Principles of Critical Care 4th Edition

Few fields in medicine have blossomed as dramatically as critical care. When we published the first edition of Principles of Critical Care in 1992, the critically ill were treated based largely on knowledge of pathophysiology, often derived from whole animal models. The evidence base for treatment was sparse and, with few exceptions, large, well-conducted clinical trials were lacking. What a change the past two decades have brought! The nature of critical illness is far better understood at molecular, cellular, organ, whole patient, and population levels. Diagnostic and monitoring tools, such as point-of-care ultrasound, stroke volume estimating equipment, and biomarkers, have altered the way we examine our patients. New drugs and devices have been devised, tested, and applied. Large clinical trials now inform a broad range of treatments, including those for respiratory failure, septic shock, acute kidney injury, raised intracranial pressure, and anemia of critical illness. Protocols and bundles aid, and sometimes frustrate, our provision of care. The modern intensivist must both master a complex science of pathophysiology and be intimately familiar with an increasingly specialized literature. No longer can critical care be considered the cobbling together of cardiology, nephrology, trauma surgery, gastroenterology, and other organ-based fields of medicine. In the 21st century, the specialty of critical care has truly come of age. Why have a textbook at all in the modern era? Whether at home, in the office, or on the road, we can access electronically our patients’ vital signs, radiographs, and test results; at the click of a mouse, we can peruse the literature of the world; consulting experts beyond our own institutions is facilitated through email, listserves, and Web-based discussion groups. To guarantee that this text remains useful in its electronic and print versions, we have challenged our expert contributors to deal with controversy, yet provide explicit guidance to our readers. Experts can evaluate new information in the context of their reason and experience to develop balanced recommendations for the general intensivist who may have neither the time nor inclination to do it all himself. A definitive text should both explicate the common mechanisms that transcend all critical illness and provide an in-depth, specific discussion of important procedures and diseases. The exceptional response to the first three editions of Principles of Critical Care showed us that we have succeeded. In this fourth edition, we have added new chapters on ICU Ultrasound, Extracorporeal Membrane Oxygenation, ICU-Acquired Weakness, Abdominal Compartment Syndrome, and Judging the Adequacy of Intravascular Volume, among others. The changing nature of modern critical care spawned new or completely revised chapters regarding Preventive Bundles, Informatics, Statistics, Rapid Response Teams, Physical Therapy, and more. In addition, we recognize that critical illness stresses entire systems, not just individual patients, so we have created new contributions on caregiver and family issues and on the implications of disordered sleep for the critically ill. We have collected up front many of the issues of organization that provide the foundation for excellent critical care as well as topics germane to almost any critically ill patient. The remainder of the text follows an organ system orientation for in-depth, up-to-date descriptions of the unique presentation, differential diagnosis, and management of specific critical illnesses. While we have made many changes, we have preserved the strengths of the first three editions: a solid grounding in pathophysiology, appropriate skepticism based in scholarly review of the literature, and user-friendly chapters beginning with “Key Points.”

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