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During the past decade there has been a considerable expansion in the understanding, assessment and treatment of critically ill patients. An attempt to portray our present knowledge of this diverse field in a comprehensive textbook is therefore a formidable and daunting undertaking. However, many colleagues in different disciplines and from different countries convinced us of the need for such a work and, greatly encouraged by their interest, we embarked upon the project. Any single text, even a very long one, cannot cover every aspect of critical illness. Our first task was, therefore, to define those areas of the subject that had to be included. This we did on a systematic basis, and although the final emphasis of the book is very largely directed to clinical matters, we felt it pertinent to include in some detail accounts of relevant physiology and technology. Care of the Critically Ill Patient is divided into twelve sections, each concerned with major facets of critical illness; each of the sixty-eight chapters includes a topical and often extensive bibliography. The many chosen contributors form an international group of specialists whose combined expertise embraces the topics that we have selected.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1990 represents the series'continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

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.