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Doody's Review ServiceReviewer: David J. Dries, MD (University of Minnesota Medical School)
Description: This multiauthored book describes the management of critical illness which becomes terminal illness in the intensive care unit.
Purpose: Articulated is a template for treating patients who do not recover from critical illness or injury. Relief of psychosocial suffering in patients and family is emphasized. Finally, practical and specific advice is given on the means to fulfill the goals of palliative care in the ICU.
Audience: The critical care fellow, attending, or teacher is an appropriate audience for this work. Authors and editors represent leading critical care programs in North America.
Features: The 28 chapters are divided into five groups. Initial chapters describe the context in which decisions to limit life support in the intensive care unit are made. Later sections help the clinician deal with feelings about death, societal input into limiting care in the intensive care unit, including the effects of race, recent legal decisions, and economic pressures. Final chapters describe end-of-life considerations for critical care practitioners dealing with patients having specific diseases, including AIDS, endstage malignancy, congestive heart failure, or chronic obstructive pulmonary disease. Chapters are clearly written with texture of type dividing major subheadings. Tables and other illustrations, as one might expect, are infrequent in a work of this kind. References allow access not only to the popular press but also legal decisions and pertinent medical literature. Medical references represent original work and date to within two years of publication.
Assessment: Due to the severity and complexity of illness in the ICU, death is common and families rate communication with healthcare providers as one of the most important skills for these individuals. This book provides background and tools which allow the intensivist to come to grips with the mortality of patients in the ICU setting.