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Critical Care: Principles and Practice of Intensive Care Monitoring

Critical Care: Principles and Practice of Intensive Care Monitoring When I was a resident in internal medicine, I remember very clearly being taught by my mentor the salient and practical measurements and monitoring tools by which to manage patients on mechanical ventilation. After committing the data to memory and then reading the original manuscripts from which the advice had been generated, I soon realized that many of the discoveries had been provided by the work of Martin Tobin. Dr Tobin is the editor of a new textbook entitled Principles and Practice of Intensive Care Monitoring. Many people in the critical care community feel that this is a book whose "time has come." Dr Tobin's earlier textbook,Principles and Practice of Mechanical Ventilation, already serves as an excellent reference for physicians who manage patients on mechanical ventilators. This new book on monitoring in the intensive care unit (ICU) is the perfect complement to the one on mechanical ventilation. When one considers that patient care in the ICU nearly always involves either mechanical ventilation or some sort of monitoring device, then one understands Dr Tobin's approach to these two textbooks. The editor is extremely well qualified to organize and lend expertise to all who manage patients in the ICU. He has authored more than 125 peer-reviewed publications, organized international investigations, contributed importantly to the American Thoracic Society's (ATS) Critical Care Assembly, as well as its Web site and on line journal club (http://www.thoracic.org), and recently been named the editor-in-chief of the American Journal of Respiratory and Critical Care Medicine. This textbook was a massive undertaking. One hundred and thirty authors from all over the world wrote its 87 chapters. There are more than 9000 references, 950 figures, and nearly 400 tables in the book. Despite this comprehensiveness and magnitude, it has the virtue of easy readability. I was able to navigate quickly and painlessly to answers regarding many frequently asked questions in the ICU. In fact, to test the usefulness and usability of the book in the trenches, I gave it to a group of house officers and medical students for one month in the Vanderbilt ICU. The medical students read it daily and wrote notes concerning different topics, which I will incorporate below. In general, they loved the book. The residents used it in daily practice and also thought it was very helpful. A few commented that, while some overlap did exist among chapters, this was inevitable and actually added strength because the authors expressed differences of opinions in controversial areas. There is no way to give an idea of the breadth and nature of the chapters in this textbook without listing some of its specific subjects. An introductory section on general principles of monitoring includes information related to clinical decision making and cost issues. The next section, on respiratory monitoring, has 25 chapters, including arterial blood gas analysis, pulse oximetry, mixed venous oxygenation, gut mucosal pH monitoring, capnometry, control of breathing, monitoring of respiratory mechanics and ventilation, and patient-ventilator interactions. In the third section, on cardiovascular monitoring, there are nine (count ‘em) chapters on various aspects of pulmonary artery catheterization. This was perhaps the residents' favorite area of the book. They liked the excellent pictures of actual insertion techniques, guidelines for interpretation of hemodynamic profiles, and excellent troubleshooting tips for different misadventures that can occur while attempting to extract diagnostic information from and deliver optimal therapy with pulmonary artery catheters. In fact, the troubleshooting concept was one that Dr Tobin obviously emphasized, as these helpful sections are included in numerous chapters throughout the text. Cutting-edge issues, such as the concept of noninvasively monitoring cardiac output via the use of impedance and inductance, are included. In that chapter, the author describes the movement from inductance to impedance, including the data validating the use of impedance in hemodynamic monitoring. One of our fellows, Greg Martin, who is conducting research in this area, thought the author did a nice job of presenting the data in a way that even a naive reader would understand without getting lost in mathematical derivatives. As Dr Tobin states in the preface, however, technological advances are occurring so rapidly that some of the absolute latest devices were not included in this and other chapters. This is more of a reality than a criticism. The remaining five sections of the book extend its importance and round out its topics. These include neurologic monitoring and monitoring of many other organ systems, including renal, hepatic, endocrinologic, hematologic, and even neonatal monitoring. Computerization and neural networks, as well as ethical, legal, and safety issues, are also covered well. Standardizing an algorithmic approach to decision making in the ICU has been shown to be increasingly important in optimizing outcomes of our critically ill patients. Alan Morris, who has been a leader in this area of critical care medicine for the last two decades, covers these topics. The potential audience is vast. In preparing for this review, I have already subjected the book to the scrutiny of students, house officers, fellows, and attendings. As it passed with flying colors, I would feel comfortable highly recommending this textbook to all clinicians who care for ICU patients and rely on any form of monitoring in the course of this care. Interestingly, the changing demographics of our population and the continued use of the ICU to care for elders during times of critical illness have led to the speculation that a dramatic increase in the number of ICU physicians will be needed in the future. As this need is hopefully addressed, all of these health care professionals may benefit from the current and subsequent editions. As I said in the beginning, this is one book whose time has come. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Critical Care: Principles and Practice of Intensive Care Monitoring

