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Mechanical Ventilation Manual FREE TO VIEW

Srinivasan Devanathan, MD
Chest. 2002;121(6):2086. doi:10.1378/chest.121.6.2086
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By Suhail Raoof, MD, FACP, FCCP, and Faroque A. Khan, MB, MACP, FCCP, FRCP(C). Philadelphia, PA: American College of Physicians, 1998; 188 pp; $40.00

Mechanical Ventilation Manual is a publication of the American College of Physicians that comprehensively addresses the application of the life-saving intervention—mechanical ventilation. The management of patients requiring a ventilator, popularly known as the “blower” among intensivists, is in some ways an art, and this book serves to perpetuate both the science and art of ventilator management.

Every medical student rotating through the neurology service learns the three famous questions: Is there a lesion? If so, what is the lesion? Where is it? Mechanical Ventilation Manual emulates this catechism in the form of three pertinent questions of its own: Whom do you ventilate? What is the “lesion”—oxygenation or ventilation? How do you ventilate? Further extension of this analogy includes two additional questions: when do you wean and what do you do if problems arise? Consequently, the text starts with a concise description of the types of respiratory failure, then focuses on the indications for, and objectives of, mechanical ventilation. Building on this foundation, the authors move on to explain the various types of ventilators in order to begin addressing the fundamental question of how to ventilate. The basic settings of a ventilator are stressed, since if this is not understood well, the inexperienced house officer is often left intimidated and confused, if not petrified.

The focus then shifts to an explanation of the various modes of ventilation, ranging from the conventional to the more sophisticated (eg, high-frequency jet oscillation). The authors appropriately address the advantages and disadvantages of the various modes in a straightforward, tabular fashion. Newer techniques of maintaining oxygenation and ventilation, ranging among inverse-ratio ventilation, permissive hypercapnia, and prone positioning, are coupled with monitoring strategies that are appropriate to the various modes. Emphasis also is placed on the prevention, recognition, and management of complications that are inherent to mechanical ventilation, as well as trouble-shooting techniques for issues such as alarms, patient ventilator dyssynchrony, and intractable hypoxemia. Finally, the authors carefully review the sometimes-thorny topic of when and how to liberate the patient from the ventilator.

The authors should be commended for going on to address the issues of sedation and paralysis, as well as the fundamental concepts of nutritional support, thereby providing a holistic approach to the patient receiving ventilation. Last but not least, the book concludes with chapters that emphasize specific diseases, such as asthma and COPD, and tools, such as ventilator graphics and mathematical formulas, that round out the repertoire that all intensivists should possess. A few “brainteasers,” an annotated bibliography, and a useful index complete the text.

Mechanical Ventilation Manual does a creditable job, given the complexity of the subject. I would have preferred a bit more in the way of ventilator graphics, but that is a relatively minor point. This book will serve as a very practical reference for respiratory therapists, medical students, residents, fellows, and all those who participate in the care of the mechanically ventilated patient.




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