Book Review

Handbook of Pediatric Intensive Care

N Engl J Med 1996; 334:275-276January 25, 1996

Article

Handbook of Pediatric Intensive Care
Second edition. Edited by Mark C. Rogers and Mark A. Helfaer. 873 pp., illustrated. Baltimore, Williams and Wilkins, 1995. $59. ISBN: 0-683-07326-5

In caring for critically ill children, the demands on one's time are great, and there is often little time left for reading. Although there are a number of excellent, comprehensive books on pediatric critical care that must be read by those in the field, there is a need for a bedside manual or guide that can be rapidly consulted for sound treatment strategies based on solid pathophysiologic information. This is the best such book on pediatric intensive care.

This second edition contains more than 800 pages of useful, well-organized material and provides concise information on the pathophysiology, diagnosis, and treatment of disorders encountered in pediatric intensive care. The standard topics are covered: cardiopulmonary resuscitation, principles of airway management, respiratory diseases, neuromuscular diseases and respiratory failure, myocardial ischemia, pulmonary edema, cyanosis, management after cardiac surgery, dysrhythmias, shock, status epilepticus, infectious diseases (sepsis, meningitis, and infection with the human immunodeficiency virus), Reye's syndrome, near-drowning, brain death, dysfunction of specific organ systems (the gastrointestinal tract and kidneys), metabolic and endocrine disorders, poisoning, hematologic and oncologic disorders, multiple trauma and spinal cord injury, and burns and inhalational injury. There is little that is not covered.

Each chapter contains a brief, well-written discussion of the disease process in question. There is enough detail to understand the process but not so much that the reader gets bogged down. Practicality is stressed. What makes the chapters user-friendly are the informational boxes interspersed throughout the text. These boxes, which cover such topics as evaluation of the patient, diagnosis, therapy, complications, and dosages and side effects of medication, are the most practical aspect of the book. In addition, there are numerous tables and figures that summarize key facts and illustrate important concepts. All these features combined make the chapters readable, informative, and useful at the bedside.

Each chapter is excellent, which is not always the case with a multiauthored book. The discussions of bread-and-butter issues — sedation, airway management, status epilepticus, respiratory failure, and shock — are all quite good, and these pages will undoubtedly become the most worn. Reye's syndrome is discussed in enough detail that although cases are less common now than in the past, one will have a ready and rational starting point for the diagnosis and management of this disorder. Increasingly, physicians will be dealing with the special needs of critically ill children with the acquired immunodeficiency syndrome, and this topic is covered well. The appendix contains a helpful compendium of relevant formulas plus a detailed formulary, which includes drug dosages, pharmacokinetic data, pharmacotherapeutic data, metabolic information, side effects, and other important pharmacologic information.

References are not provided for the text, only for some of the tables and figures. Some readers may find this omission objectionable, but I found that it streamlined the text.

This handbook is useful in at least two ways. First, it can serve as a mini-textbook on pediatric intensive care. It is not meant to be a substitute for any of the major works in the field, but it does provide enough information for the reader to gain more than a superficial understanding of the disease process in question. The busy medical student and house officer would be far better served by reading this entire book during a month's rotation than by wading through a few pages of detailed pathophysiology and basic science in a large textbook. Second, the book can be used to obtain information rapidly on diagnosis and therapy in order to guide one's clinical decision making in a specific case. This is the book's real purpose, which it fulfills well.

Any physician involved in any aspect of the care of critically ill children — whether in the emergency room, in transport, or in the intensive care unit — should have this book. The practicing pediatrician or family physician who leaves the care of a critically ill child to the intensive care physician would also do well to have this book. It will give the primary care physician a better understanding of how his or her patient is being treated and result in a more meaningful dialogue with the child's family. The most important beneficiaries of this book, of course, are the critically ill children whose care will be improved because of the efforts of the authors.

A final note to all physicians caring for children: two of the biggest mistakes one can ever make in caring for sick children may occur before a child reaches an intensive care unit — the failure to recognize the early signs of shock and the failure to recognize deteriorating respiratory status. This book will help physicians address these issues, and many others, very well.

Jonathan D.K. Trager, M.D.
New York Hospital, New York, NY 10021