The role of the pharmacist in critical care medicine has become increasingly impor­tant and multifaceted in recent years. Critically ill patients are highly heterogeneous in terms of age, underlying comorbidities, prehospital medication usage, admission diagnoses, allergies, concurrent organ replacement therapies, and so on. The acute nature of their illness means that their condition and hence management can change rapidly during their stay, and the disease severity means that many will require mul­tiple medications during, and after, their ICU stay. As integral members of the criti­cal care team, ICU pharmacists have the essential training and knowledge to ensure that prescriptions are individualized such that each patient receives the best drug for them, at the optimal dose, with minimal adverse effects throughout their ICU and hospital stays. ICU pharmacists are also pivotal to successful antimicrobial steward­ship programs and accurate interpretation of therapeutic drug monitoring, and their involvement in the diagnostic process and in identifying diagnostic, as well as medi­cation, errors is increasingly encouraged.

Despite their increased presence on our ICUs and involvement in patient manage­ment, there are few textbooks aimed specically at critical care pharmacists, particu­larly in terms of their potential role in diagnosis. Recognizing this important gap, the editors of this comprehensive book have gathered together 55 chapters that provide an overview of core aspects of critical care patient management from the pharma­cist’s perspective. The chapters, written by an international team of more than 100 experts, provide an important update on the physiological and pathological mecha­nisms of key areas of critical illness and the diagnostic and therapeutic approaches to these conditions for the pharmacist. There are chapters focusing on specic dis­eases or conditions, including shock, acute liver failure, acute kidney injury, delir­ium, and acute pulmonary embolism; chapters on interpretation of diagnostic tests, such as radiology and electrocardiography; chapters on therapeutic interventions, including mechanical ventilation, intravenous uids, renal replacement therapy, ECMO, nutrition, and blood transfusion; and chapters on specic groups of ICU patients, including obstetric, oncology, transplant, and burn patients. Two of the chapters, on the approach to clinical reasoning in critical care and sustainable phar­macy practice in the ICU, are unique chapters to pharmacy education and training.

Providing an up-to-date overview of topics related to critical care and emphasiz­ing the importance of correct diagnosis in providing appropriate and optimal treat­ment, this collection will help prepare ICU pharmacists for their multifaceted responsibilities as members of the ICU team, including an expanded role in limiting misdiagnosis. This book will serve as a useful resource for all pharmacists involved in the management of critically ill patients, whatever their level of experience and training, and I congratulate the editors on their achievement.

The critical care environment, encompassing the intensive care unit as well as criti­cal care outreach to intermediate care units and the general ward in the form of rapid response systems and medical emergency teams, is tremendously challenging clini­cally and in terms of patient safety and quality. Pharmacists have a crucial and central role in ensuring the best quality of clinical care and promoting patient safety. Medication errors in these high-stress environments and situations are one of the most common patient safety and quality concerns, and pharmacists are the experts that intensivists, nurses, and respiratory therapists turn to for help in avoiding these types of medical errors. In addition, critically ill patients often receive a large num­ber of medications and have deranged physiology and pharmacodynamics and phar­macokinetics that create a complicated milieu that needs to be carefully balanced to avoid complications and optimize outcome. Pharmacists enhance the quality of care by using their knowledge and education to guide the care team in making the best pharmacological choices for each patient. They also assist prescribers in making the most cost-effective choices, something that is crucial in the current healthcare envi­ronment where costs are a major concern. Their role, however, goes well beyond optimization of drug therapy and prevention of medication errors. In the ICU, phar­macists’ role is increasingly underscored in ensuring precise diagnoses, a corner­stone for effective drug therapy. Notably, diagnostic errors in the ICU pose substantial concerns, as evidenced by a systematic review led by Winters et al. (2012), revealing alarming rates of errors, including those with lethal implications. Actively engaging in diagnostic deliberations, pharmacists leverage their extensive knowledge in pharmacotherapy to offer invaluable insights that either corroborate or challenge diagnoses. This interdisciplinary synergy is pivotal in aligning treat­ments with accurate diagnoses, thereby elevating the caliber of patient care.

Department of Anesthesiology and Critical Care Medicine, Co-Director of the Johns Hopkins Hospital Surgical ICUs and the Bayview Medical Center Surgical and Burn ICUs, Core Faculty Armstrong Institute for Patient Safety and Quality The Johns Hopkins University School of Medicine, Baltimore, MD, USA

This text provides a comprehensive view into the broad and expanding world of critical care pharmacy and pharmacologic challenges. I am consistently impressed and amazed by the dedication, knowledge, and creativity of my colleagues world­wide. We have come a long way from gentamicin dosing as a primary focus! The author list of this text includes an amazing group of contributors, and I congratulate them and the editors for comprehensive topics that illustrate current and future roles.