Abstract: Critical Care of Infants and Children, I. David Todres and John H. Fugate, eds. Boston: Little Brown, 1996, ISBN 0-316-85020-9, 752 pp, $99.95. Critical Care of Infants and Children represents a well integrated effort by the editors and the 86 contributing authors, resulting in a textbook that crisply provides the information necessary to practice critical care medicine. Unlike other publications on the same subject, this text does not put a critical care spin on general pediatric medicine, but rather focuses on the body of knowledge encompassing the subspecialty of critical care. According to the preface, the editors intend the book for critical care trainees, their trainers, and physicians who do not regularly confronting the challenges critically ill or injured patients present. However, the text will refresh the memory of regularly practicing critical care physicians and provide them with an efficient resource. Organized into 19 sections spread over 752 pages (which have a matte finish, thus sparing the reader the glare of a light source), the book opens with a section titled "Evaluation, Management, and Procedures." The authors devote particular attention to helping critical care practitioners perform these maneuvers with safety in mind. They accomplished this goal by using text and illustrations that are simple and clear. Unfortunately, the black and white photographic reproductions in this section and throughout the text are disappointing. Eight sections cover organ systems, disorders of which commonly lead to critical illness. One section includes diseases involving the integument, often omitted in critical care textbooks, which pose a threat to a child's life. The format for the presentation of the material efficiently provides the reader with current information on epidemiology, pathophysiology, and management. There are algorithms throughout the text to facilitate the transfer of the information contained in the text to practice. Where controversy exists, alternatives are described. All the material is well referenced so that the reader can explore the subject in more detail using the original reports. The editors place the discussion of circulatory shock in the section on infectious disease. The contributing authors focused on septic (distributive) shock, quite a common challenge for practitioners of critical care, and a somewhat infrequently and newly encountered (100 cases worldwide) abnormality, hemorrhagic shock and encephalopathy. Omitted is a classification and description of other shock states. This reviewer believes that this is a major omission, because trainees with limited funds to purchase critical care texts will be obligated to go elsewhere for this important information. A chapter titled "Development Pharmacology" discusses the impact of maturing systems influencing drug effect. However, a more complete discussion of pharmacokinetic and pharmacodynamic principals would be of benefit to the readers of this text. The inclusion of a chapter dealing with patients with chronic illness and disability provides physicians focusing on critical care with a strategy for managing a growing population of children for whom they must care. Those who recover incompletely from critical illness or through advanced medical care live with disabilities of such magnitude that when they are hospitalized their care may require a critical care practitioner. The last section of the text deals with issues increasingly recognized as playing a vital role in the management of critically ill and injured children. Among the chapters in this section, titled "Ethical, Psycho-Social, and Organizational Issues," the one that deals with the ethical aspects of critical care nicely describes and reminds us of the principles that should guide us in our practice. Ethics has been a long-time interest of David Todres. As readers move through this chapter and, indeed, this entire section, they are reminded of the sense of commitment and compassion to children that the photograph of Dr. Todres, which appears in the cover of the book, conveys. Critical Care of Infants and Children should be in the library of physicians who concentrate their practice on the care of critically ill and injured infants, children, and adolescents, as well as those who occasionally encounter these patients. They will find it a resource that efficiently provides them with the fundamentals to practice critical care. For those who choose to explore the principles in more detail, the references will enable them to do so. Russell C. Raphaely, MD Department of Anesthesiology and Critical Care Medicine; The Children's Hospital of Philadelphia; University of Pennsylvania School of Medicine; Philadelphia, PA 19104-4399