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The interrelated syndromes of shock and the adult respiratory distress to attract the attention of both clinical and syndrome (ARDS) continue laboratory scientists. This reflects both the size of the problem and its unresponsiveness to current lines of treatment. Doubtless, a greater appreciation of the underlying pathophysiological disturbances during the past two decades has led to appropriate action and increased survival in the early stages but once established these syndromes have remained remarkably immune to a wide spectrum of therapeutic modalities. This observation stresses the importance of prevention but also indicates the need for continued research into the nature of the established syndromes and the means whereby they may be reversed. Drs Kox and Bihari are to be congratulated on bringing together within the covers of this volume many of the acknowledged European experts in these two fields of investigation. Each author has provided an up-to-date account of his current experimental and clinical research, and their com­ bined contributions makes fascinating reading. Undoubtedly, these are exciting times in the development of understanding of shock and ARDS. Inevitably, more questions are raised than answers provided, but the accumulated knowledge presented here adds significantly to our under­ standing of this complex biological jigsaw. From this corporate endeavour will come the clinically useful developments of the future and with them the ultimate hope that the term'refractory'shock may be finally removed from our vocabulary.

In theory, treatment decisions and assessments of response to therapy in critically ill patients should usually be based on measures of physiological function. Nevertheless, the most appropriate use of the information embodied in such measures is often unclear, and rarely supported by prospective clinical trials. In reality, the bedside clinician is therefore forced to rely primarily on physiological principles when deciding upon the best treatment. Unfortunately, however, the necessary knowledge base of the clinician is often less than optimal for the purpose, and habit or prior training may be more influential than science. Against this background, this second, revised edition of Applied Physiology in Intensive Care Medicine aims to help overcome the fundamental unevenness in clinicians'understanding of applied physiology. It is divided into three sections. The first comprises a series of'physiological notes'that concisely and clearly capture the essence of the physiological perspectives underpinning our understanding of disease and response to therapy. The second section contains more detailed associated reviews on measurement techniques and physiological processes, while the third provides a number of seminal studies on diverse topics in intensive care. This up-to-date compendium of practical bedside knowledge essential to the effective delivery of acute care medicine has been written by some of the most renowned experts in the field. It will serve the clinician as an invaluable reference source on key issues regularly confronted in everyday practice.