Practical Pulmonary and Critical Care Medicine: Disease Management PDF

Preface

Over the past decade, the pace of progress in medicine has been astounding. New developments in diagnosis, management, and therapeutics occur at a breathtaking rate. A new disease emerges and, aided by the ease of transcontinental travel, threatens to become the next pandemic. And just as quickly, the causative agent is identified with diagnostics and therapeutics soon to follow. Old diseases have their mysteries unraveled, and targeted therapeutics provide hope where there was once despair. Some conditions come under control in less than a generation's span, while others plod along inexorably to the end, with little available to alter their course.

Just as the conditions of disease have changed, so have the conduits for information. The speed and availability of electronic databases now allow access to vast warehouses of information at the click of a mouse or flick of a stylus. Where once the houseofficer carried a worn copy of a spiral bound manual, handheld computers are now the essential accessories. The grand old textbooks have followed suit, available in versions abbreviated to fit file-size limits or available in their own electronic internet based versions. This electronic world not only allows but mandates frequent content changes. Information can be updated daily and even more frequently if necessary. The online resource is now predominant in an arena that was once the domain of the print journal. Whereas attendance at national or international meetings once offered the latest developments, this information can now be accessed from a remote site and disseminated at near-instantaneous speed, certainly before one can return home.

Why then, in this information rich era, would there be a need for this book? First of all, even though there is instant access and availability to volumes of information, there remains a dearth of practical information. No one functions in the vacuum of cyberspace or isolation of an information warehouse. Everyone faces the limitations of available technology, restricted formularies, time pressures, and treatment preferences. In addition to the wealth of knowledge, one requires the wisdom of experience and expediency of practical management. The best technology or therapeutic is only as effective as the treatment that can be instituted by the lone practitioner. Treatment available only to the few or the very specialized usually has no role in general management.

Filling this void is the guiding premise of this book. Even if mutations threaten to render current antimicrobials ineffective or new disease entities emerge, there remains a need for comprehensive and effective supportive care. This care is best provided not by the disease specialist, but by physicians who carry a broader perspective while also maintaining focus on the most pressing problems. In the new lexicon of medicine, this is the hospitalist or intensivist.

This has required the intensivist to assume many roles in patient management, but none more important than as the functional equivalent of a chief executive with oversight over total management. This has required familiarity with areas where they are not generally considered expert, and reliance on a multi-disciplinary approach to care. These sections in the text are authored by experts in the area who provide a broad overview but highlight those issues most important in managing critically ill patients. This brings the intensivist's view to the specialist's world.

Practical Pulmonary and Critical Care is divided into two volumes. The first volume focuses on immediate management and diagnosis. This second volume covers frequently encountered disease conditions such as decompensated asthma, chronic obstructive pulmonary disease (COPD), pneumonia, acute respiratory distress syndrome, hemoptysis, acute coronary syndrome and heart failure, and provides in-depth coverage on management. Consideration is given to therapy both as primary conditions and as secondary complicating conditions. This includes pneumonia, pulmonary embolism, sepsis, neurologic and neuromuscular conditions, gastrointestinal bleeding, and renal failure. For example, renal replacement therapy is viewed not only in terms of a presenting symptom or condition, but also in its role in the management of the patient with acute gastrointestinal bleeding or sepsis. It is a unique perspective that focuses not only on supportive care, but also on management to facilitate recovery.

There is also coverage on management issues that have previously not been given much consideration. This includes chapters on nutrition, sedation, infection control, and bioethics. In the past decade, these topics have emerged in the realm of the patient care as they can adversely affect patient outcome and duration of stay. These are often considered to be supportive or ancillary issues, but they are not optional for optimal patient care. And there is also coverage on an aspect of patient management that has only recently been recognized as crucial for quality patient care, the use of the electronic health record in patient care. This has evolved beyond being a repository for patient notes, to being an indispensable component of patient care. It is now recognized that medical errors and/or inefficiencies are linked to inaccessible or illegible medical records, a problem that is almost fully remedied by electronic order entry, decision support systems, near instantaneous access to prior history, medications, and medical references. The systems can also provide safeguards against dosing errors or deleterious drug interactions. Although these systems are available, they are underutilized.

In summary, we present a reference that uses its scientific foundations to provide a focus on the practical and efficient management of critically ill patients. It is this perspective that not only defines this book, but hopefully lends an enduring quality to its content. A paper-based textbook may not have the allure of electronic media, but instead can provide a roadmap and framework for efficient and pragmatic care. Once in place, additional information can only enhance the work and final product. We share a common goal to enhance the recovery of patients from a critical illness. We hope this book can contribute to that end result.