Critical care is a high-stakes activity—both from outcome and cost perspectives. What should a young intensivist be taught? Our worlds of medical education and practice continue to change quickly. While electronic retrieval of patient information and scientific literature is of immeasurable help, electronically facilitated submission, peer review, and production methods have accelerated publication turnover. Pressures to shorten time in hospital and improve documentation tug the team toward the computer and away from the patient, placing strains on face-to-face communications among doctor, patient, family, and nurse. Because of mandated and pragmatic changes in practice, there has been a dramatic shift in care from a “one doctor-one patient” relationship to one in which there are frequent personnel changes. The chances for error in this new system are magnified. Simultaneously, older patients with chronic multisystem dysfunction and attendant complex problems account for a growing fraction of those admitted. While practicing on the cutting edge of intensive care medicine has always been challenging, there now seems more to know and too much to keep track of. We do not seem to be winning the race.
Another trend seems clear. In this exciting age of molecular medicine, mastery of bedside examination and physiology has been de-emphasized. Simultaneously, clinical research has shifted from exploration of problems confronted at the bedside to large population-based interventional trials. When well done (and we are getting better at them), these studies hold considerable value and often help decide initial “best practice” for many patients. Yet, clinical trials will never inform all decisions, and it is incumbent upon the practitioner to know when clinical research does not apply to the patient at hand and to recognize when the initial plan suggested by trial results needs modification. Physicians who apply “best practice” to the individual cannot rely only on protocols and the latest guidelines. Recommendations come into and drop out of favor, but physiologic principles and fundamentals of critical care change very little. Because problems are complex and treatment decisions interwoven, well-honed analytical skills are indispensable. Management must be guided by informed judgment, applying the best information presently known based on core physiological principles and patient response.
Cardiorespiratory physiology forms the logical base for interpreting vital observations and delivering effective critical care. Committed to short loop feedback and “mid-course” corrections, the intensivist should be aware of population-based studies but not enslaved to them. Likewise, it is important to realize that treatments that improve physiological endpoints do not always translate into improved patient outcomes and that failure of a patient to respond as expected to a given treatment does not invalidate that intervention for future patients. Add to these traits those of cost consciousness, empathy, and effective communication, and you are well positioned to deliver cost-effective care in our demanding practice environment.
Multiauthored books—even the best of them—have chapters of varying style and quality that are often lightly edited. We believe that a book intended for comprehension is best written with a single voice and purpose. After nearly 25 years and four editions working together, we feel free to comment freely, quibble, complain, and edit each other's work.
As in preceding editions, we have tried to extract what seem to be those grounding bits of knowledge that have shaped and reshaped our own approach to daily practice. We titled this book “The Essentials” when it was first written, but admit that our own tips and tricks—useful pearls that we think give insight to practice—have been sprinkled liberally throughout. We practice in widely separated hospitals and our research interests involve different types of problems and methods. This diversity helps keep perspective on what is “essential”—or at least interesting to know. This book was written to be read primarily for durable understanding; it is not intended for quick look up on-the-fly. It is not a book of quick facts, bullet points, check lists, options, or directions. It would be difficult to find a white coat pocket big enough to carry it along on rounds. Depth of treatment has not been surrendered in our attempt to be clear and concise.
The field of critical care and the authors, both once young, have now matured. Fortunately, we remain committed to caring for the sickest patients, discovering new ways to thwart disease, and passing on what we know to the next generation who eventually will care for us. Many principles guiding surgery and medicine are now time-tested and more or less interchangeable. For the fourth edition, we have streamlined the book's organization with this in mind. We have examined and updated the content of each chapter, added and changed illustrations, and in a few cases, discarded what no longer fits. Mostly, however, we fine-tuned and built upon a solid core. This really is no surprise—physiologically based principles endure. It is gratifying that most of what we wrote three editions ago still seems accurate—and never more relevant.
-- John J. Marini and Arthur P. Wheeler
Key Features
- Clear, simple line drawings illustrate concepts.
- Concise, easy to read chapters.
- Consistently written, with little redundancy.
- Covers all aspects of critical care.
- Strong on pathophysiologic basis of illness and treatment.
New to this edition
- NEW: Controversies in Critical Care boxes.
- NEW: Enhanced discussion of CT for abdominal disorders.
- NEW: Updated ACLS guidelines.
- NEW: New material on removable IVC filters.
- NEW: New material on interventional radiologic techniques for GI bleeding.
- NEW: New material on use of vascular ultrasound.
Contents
Section I: TECHNIQUES AND METHODS IN CRITICAL CARE
- 1: Hemodynamics
- 2: Hemodynamic Monitoring
- 3: Support of the Failing Circulation
- 4: Arrhythmias, Pacing, and Cardioversion
- 5: Respiratory Monitoring
- 6: Airway Intubation
- 7: Indications and Options for Mechanical Ventilation
- 8: Practical Problems and Complications of Mechanical Ventilation
- 9: Positive End-Expiratory and Continuous Positive Airway Pressure
- 10: Weaning and Discontinuation of Mechanical Ventilation
- 11: Intensive Care Unit Imaging
- 12: Acid-Base Disorders
- 13: Fluid and Electrolyte Disorders
- 14: Blood Conservation and Transfusion
- 15: Pharmacotherapy
- 16: Nutritional Assessment and Support
- 17: Analgesia, Sedation, and Therapeutic Paralysis
- 18: General Supportive Care
- 19: Quality Improvement and Cost Control
Section II: MEDICAL AND SURGICAL CRISES
- 20: Cardiopulmonary Arrest
- 21: Acute Coronary Syndromes
- 22: Hypertensive Emergencies
- 23: Venous Thromboembolism
- 24: Oxygenation Failure, ARDS, and Acute Lung Injury
- 25: Ventilatory Failure
- 26: ICU Infections
- 27: Severe Sepsis
- 28: Thermal Disorders
- 29: Acute Kidney Injury and Renal Replacement Therapy
- 30: Clotting and Bleeding Disorders and Anticoagulation Therapy
- 31: Hepatic Failure
- 32: Endocrine Emergencies
- 33: Drug Overdose and Poisoning
- 34: Neurological Emergencies
- 35: Chest Trauma
- 36: Acute Abdomen
- 37: Gastrointestinal Bleeding
- 38: Burns and Inhalational Injury
Appendix
About the Authors
- John J. Marini MD, Director of Physiological and Translational Research, HealthPartners Research Foundation; Professor of Medicine, University of Minnesota, Minneapolis/St. Paul, Minnesota (USA).
- Arthur P. Wheeler MD, Director, Medical Intensive Care Unit; Associate Professor of Medicine; Director, Vanderbilt Clinical Coordinating Center, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee (USA).
Product Details
- Paperback: 720 pages
- Publisher: Lippincott Williams & Wilkins; Fourth edition (2010)
- Language: English
- ISBN-10: 0781798396
- ISBN-13: 978-0781798396
- Product Dimensions: 9.9 x 7 x 1.1 inches
List Price: $79.00