Book Review

Pediatric Critical Care: The essentials

N Engl J Med 2000; 342:1145-1146April 13, 2000

Article

Pediatric Critical Care: The essentials
Edited by Joseph D. Tobias. 465 pp., illustrated. Armonk, N.Y., Futura, 1999. $75. ISBN: 0-87993-428-X

This book is targeted to residents who need an introduction to the pediatric intensive care unit and to generalists who may have to care for an ill or injured child. The 21 chapters cover the essentials of critical care and, in general, are well written and informative. There are not as many illustrations as in many other textbooks, but this is not intended to be an inclusive guide to pediatric critical care.

The most comprehensive chapters are those describing airway management, shock, mechanical ventilation, acute respiratory distress syndrome, alternative methods of respiratory support, and nutrition. These chapters provide the essential information needed for the care of children. The discussion of the laryngeal-mask airway is excellent and is one of the most complete found in any textbook on critical care.

The weakest aspects of the book are the discussions of procedures and specific illness and injury. For example, there is no mention of the length-based method to calculate drug doses and equipment. The picture of a disposable carbon dioxide detector shows an adult-size, not a pediatric, detector. Although measurement of pulmonary-capillary wedge pressure is discussed at length, central venous access and intraosseous infusion are not. There is no discussion of bronchiolitis, a condition that fills hospitals and pediatric intensive care units each winter.

The discussion of asthma does not refer to the consensus guidelines of the National Heart, Lung, and Blood Institute (April 1997; NIH publication no. 97-4051), which provide practitioners with guidelines for treating the acute and chronic forms of this illness. The discussion of diabetic ketoacidosis is good and cautions against overzealous use of fluids; however, the controversy about sodium bicarbonate therapy, even with severe acidosis, is not mentioned. Although bolus injections of insulin are still used by some pediatricians for treatment of severe diabetic ketoacidosis and hyperglycemia and although they are recommended in this book, many diabetologists recommend the use of slow infusions of insulin, starting with 0.05 U per kilogram of body weight per hour, to be reevaluated after the first hour of therapy.

The only glaring error I found in this book was in the calculation of the “rule of sixes” for inotropic agents. Here the author suggests the addition of a specified amount of drug to 100 ml of fluid. This is contrary to the Pediatric Advanced Life Support guidelines of the American Heart Association (Guidelines for cardiopulmonary resuscitation and emergency cardiac care. VI. Pediatric advanced life support. JAMA 1992;268:2262-75), which suggest that the drug should be added to make 100 ml. In addition, one would rarely suggest an infusion of 1 ml per hour unless the patient's fluid intake needed to be severely restricted. In the chapter on blood products, there is no discussion of the replacement of specific factors for hemophilia. We have lost an entire generation of children with this illness to infection with the human immunodeficiency virus, and only now are we seeing a resurgence of life-threatening bleeding abnormalities in this population. Hemophilia has once again become an important topic, even for the novice.

In general, this textbook reaches its stated goals. It is concise and well written, and despite the few errors and omissions, it will be a useful addition to the libraries of general pediatricians and pediatric residents.

James S. Seidel, M.D., Ph.D.
Harbor–UCLA Medical Center, Torrance, CA 90509