Is UpToDate ready for the ICU?

Owing to the complexity of modern medical care, providers are increasingly turning to a growing arsenal of computer-based references for quick and reliable clinical information. In recent years, UpToDate has emerged as one of the leading subscription-based software packages. The latest version (10.2) was released in June 2002 and includes an impressive 6259 topics from the fields of internal medicine and pediatrics. Thirteen medical subspecialties are also covered, including pulmonary and critical care, gastroenterology, and infectious diseases. In most cases, the authors are established experts in their respective field. Individual topics follow a review article format, including a brief introduction, subject explanation, some future predictions, graphics, tables, and references. The sidebar table of contents allows quick navigation to any section in the article. Whenever possible, links to other related topics are highlighted within the text. Click on a medication name and a pop-up window displays a concise monograph for the drug. Similarly, click on any reference and a pop-up window displays the citation's Medline abstract. Although UpToDate is well regarded by general internists and pediatricians, I decided to challenge the software with a variety of contemporary critical care topics. These included ventilator management in acute respiratory distress syndrome, glycemic control in the intensive care unit (ICU), recombinant activated protein C for sepsis, blood product transfusions in the ICU, corticosteroid administration for refractory shock, and nosocomial infections in the ICU. Overall, UpToDate performed well, and consistently returned the type of results I desired. Rarely did I need to refine my search strategy. Most topics were well written and emphasized the current scientific evidence. Graphics and tables were always printer-friendly. Needless to say, the references were up to date (all topics had been revised in the past six months). Although I recommend it, be prepared to pay. All these features come with a price tag. The deceptively plain navigation bar includes a speedy search engine that can quickly generate an impressive list of results. The cost (US$495.00) will probably deter many individual users. Note that the pricing for groups and trainees is more competitive. In cases when free full-text articles are already available online, links straight to those sites will save the user considerable time. The merger of online pioneer WebMD with the venerable publication Scientific American has resulted in yet another choice for practitioners who desire a respectable, evidence-based online reference. With the recent addition of a Respiratory and Critical Care …