Brian T. Andrews and Gregory B. Hammer, Editors, American Association of Neurological Surgeons, Park Ridge, IL, 60068, 1997, $79.95, 310 pages, ISBN 9624246-6-8
Pediatric Neurosurgical Intensive Care is a succinct compilation of pertinent neurosurgical topics authored mainly by pediatric neurosurgeons and intensivists. The chapters include neurological examination; physiologic monitoring; perioperative care; pathophysiology and management of increased intracranial pressure; fluid, electrolyte and neuroendocrine physiology; nutritional support; infections; the head-injured child's cardiorespiratory and intensive care management; spinal cord injuries; and cerebral ischemia. Nontraumatic intracranial hemorrhage, spinal dysraphisms, brain tumor, epilepsy, and interventional radiology's management of vascular abnormalities are also addressed. The final chapter covers end-of-life decision making in the pediatric intensive care unit, a unique consideration not found in other texts.
In the preface, the editor acknowledges that the book's main focus is to assist neurosurgeons who are not pediatric-credentialed specialists, yet still care for critically ill children in their practice. This focus is both a strength and a weakness for the neuroscience nurse. The brevity and clarity of the text serves well to explain the rationale, advantages, and potential problems associated with treatment; consequently, nurses may not find the information sufficiently detailed for bedside application. Conversely, this text may encourage the professional nurse toward supplemental reading from nursing literature or the extensive bibliography at the end of each chapter.
Since this text was published in 1997, the reader needs to consider the changes and more recent developments in pediatric neurosurgical critical care that are obviously not covered in this book's discussions. Examples of such changes include today's standard of care of not using intravenous steroids for spinal gunshot wounds, or using brain tissue oxygen monitoring or hypertonic saline. One may still value many of the pathophysiology and generic treatment discussions in spite of that.
Although the text is extremely concise, the content is devoid of nursing concerns. The chapter on epilepsy is, in reality, a discussion of status epilepticus treatment and does not include postoperative care of the child undergoing elective epilepsy surgery. Interestingly, this is one of the few chapters to even mention nursing involvement in patient care.
The discussion of spinal dysraphisms includes embryology and the increased incidence of shuntdependent hydrocephalus, Chairi malformation, and latex allergy in this population. With the focus of this text on intensive neurosurgical care, the bedside nurse will miss any mention of urologic testing, early orthopedic and physical therapy intervention, or discharge planning.
A highlight of the book is the well-written chapter on end-of-life decision making. This chapter would be an excellent resource for a medical ethics course, seminar discussion, or personal reflection. Ethical standards, often competing with each other for priority status, are synthesized with applied examples, pivotal legal decisions, and sociological concerns. The perspective of the patient, parent, and surgeon are articulated with intelligent objectivity and remarkable brevity.
While this text was targeted to meet the neurosurgeon's needs in caring for these unique patients, the nurse may glean some insight into the neurosurgical mindset, appreciate the nondiluted pathophysiology and treatment planning, but miss the whole patient approach to nursing care. The exclusion of nursing in this text underscores the need for nursing input. However, it remains a valuable text to supplement other nursing texts for the nurse caring for critically ill children.
nurse practitioner, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA.