Paediatric Intensive Care is a concise yet broad-based, fundamental resource for those encountering critically ill children. The book is well suited for its target readership, which is stated to include primary pediatricians, emergency-department staff, pediatric intensive-care trainees and consultants, anesthetists, nurses, and paramedics.
The editors “aimed to provide a comprehensive, practical guide to the care of the critically ill child, both on an intensive care unit and in other clinical areas…. It is a book to be picked up to find answers to specific problems and for guidance on how to manage specific issues.” The book does indeed fulfill these objectives exceptionally well.
Pediatric Intensive Care is partitioned into 4 sections, which proceed in a logical sequence: Introduction to Pediatric Intensive Care; Organ System Support and Related Practical Procedures; Specific Specialties; and Compassionate and Family Centered Care. An appendix and index are also included.
Section 1 provides an overview of the development of pediatric critical care as a specialty and describes its role in current medical practice. It includes sections on basic medical stabilization, principles and fundamentals of physiologic monitoring, and diagrams and descriptions of typical invasive procedures. The information is succinct, practical, and would be an easily reviewed format for upcoming certification examinations.
Section 2 is a thorough review of basic medical support, including airway and respiratory support, sedation and analgesia, issues encountered in general anesthesia, circulatory support, cardiac-bypass fundamentals, interpretation and correction methods for electrolyte imbalance, and basics of renal-replacement therapies and nutritional support. Each of these topics is presented with a brief discussion of the physiology, followed by either bullet-point or decision-tree formatted diagnostic and treatment plans. The section on medical transport includes practical information of high-altitude physiology and an infrequently approached subject: adverse events during transport. Again, the text is an excellent reference for specific questions (sodium correction, comparison of bypass circuits, how to manage peritoneal dialysis).
Section 3 provides more detail and current description of the major tertiary disciplines, including pulmonary medicine, congenital cardiac disease, gastroenterology and hepatology, nephrology, genetics and metabolism, hematology, trauma, and others. As an example, the chapter on congenital cardiac disease and postoperative management is a superb overview of typical structural lesions, accompanied by easily understood diagrams, followed by concise diagnostic and management recommendations. Somewhat novel chapters include those on neurocritical care, laboratory investigations of infectious disease, organ donation, and death and critical care in the developing world. Another helpful chapter provides a quick reference on neonates in the pediatric intensive care unit.
Section 4 includes helpful discussions of end-of-life care, consent and assent issues, and risk management.
The appendix includes helpful tables of normal values, age- and size-appropriate equipment standards, and resuscitation suggestions. The index easily refers the reader to appropriate sections.
The book is easily read, and has important text boxes with, for instance, differential diagnoses and comparison tables, which are set off with shaded background for easy scanning. The diagrams are uncluttered, clear, and well labeled. Unique about this text is that it includes unusual, difficult-to-find information from a wide variety of areas, including such things as calculation of the optimal number of intensive-care-unit beds, altitude effects on alveolar gas, and peritoneal dialysis solution content.
The authors are from the United Kingdom, so some aspects are not applicable in other countries. As examples, some of the medications (eg, paracetamol) and legal issues mentioned are of interest, but the reader may need to rely on regional sources for such information.
The text has a few shortcomings. There is no chapter on oncology, and no material on delirium and intensive-care-unit psychosis. The references (listed after each chapter) are limited but generally quite current. In general, an in-depth review of a subject, such as the role and regulation of inflammatory cytokines in the pathogenesis of sepsis, will not be found in this book, as this was not the stated intent in compiling it.
In summary, Paediatric Intensive Care is an excellent text for basic pathophysiology, diagnostic pathways, and management guidelines. It is well suited for its target audience and serves as a ready reference for urgent or difficult critical-care questions. It was the only critical-care text I brought on a medical outreach trip to China, and the Chinese physicians specifically asked for this book for future use. The rest of my medical team intends to purchase personal copies. No more enthusiastic or genuine endorsement of this text's quality can be found.
Footnotes
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The author has disclosed no conflicts of interest.
- Copyright © 2011 by Daedalus Enterprises Inc.
