysfunction.

The chapter on acute coronary care is also particularly interesting, discussing the new reperfusion strategies and the use of anti-aggregant agents. This chapter is highly illustrated with several decision trees. The chapter on arrhythmias is also richly illustrated and would be very useful in helping to manage such cases. Young trainees will find interesting information on the use of cardiac pacing and on post-operative care after cardiac surgery.

The section on respiratory care is also rather heterogeneous. The aspects of respiratory monitoring and thoracic imaging are the most interesting; the chapter on invasive mechanical ventilation is quite limited and the chapter on non-invasive mechanical ventilation is insufficient.

Sometimes the search for conciseness is detrimental to the information presented. For example, in the chapter covering renal replacement therapy, the various techniques are well described, but the practical and very important aspects of anticoagulation and drug prescription are covered very briefly so that the reader cannot even find sufficient information to manage patients undergoing continuous hemofiltration.

The book also includes several appendices. Even though the utility of some of these can be questioned, several are very useful, including physiological equations and several severity scores.

In summary, this manual may be useful for trainee intensive care physicians, with easy access to basic but up-to-date information on all aspects of modern intensive care medicine.

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Correspondence to Daniel De Backer.

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The author(s) declare that they have no competing interests.

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De Backer, D. A useful tool for trainees in intensive care. Crit Care 9, E13 (2004).

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