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By F M Wijdicks. Published by Oxford University Press, New York, 2002, pp 415, £79.50. ISBN 0-19-514079-6
On the morning that the request for a review of this book arrived, I had received two urgent phone calls to visit patients in our intensive care unit. One patient was stubbornly failing to awake after major surgery, and the second had apparently wakened, but was not moving very well. The cause of the problem in the first patient was the effects of prolonged sedation, and the patient eventually recovered. The second patient had a critical illness neuropathy. These are two particularly common problems in critical care medicine, and even someone not experienced in this topic would have been able to make the diagnosis in my two cases with the help of the first edition of this book.
I therefore had to consider whether or not a second edition would assist us even more.
Many of the chapters have been expanded with new information and the chapters give good common sense information about diagnosis and prognosis. There are some important sections dealing with the difficult problems of the effects of drugs on a patient in the intensive care unit. There is appropriate emphasis on the important point that drugs often have effects much longer than might be expected by their known metabolism.
What really sets this book above others dealing with similar topics are the sections dealing with prognostication. It is clear the author has carefully researched the literature in this field and particularly helpful information is contained within the section on neurological complications of cardiac disease and the chapter dealing with the outcome of acute injury to the central nervous system. The data in these chapters are supplemented with a chapter dealing with the difficulty issue of withdrawing life support. This deals with the various problems in a sensitive, yet thorough, manner and discusses palliation.
In a book with so much information and dealing with so many diverse topics, it is always possible to find areas that can be criticised. In an otherwise excellent section dealing with the guidelines for the clinical diagnosis of brain death, I felt that there was not sufficient emphasis on the need for the diagnosis of an irreversible cause for the brain damage.
This second edition is a book that all trainees in neurology should read and indeed all of us should have available to us when we visit patients in an intensive care unit. The difficult questions that we are increasingly asked about diagnosis and prognosis will be readily answered by this book, which I firmly and unreservedly recommend.
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