Foreword
In the United States during the 1950s, the development of mechanical ventilation led to the
organization of special units in hospitals, where health care personnel with specific expertise
could efficiently focus on patients with highly technical or complex needs. Over the ensuing
years the sickest patients as well as those needing mechanical ventilation were grouped into
special care units. In 1958, Baltimore City Hospital developed the first multidisciplinary
intensive care unit. The concept of physician coverage 24 hours a day, seven days a week
became a logical approach to providing optimal care to the sickest, most complex patients.
Now, 50 years after the first multidisciplinary intensive care unit was opened, there are
now 5000 to 6000 intensive care units in the United States: Over 4000 hospitals offer one or
more critical care units, and there are 87,000 intensive care unit beds. Critical care represents
13.3% of hospital costs, totaling over $55 billion per year.
Health care providers are well aware of the role that infections play in the intensive care
unit. A substantial number of patients are admitted to the intensive care unit because of an
infection such as pneumonia, meningitis, or sepsis. A substantial number of patients admitted
to intensive care units for noninfectious disorders develop infections during their stay. Thus,
intensivists need expertise in the diagnosis, treatment, and prevention of infectious diseases.
Management of infections is pivotal to successful outcomes.
In this third edition ofInfectious Diseases in Critical Care Medicine, Burke Cunha has
organized 31 chapters into an exceedingly practical and useful overview. Providers often find
it surprisingly difficult to distinguish infectious and noninfectious syndromes, especially when
patients have life-threatening processes that evoke similar systemic inflammatory responses.
Part I and Part II provide many clinical pearls that help with diagnosis and with developing a
strategy for initial patient management. Specific chapters focus on special intensive care unit
problems, such as central venous catheter infections, nosocomial pneumonias, endocarditis,
andClostridium difficileinfection. Particularly useful are chapters on special populations that
many clinicians rarely encounter: tropical diseases, cirrhosis, burns, transplants, or tubercu-
losis. Chapters on therapy also provide practical advice focused on critically ill patients, in
whom choice of agent, toxicities, drug interactions, and pharmacokinetics may be substantially
different from patients who are less seriously ill.
Critical care medicine is becoming more and more technology based. Genomics and
proteomics can predict susceptibility to various diseases and drug metabolic problems.
Patients can be assessed by ultrasonography to supplement physical examination. Diagnostic
biopsies can be performed on virtually any organ. Invasive arterial and venous monitoring as
well as monitoring of central nervous system and cardiac activity is commonplace.
Despite these advances in technology, knowledge of differential diagnosis, natural history,
and therapeutic options is still essential. To understand these processes, Burke Cunha has
assembled an impressive team of experienced clinicians to provide insight into the infectious
challenges of critical care medicine. This edition continues to provide relevant, current information
that will enhance clinical practice with this growing segment of hospitalized patients.
Henry Masur
Department of Critical Care Medicine
Clinical Center
National Institutes of Health
Bethesda, Maryland, U.S.A.