JAMA , Volume 282 (15) – Oct 20, 1999

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Publisher
American Medical Association
Copyright
Copyright © 1999 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.282.15.1486-JBK1020-3-1
Publisher site
See Article on Publisher Site

Abstract

When I was a resident in internal medicine, I remember very clearly being taught by my mentor the salient and practical measurements and monitoring tools by which to manage patients on mechanical ventilation. After committing the data to memory and then reading the original manuscripts from which the advice had been generated, I soon realized that many of the discoveries had been provided by the work of Martin Tobin. Dr Tobin is the editor of a new textbook entitled Principles and Practice of Intensive Care Monitoring. Many people in the critical care community feel that this is a book whose "time has come." Dr Tobin's earlier textbook,Principles and Practice of Mechanical Ventilation, already serves as an excellent reference for physicians who manage patients on mechanical ventilators. This new book on monitoring in the intensive care unit (ICU) is the perfect complement to the one on mechanical ventilation. When one considers that patient care in the ICU nearly always involves either mechanical ventilation or some sort of monitoring device, then one understands Dr Tobin's approach to these two textbooks. The editor is extremely well qualified to organize and lend expertise to all who manage patients in the ICU. He has authored more than 125 peer-reviewed publications, organized international investigations, contributed importantly to the American Thoracic Society's (ATS) Critical Care Assembly, as well as its Web site and on line journal club (http://www.thoracic.org), and recently been named the editor-in-chief of the American Journal of Respiratory and Critical Care Medicine. This textbook was a massive undertaking. One hundred and thirty authors from all over the world wrote its 87 chapters. There are more than 9000 references, 950 figures, and nearly 400 tables in the book. Despite this comprehensiveness and magnitude, it has the virtue of easy readability. I was able to navigate quickly and painlessly to answers regarding many frequently asked questions in the ICU. In fact, to test the usefulness and usability of the book in the trenches, I gave it to a group of house officers and medical students for one month in the Vanderbilt ICU. The medical students read it daily and wrote notes concerning different topics, which I will incorporate below. In general, they loved the book. The residents used it in daily practice and also thought it was very helpful. A few commented that, while some overlap did exist among chapters, this was inevitable and actually added strength because the authors expressed differences of opinions in controversial areas. There is no way to give an idea of the breadth and nature of the chapters in this textbook without listing some of its specific subjects. An introductory section on general principles of monitoring includes information related to clinical decision making and cost issues. The next section, on respiratory monitoring, has 25 chapters, including arterial blood gas analysis, pulse oximetry, mixed venous oxygenation, gut mucosal pH monitoring, capnometry, control of breathing, monitoring of respiratory mechanics and ventilation, and patient-ventilator interactions. In the third section, on cardiovascular monitoring, there are nine (count ‘em) chapters on various aspects of pulmonary artery catheterization. This was perhaps the residents' favorite area of the book. They liked the excellent pictures of actual insertion techniques, guidelines for interpretation of hemodynamic profiles, and excellent troubleshooting tips for different misadventures that can occur while attempting to extract diagnostic information from and deliver optimal therapy with pulmonary artery catheters. In fact, the troubleshooting concept was one that Dr Tobin obviously emphasized, as these helpful sections are included in numerous chapters throughout the text. Cutting-edge issues, such as the concept of noninvasively monitoring cardiac output via the use of impedance and inductance, are included. In that chapter, the author describes the movement from inductance to impedance, including the data validating the use of impedance in hemodynamic monitoring. One of our fellows, Greg Martin, who is conducting research in this area, thought the author did a nice job of presenting the data in a way that even a naive reader would understand without getting lost in mathematical derivatives. As Dr Tobin states in the preface, however, technological advances are occurring so rapidly that some of the absolute latest devices were not included in this and other chapters. This is more of a reality than a criticism. The remaining five sections of the book extend its importance and round out its topics. These include neurologic monitoring and monitoring of many other organ systems, including renal, hepatic, endocrinologic, hematologic, and even neonatal monitoring. Computerization and neural networks, as well as ethical, legal, and safety issues, are also covered well. Standardizing an algorithmic approach to decision making in the ICU has been shown to be increasingly important in optimizing outcomes of our critically ill patients. Alan Morris, who has been a leader in this area of critical care medicine for the last two decades, covers these topics. The potential audience is vast. In preparing for this review, I have already subjected the book to the scrutiny of students, house officers, fellows, and attendings. As it passed with flying colors, I would feel comfortable highly recommending this textbook to all clinicians who care for ICU patients and rely on any form of monitoring in the course of this care. Interestingly, the changing demographics of our population and the continued use of the ICU to care for elders during times of critical illness have led to the speculation that a dramatic increase in the number of ICU physicians will be needed in the future. As this need is hopefully addressed, all of these health care professionals may benefit from the current and subsequent editions. As I said in the beginning, this is one book whose time has come.

Journal

JAMAAmerican Medical Association

Published: Oct 20, 1999

There are no references for this article.