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Evidence-Based Critical Care: A Case Study Approach

Article in Anesthesia & Analgesia · April 2018

DOI: 10.1213/ANE.0000000000002816

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Evidence-Based Critical Care: A Case
AQ1 Study Approach
T he role of anesthesiologists continues to expand beyond
the traditional operating room. Historically, the specialty
of critical care medicine was founded and developed by
anesthesiologists. Over the years, critical care has evolved
into an independent specialty; however, its links with anes-
thesiology and perioperative medicine remain very strong.
In many countries, anesthesiologists remain leaders of
intensive care.
In this context, Evidence-Based Critical Care: A Case Study
Approach is an invaluable source of knowledge and reference
for anesthesiologists and perioperative physicians. This
textbook is a well-written, easy-to-understand reference
that covers a broad range of critical care topics organized
according to syndrome or diagnosis. Ultimately, despite a
few shortcomings, we recommend this book for purchase.
The editor, Dr Robert Hyzy, has a background in inter-
nal medicine with a focus on pulmonary and critical care
medicine. The qualities behind his teaching awards and
participation in clinical research are evident in the construc-
tion of this textbook: the material is easily digestible and the
evidence emphasized; tables and figures are appropriately
chosen to illustrate important material. The format is such
that one could easily pick it off the shelf for a short review of
a topic or to answer a question in a few minutes. Clinicians
in training will benefit from the entirety of the chapters,
whereas attending physicians may find the greatest value
in the evidence portions.
Topics are introduced through a short case presentation
and followed by an important clinical question, abbreviated
answer, and continuation/resolution of the case. The case
presentation is followed by a discussion relating to the diag-
nosis and management underlying the abbreviated answer
to the clinical question. The unique aspect of this book is
the “Evidence Contour” section of each chapter in which
each author provides an interpretation of the evidence for
the diagnosis and management of the case. Whereas many
conventional critical care textbooks simply state the ratio-
nale and cite a trial or other evidence, here we find a more
nuanced discussion of the aspects of diagnosis and manage-
ment, including strengths, weaknesses, knowledge gaps,
and ongoing questions, that are still subject to debate. It is
akin to an abbreviated journal club discussion. Considering
the heavy emphasis on evidence, it is important to note that
the most recent evidence discussed is generally from the
2015 vintage. Since that time, there has been a number of
important trials, but this observation is applicable to most
textbooks.
Although the textbook is available in both hardcover and
online versions, this review is based on the hardcover ver-
sion. The quality of the printing is good with solid bound-
ing, print quality, and clear images. Online supplements are
not uniform and their quality varies among chapters.
Bearing in mind that this is a first edition work, it is
not surprising that we noticed a number of small errors
DOI: 10.1213/ANE.0000000000002816
XXX 2018 • Volume XXX • Number XXX
Copyright © 2018 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited.
01/4/18 16:42 Art: AAJ-D-17-02687
E BOOK REVIEW
in formatting during our review, and we cannot be certain
that others do not exist: for example, 1 introductory case is
presented in italics, abbreviations vary by chapter, no ques-
tion/answer was given for massive hemoptysis, and varia-
tions exist in the use of SI and imperial units. The frequency
and magnitude of formatting errors we saw are minor and
do not affect the utility of the textbook.
One area that requires specific commentary is the dis-
cussion pertaining to surgical critical care. Based on page
count, only 10% of the textbook is dedicated to the care of
the surgical patient. It should be noted that there are several
specific textbooks dedicated to the care of surgical patients,
so it would be unfair to criticize the authors accordingly,
but anesthesiologists looking for material in this field may
be disappointed. Specific areas of critical care that may be
of interest to an anesthesiologist but have minimal presence
include: the management of surgical patients (cardiac sur-
gical, transplantation, general postoperative care); airway
management; transportation; systems-based management
(quality improvement, patient safety, and institutional orga-
nization); and communication. On the other hand, this text-
book would most likely benefit the anesthesiologist seeking
to improve knowledge of issues pertaining to medical criti-
cal care. The relative paucity of surgical commentary may
give the potential buyer some pause, but this may be less
applicable to anesthesiologists because of our increased
familiarity with the care of perioperative patients.
Readers may also find that the quality of the chapters
varies; some chapters provide a more fulsome case or dis-
cussion on the evidence for a given topic. This variation
between chapter authors is not an uncommon finding in
collaborative publications, and, by and large, this does not
detract from the utility of the textbook.
In conclusion, we recommend that readers seeking to
update the evidentiary basis for critical care decisions—the
how and why of medical knowledge—buy this textbook.
The only major considerations for anesthesiologists are the
relatively lesser coverage of topics pertaining to surgical
critical care and the need for ongoing evidentiary updates.
Anesthesiologists may forgive the surgical coverage because
of their increased familiarity with the subject matter, but the
evidentiary component is a special asset and needs to be rem-
edied because it is a one of the major selling points of this
particular compendium.
Warren Luksun, MD, FRCPC
Marcin Wąsowicz, MD, PhD, FRCPC AQ2
Department of Anesthesia and Pain Management
Toronto General Hospital
Toronto, Ontario, Canada
Cardiovascular Intensive Care Unit
Toronto General Hospital
Toronto, Ontario, Canada
Department of Anesthesia
Faculty of Medicine
University of Toronto
Toronto, Ontario, Canada
marcin.wasowicz@uhn.ca
www.anesthesia-analgesia.org 1
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