New standard in intensive care

In an era of instantaneously available, Internet-based medical information, why would we buy a textbook? The new editors of Oh’s intensive care manual address this question in their preface to the fifth edition: it is to provide information which is “weighed and measured” as opposed to “raw and unfiltered”. Weighed, presumably, against the best available published evidence, and measured against the yardstick of personal experience.

Evolving from a collection of handouts, through a handy “bench book” into an international textbook over 25 years, this new edition is remarkably contemporary, with references from late 2002. How these references were selected is not clear, but the book has never pretended to appeal to evidence-based-medicine (EBM) buffs. It owes its popularity more to its succinct and practical style, with lots of tables, algorithms and definitive statements. We Australian intensivists put our trust in acknowledged experts (with rolled up sleeves) rather than in the distant promises of EBM.

So who are these experts, and should we believe them? Andrew Bersten (Adelaide) and Neil Soni (a long-time émigré to London) are the new editors, and are clinically and academically highly credible in both countries. Their team of contributors (89 in total, 49 of them new to this edition) are drawn from the UK and Australia, giving this edition an international flavour lacking in the past.

There are few completely new chapters, and many of the old ones are much the same, but 40 of the 104 chapters have been extensively rewritten by these new contributors, and this is the main reason why owners of the much-loved fourth edition should invest in the fifth.

For the rest — students, junior or senior medical staff and nurses — if you are ever likely to encounter a patient shocked or unable to breathe, this text remains the definitive guide to diagnosis and management. As Bersten and Soni might say — try doing that with Medline.

W Peter SaulIntensive Care Unit John Hunter HospitalNewcastle, NSW

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