It is a paradox that this erudite textbook of almost 1400 pages with contributions from 450 authors from 20 countries deals with a subject which in many of those countries is not recognized as a specialty in its own right. It does seem unfortunate that a discipline as complex, subtle, and important as intensive care has clearly become, should still be regarded by the medical profession as a subspecialty of other longer-established disciplines. The fact that this book has involved so many authors from such a wide variety of backgrounds and interests indicates that intensive care has matured and will certainly play an increasingly pivotal role in the care and management of rising numbers of hospital patients.

This role will range from transporting critically ill patients between hospitals to advising colleagues in other specialties on the management of severe illnesses likely to be associated with a high mortality. The major role of intensive care specialists in treating patients is likely to increase rapidly as the population grows older, patients' expectations rise, and therapeutic options multiply. This is bound to lead to more demands on intensive care resources and staff. The processes involved in such an undertaking are very complex and require the intensive care specialist to have a wide range of skills. Not only do these specialists need extensive clinical expertise and significant managerial experience, but they must also keep abreast of the rapid technological developments taking place in therapeutics and equipment. This is turn may well accentuate the ethical dilemmas with which intensive care staff are often faced, resulting in the rising levels of stress so familiar to most of them. Ideally, an intensive care specialist needs to be a jack of all trades and master of most. In reality it is unlikely that any single individual can ever possess all these attributes, and this emphasizes the intensive care must be a multidisciplinary subject with close co-operation with many disciplines on a regular and frequent basis.

Any textbook that attempts to deal in a substantive way with these wide-ranging and complex issues is a massive undertaking, and I believe that the editors and authors of this book have succeeded admirably in completing this task. The editorial decision to limit the individual topics to not more than two or three thousand words is wise in that authors feel less pressurized and are more likely to produce a clear and focused contribution with an appropriate number of key references. This decision has, I believe, been amply justified.

Readers have the opportunity of using the book in several ways. They may use it as a learning tool in preparing for the various diplomas and examinations in intensive care that many countries have set up or are planning. Others might use the book to help with a diagnostic problem or to seek advice on a question of clinical management. The key references are helpful in directing readers towards the large body of literature that is now readily accessible electronically. The book not only deals with an enormous number of clinical issues but also covers other important matters outside the mainstream. These include ethics, the problems associated with research in the intensive care unit, planning and equipping the unit, and general planning and financial matters. Because the book is so comprehensive in its coverage, it should appeal to a wide audience ranging from doctors to nurses to technicians and students and perhaps even managers.

The reputation and power of this book will, I believe, be considerably enhanced by its availability as a CD-ROM. Many working in the intensive care environment are computer literate and will certainly welcome accessing such a substantial body of information at the touch of a button. Indeed, it is not outside the bounds of possibility that such instant access might in due course lead to a measurable improvement in clinical performance. The editors are to be congratulated for the vision with which they have produced this book. I know how hard they have worked, and this has resulted in what I believe to be a very important addition to the literature of intensive care medicine. Finally, I hope that this substantial contribution to the medical literature helps to convince some of our more doubting colleagues that intensive care has at last come of age.

E. D. Bennett St George's Hospital Medical School

London, UK

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