Since the late 1970s, critical care medicine as a specialty has come into its own. Each of the major medical disciplines has developed it sown fellowship and certification systems, and each new emergence has been accompanies by a proliferation of books addressing all facets of the specialty. The preface to Critical care Medicine: Principles of Diagnosis and Management clearly states that this text was compiled for the internal medicine intensivist. The authors have done a masterful job.

Organizationally, the text follows a fairly standard format. It first presents cardiopulmonary resuscitation and airway management in chapters that are well written and that generally keep to the point. The next several chapters deal with intensive care unit monitoring, procedures, and technology. Specific sections on organ systems make up the bulk of the text; the cardiovascular, vascular, and pulmonary sections compose the next 500 pages. Succeeding sections cover the other major organ systems (such as renal, neurologic, and gastrointestinal) as one would expect. The final four sections address physical and toxic injury, psychosocial and ethical issues in the intensive care unit, injury scoring systems, and illustrative cases. An extensive appendix reviews drugs used in the intensive care unit. Individual chapters are well written and all generally have the same organization: a presentation of normal physiology followed by discussions of pathophysiology, clinical presentation, management, and controversial issues. At the end of each chapter, a "Key Points" section summarizes the salient facts in less than a page. All chapters are completely referenced.

The major strengths of the text are its tight organization, excellent writing, extensive index, and consistent internal medicine "theme." Metabolic emergencies are well discussed in several chapters; these are usually less well reviewed in other texts. Conspicuously absent are chapters on topics such as cytokines, mediators of sepsis, and nitric oxide. Although these are presently areas of intense research, they have not reached the clinical mainstream and are presented in sufficient detail in appropriate chapter subsections. The individual authors generally remain intellectually honest in presenting all of the relevant data and theories rather than just their own personal biases.

The book has a few negative aspects. Although it is an internal medicine text, a chapter on acute abdominal catastrophes and one on obstetric critical care would have been helpful. Surprisingly, there is a chapter on burns, an area rarely managed by internists, but no chapter on other dermatologic aspects of critical care. The section on echocardiography is lengthy.

Drs. Parrillo and Bone have organized a superb text that will probably become a mainstay for the internal medicine intensivist. This book will make an excellent addition to the library of any intensive care unit. Because of its outstanding writing, the text is highly recommended to residents and fellows preparing for certification examinations or intensive care unit rounds.