Preface

Few specialties are as exacting as critical care; the holistic complexity of the patient with multisystem dysfunction, the out-of-hours commitment, the often stressful and highly charged situations requiring considerable agility of brain and hand, and the continuing evolution (and occasional revolution) in perceived 'best practice' place major demands on intensive care unit staff.

Decision-making at the bedside should ideally be systematic, problem oriented, and based upon sound pathophysiological principles. Rapid access to up-to-date information is necessary, and this may need to be drawn from other medical or non-clinical disciplines. The Oxford Textbook of Critical Care is a single-volume major reference book of adult intensive care medicine aimed at fulfilling most of these requirements, albeit acknowledging that every single topic of importance to critical care medicine cannot possibly be covered in detail. Thus we decided that specialist monographs rather than comprehensive, detailed, and weighty reviews were more suited to our purpose. We also decided to avoid the specialty of pediatric critical care, recognizing key differences between the needs of and some of the disease processes in the critically ill child and adult. Notwithstanding these limitations, this is a state of the art book and should be used as a reference in the intensive care unit and the emergency department and also by all health care providers, including physicians, nurses, and respiratory therapists, who take care of critically ill patients.

Recognizing the needs of those working within the critical care environment, we have incorporated several important features. The book was written with CD-ROM in mind such that all text was 'tagged' at the outset for electronic cross-linking to allow rapid access to relevant information on the desktop PC. Access to electronic media is expanding rapidly; we envisage the CD-ROM version of the book as a central information resource within the critical care unit or library. Another advantage of publishing for both media is the disciplined organization required for the CD-ROM version. Thus the traditional chapter layout of a textbook was abandoned in favor of system-oriented sections. Each section is subdivided into short topics grouped within the section according to clinical problems, as we believe that the reader will often come to this book wishing to update on a specific clinical problem that matches an issue experienced at the bedside. Furthermore, this layout facilitates manageable printing of relevant searches from the CD-ROM. This editorial strategy constrained authors to write within a rigid framework for each chapter. Although we did not attempt to constrain individual styles, we hope that acceptable consistency has been achieved.

We acknowledge that there are often local, national, and international differences in philosophy and management strategy. Some of these differences are seemingly contradictory and it is often difficult for physicians in one country to assimilate information that is produced for another. We intended from the outset that the Oxford Textbook of Critical Care would be an international text. We have attempted to give a balanced view where international differences exist, and in many cases have sat squarely on the fence. We make no apology for this since we believe that the book should inform rather than dictate.

Many major textbooks take several years to come to fruition, in which time changes in theory and practice may have occurred. The idea for this textbook was conceived during late 1995, with publication just three years later. It was a mammoth task, co-ordinating the efforts of over 400 authors from all corners of the world, but the result is a textbook that we hope will remain current for longer. The thanks of the editors go to all those who have contributed to this project with a timeliness that has ensured the short production time, and to members of the staff of Oxford University Press for persuading us that this project was worth the blood, sweat, tears, and burnt midnight oil, and whose skill and support have been essential to the editorial and production process. Finally, the editors were saddened to hear of the deaths of Professor T. W. Smith and Dr P. B. Hazard since the submission of their contributions to the book.

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