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Doody's Review ServiceReviewer: Walter J. Chwals, MD (University of Chicago Hospitals)
Description: This is the second edition of a textbook dealing with surgical nutrition and metabolism, first published in 1983. The editor and many of the 57 contributors are internationally recognized leaders and investigators in the field. The book entails a comprehensive overview of the interaction of metabolic components important in normal physiologic homeostasis and in acute injury states as well as a discussion of nutritional strategies that may be used to support the acute metabolic needs of the critically ill patient. It represents a substantial improvement over the previous edition and reflects the remarkable advancement of scientific understanding in this field during the past 13 years.
Purpose: The purpose is to familiarize the reader with an updated understanding of the metabolic changes that accompany critical illness and to suggest clinical approaches of proven or putative benefit in the intensive care setting that have evolved, largely from clinical or laboratory investigations, based on the theoretical framework presented.
Audience: The audience includes all practitioners of nutritional support who serve patients in the intensive care setting, and it is particularly useful for surgeons and intensive care professionals who care for patients during acute injury states.
Features: The book begins with general theoretical considerations, which includes an excellent discussion of mediators that regulate the response to injury, and sets the groundwork for further discussion of intermediate metabolism. The specialized use of particular substrate components, such as glutamine, arginine, omega-3 fatty acids, and short-chain fatty acids, are nicely integrated with a discussion of body defense and reparative functions. The text then considers specific patient assessment and metabolic response characteristics in various clinical settings, such as starvation, trauma, infection, and neoplasia. The book concludes with a discussion of the risks and benefits (including cost) of specific modes of nutritional therapy. As with any text of this magnitude, there is some variability in the quality of the material presented, although the majority of the chapters are well written, present a comprehensive and balanced discussion of the data in the contemporary literature, and are well-referenced. In addition, each chapter concludes with a selected readings section, highlighting several key publications (with a short synopsis of each one) that frame the perspective of the preceding chapter. The pictures, including electron micrographs, are remarkably well reproduced, as are most of the diagrams and figures.
Assessment: This well-conceived textbook will prove to be an excellent teaching and clinical resource to practitioners who wish to provide high-quality and cost-effective metabolic and nutritional support of the critically ill patient.