Book Review

Pathophysiologic Foundations of Critical Care

N Engl J Med 1993; 329:1663-1664November 25, 1993

Article

Pathophysiologic Foundations of Critical Care
Edited by Michael R. Pinsky and Jean-Francois Dhainaut. 975 pp., illustrated. Baltimore, Williams and Wilkins, 1993. $115. ISBN: 0-683-06888-1

This book on critical care medicine is approximately half the size of some other recently published works on the topic. It does not provide an encyclopedic listing of disease states, treatments, or procedures. The intent of the editors is revealed in their title and stated in their preface: “We did not wish to catalog disease processes and therapies, but to describe the pathophysiological processes that underlie these disease states and the principles of management that reflect an understanding of these processes.” Did the editors succeed in their intent? Yes and no.

The book is divided into sections according to organ system. The best chapters first summarize the pertinent physiology before describing the pathophysiology of specific illnesses, the diagnosis of these illnesses, and their treatment. With this format, the authors are able to introduce and expand on some relatively new concepts in critical care medicine, including oxygen-supply dependency, selective bowel decontamination, lusitropy, dynamic hyperinflation, and the polyneuropathy of critical care illness. However, the chapters are not uniform in format and quality, and the book is not balanced in its treatment of subject matter. No less than five chapters are focused on the concept of oxygen-supply dependency, whereas subjects conspicuously underrepresented are liver disease and liver failure, thromboembolism, burns, poisoning, drug overdose, and neuropsychiatric disorders and coma.

The international contributions (78 authors from nine countries) provide some diversity of opinion and practice style, which I found stimulating. The writing is equally lucid regardless of the authors' origins. The tables are numerous and helpful in summarizing discussions, and the chapters are well referenced. However, many chapters contain redundant information. The six chapters on renal disease could have been more efficiently condensed into three at most.

Pathophysiologic Foundations of Critical Care is at its finest when its authors, realizing the intent of its editors, felt at liberty to write on such topics as the reductionist scientific method (based on Newtonian and Cartesian philosophy) as an explanation of our practice patterns or on the mechanisms of tissue injury and cell death. As I read, I became more convinced that this book is a needed addition to the libraries of those for whom intensive care medicine is a major interest. Workers in the field of critical care should welcome this attempt to provide a scientific basis for our way of practice. Future editions would be improved by a uniformity of format and quality, a balance in the treatment of subjects, and additional chapters dedicated to the disciplines of immunology, transplantation, and applied pharmacokinetics.

David J. Plevak, M.D.
Mayo Clinic, Rochester, MN 55905