Reviews of Educational Material  |   December 2009
International Anesthesiology Clinics. Critical Care: Current Challenges and Future Directions.
Author Notes
  • Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Article Information
Reviews of Educational Material / Critical Care
Reviews of Educational Material   |   December 2009
International Anesthesiology Clinics. Critical Care: Current Challenges and Future Directions.
Anesthesiology 12 2009, Vol.111, 1393-1394. doi:
Anesthesiology 12 2009, Vol.111, 1393-1394. doi:
International Anesthesiology Clinics. Critical Care: Current Challenges and Future Directions.  Edited by Sherif Afifi, M.D., F.C.C.M., F.C.C.P., Hagerstown, Maryland, Lippincott Williams & Wilkins, 2009. Pages: 173. Price: annual subscription rate (individual), $331.00; single copy rate, $149.00.
As a critical care practitioner, I am always looking for a resource that can give me that quick yearly update and review but also leave me satisfied at the end, without that guilty feeling that I just read the “Cliff Notes” of critical care. Finding such a review in International Anesthesiology Clinics  was a pleasant and refreshing surprise. Dr. Afifi, the volume’s editor, chose the subject matter well and was not afraid to incorporate controversial areas within our discipline, such as renal replacement therapy, Acute Spinal Cord Injury, corticosteroids, glucose Control, and the emerging area of telemedicine-Intensive Care Unit (ICU). Important areas that should be covered in a year-in-review course (and if I could design one) are also included in this volume and complete this concise annual review of critical care: cardiopulmonary resuscitation and advanced cardiac life support, trauma, sepsis, adult respiratory distress syndrome, and nutrition (evidence-based).
Edited by Dr. Afifi, Division Chief of Anesthesiology and Critical Care at Northwestern University, and his department was well represented in the Contributing Authors section. As were other academic institutions, including the University of Florida (Tampa), Yale University, the Cleveland Clinic, and the University of Kentucky. The target audience for this resource is mentioned in the preface as “all who are involved in the care of the critically ill patients.” Agreeably, I believe they hit their mark with this resource.
The cardiopulmonary resuscitation section was a good way to ease into subject matter deserving of an annual review. It seems that how we used to treat a patient in cardiac arrest may sometimes produce worse outcomes, as new evidence-based studies become available. A recent example of our unintentional harmful practice is hyperventilation with long compression breaks while checking for a rhythm (and allowing the intern to gain central access). This is illustrated nicely with a concise reiteration of the updates. This chapter ends with discussion of hypothermia after cardiac arrest and rapid response teams.
The section renal replacement therapy is concise but packed full of information that includes epidemiology of acute kidney injury and the Risk, Injury, Failure, Loss and End-stage kidney disease classification defining three grades of severity and two outcome classes. The chapter then gives a nice synopsis of the various modalities of renal replacement therapy that have been used. This chapter appropriately ends with a discussion of timing and prognosis.
The Trauma chapter is not just a rehash of Advanced Trauma Life Support. Along with a discussion of epidemiology and the initial assessment of trauma patients, the discussion highlights important, new areas in the treatment of trauma patients. Resuscitation, including a discussion of factor VIIa, Damage Control, End Points of Resuscitation, management of Closed Head Injury, Abdominal Compartment Syndrome, and management of Complex Pelvic Fractures round out this high-yield chapter.
The “Acute Spinal Cord Injury” chapter begins with the appropriate classification and initial resuscitation, and fortunately the authors are not afraid to discuss controversial pharmacologic management strategies, including corticosteroids, gangliosides, and opioid antagonists. A distinct section on Functional Electrical Stimulation is also presented. Hypothermia, ventilatory support, and hemodynamic management are also presented in a separate Intensive Care section. The available evidence for surgical decompression is also presented concisely.
The corticosteroid section is an excellent review and presents the controversies associated with diagnosis and treatment. It is a well-written chapter and all-encompassing, but I did not see mention of the corticosteroid therapy of septic shock study group2 study, which has thrown a wrench into the bottle of hydrocortisone over the past year. Perhaps this chapter was submitted before the release. Fortunately, it is mentioned in the “Management of Sepsis” section (the chapter just before). And I appreciated the important table from the Goodman & Gilman  text1 that shows the various potencies of the different steroid compounds.
The “Adult Respiratory Distress Syndrome” chapter presents the proverbial protective lung strategy, and it also mentions the recent trials with high positive end-expiratory pressure and fluid management. Pharmacologic management is presented at the end of the chapter, along with the discussion of inhaled nitric oxide (which is also discussed in the subsequent Pulmonary Hypertension and Right Ventricular Function chapter). There is also a discussion that presents the available evidence for the administration and timing of steroids and surfactant in this ICU-centric disease.
The nutrition chapter is an excellent review for those needing to take the written board examination, because it describes the Harris-Benedict equation, timing of nutrition, and disease-specific formulations of support (which is big business). With my practice population, I found it helpful that a separate discussion on nutritional support of the Morbidly Obese ICU patient was included, because this is not a patient demographic that will be going away soon.
This review ends with a description of telemedicine-ICU. Admittedly, this is an area of critical care with which I have had no interaction in my practice. I have had trouble envisioning the process of care in this environment. But I then read with interest the “Case” section, which was a sort of day in the life of an electronic-ICU physician. The description of a telemedicine-ICU patient interaction was eye-opening to say the least. The financial evidence that permits the continued dissemination of this new paradigm of critical care medicine is compelling. Organizational issues and barriers to implementation appropriately end the chapter.
I do recommend this review. Overall, it is concise and hits the important subject matter as could be presented at an annual review course for current practitioners (Aspen, Colorado, sounds like a nice venue for this one). Many of the chapters could also be helpful for a fellow in training and could be used as updated supplemental material just before the board examination. Unfortunately, I wasn’t able to read this one at altitude after a fresh snowfall, but reading it comfortably on my porch with the sun and summertime air wasn’t all that bad either.
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Brunton L, Parker K, Blumenthal D, Buxton I: Adrenocorticotropic Hormone, Adrenocortical Steroids and Their Synthetic Analogs, Goodman & Gilman’s Manual of Pharmacology and Therapeutics. New York, McGraw-Hill Professional, 2008, pp 1025–38Brunton, L Parker, K Blumenthal, D Buxton, I New York McGraw-Hill Professional
Sprung C, Annane D, Keh D, Moreno R. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358:111–24Sprung, C Annane, D Keh, D Moreno, R