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The Washington Manual of Critical Care, 3rd ed

F. McGain

Published 2018 in Anesthesia and Analgesia

ABSTRACT

e102 www.anesthesia-analgesia.org December 2018 • Volume 127 • Number 6 DOI: 10.1213/ANE.0000000000003826 Undoubtedly, The Washington Manual of Critical Care serves its purpose well “to assist all health care providers involved in the care of the critically ill in some meaningful way.” The manual is meaningful for (1) the practicing physician wishing to update his or her knowledge base, (2) residents just being introduced to critical care, (3) critical care nurses wishing to know more about diseases they see in the intensive care unit (ICU), and (4) junior doctors/medical students searching for an introduction to the field of critical care. Further, for those sitting critical care and anesthesiology board examinations, the book serves as a guide ensuring that they are well acquainted with the breadth of important areas of their study material and highlight further areas to research elsewhere. The manual does all of this while providing excellent value for the money. The third edition of The Washington Manual of Critical Care (the “manual”) has been updated, refined, and expanded from the 2012 second edition to include 91 chapters, with 94 authors, 86 of whom are from a variety of critical care and specialty medicine divisions of Barnes-Jewish Hospital/Washington University, St Louis, MO. Most subspecialty areas of critical care are covered, with the exception of pediatric critical care. Certainly, all of the usual critical care topics, such as shock, respiratory failure, cardiac dysfunction, renal support, are present within the pages of this compact, inch-thick manual. Some specialty areas are covered, such as the critically ill transplant patient and a few chapters on surgical themes. Further, there is an extensive section of 11 chapters on the important and growing field of neurocritical care, including chapters devoted to acute spinal cord disorders and traumatic brain injury. The chapters are well written, easy to follow, and generally 10 pages or less, making each chapter brief yet detailed enough to be read in its entirety without becoming overwhelmed. The manuals’ images are good, and most of the algorithms and tables are detailed though not exhaustive (eg, for antibiotic management of septic shock). There is a convenient, associated electronic manual that enhances the book and can be “opened” simultaneously with the book for ease of review of written material. The e-manual is actually easier to follow, as one can increase the font size (for older eyes!) to more easily read the algorithms and tables. All editors and authors are practicing clinicians mainly in critical care but also in various medical and surgical fields. The manual is comparable to other similar manuals, such as Marino’s The ICU Book1 or Oh’s Intensive Care Manual.2 Such manuals are not the definitive reference textbooks in intensive care medicine. Nevertheless, with a sound understanding of the contents of The Washington Manual of Critical Care, any resident or consultant would be well equipped for the “daily grind” in the ICU. Some, but not all, chapters of the manual have very useful summaries. Chapters that could have benefited from such summaries include large chapters, for example, electrolyte abnormalities, and specialty areas, for example, infections in the immunocompromised host. The suggested reading at the end of each chapter is useful, particularly when the chapter author elaborated on why each reference was useful, even if it was only a sentence. Other areas worth mentioning for their utility are as follows: (1) chapter 4, Cardiogenic Shock: The Update on New Cardiovascular Devices, (2) chapter 8, Initial Ventilator Setup, and (3) chapter 14, The Story of Right Ventricular Failure. Perhaps the most challenging limitation of The Washington Manual of Critical Care is that some algorithms are simply too detailed with minuscule font, when 2 algorithms may have been preferable. The manual is understandably United States focused but surprisingly has no information on tropical diseases such as malaria or dengue. Similarly, no pediatric conditions are included, perhaps because no children are seen by intensivists in adult US ICUs. Understandably, due to the relative importance of differing topics, there is variability in the depth and complexity of covered material within the manual, but this does sometimes appear skewed, for example, in Acid-Base: as much about renal tubular acidosis as other common causes of metabolic acidosis. Some of the tables could stress common causes ahead of unusual causes of conditions, for example, “Causes of Adrenal Insufficiency” could include in bold/ capitals cessation of steroids and septic shock earlier. Some overlaps were found that could be combined, for example, chapter 4: Cardiogenic Shock and chapter 22: Acute Heart Failure. Finally, further elaboration on end of life issues/advance care planning could occur in one of the earlier chapters, because a large proportion of hospital patients die in the ICU, and it is a topic that is simply growing in importance. Currently, controversial areas of intensive care medicine are included, for example, 3.1. Fluid Management of Septic Shock. Where there is such controversy, the manual wisely steers a course toward what is safest for the care of the critically ill patient. In summation, I would recommend The Washington Manual of Critical Care as a helpful, effective, and pragmatic book to assist anyone entering the critical care unit. The manual is just the right size to be packed into a small bag ready for assistance at work or elsewhere. At just over 1′′ thick, by 8′′ (20 cm) long, and 5′′ (12.5 cm) wide, the manual truly can still be carried in one hand and hopefully impart wonderful knowledge to the holder!

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