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Irwin and Rippe's Intensive Care Medicine BOOKS,SOFTWARE,&OTHER MEDIA findings. This chapter emphasizes a step- therapy and explains the various classes of ment chart would have been extremely help- ␤ by-step approach to thorough physical ex- drugs, such as anti-infectives, 2 adrener- ful. amination and defining normal findings with gics, corticosteroids, and xanthines. In- The highlights in each of these chapters abnormal findings that the practitioner may cluded in this section are drug-delivery were the author’s inclusion of educational encounter. The chapter also includes “age methods (eg, metered-dose inhaler, powder discharge notes, which will help clinicians awareness” alerts to which the clinician inhaler), indications, adverse effects, and and student prepare the patient and family should pay close attention when assessing points to which the clinician should pay close for discharge by making them aware of pos- children or the elderly, and “red flags” to attention when delivering medications. Also sible outcomes. Overall, each of these chap- highlight subjects that could be of great im- included are discussions on inhalation ther- ters was what I would call the “CliffNotes” portance (eg, during chest inspection, watch apy, continuous positive airway pressure, for most common respiratory diseases and for areas of abnormal collapse during inspi- mechanical ventilation, and bronchial hy- problems. These supplement big heavy ration or abnormal expansion during expi- giene. I found all the treatments to be very pathophysiology books very well, and this ration, which could signify paradoxical accurate and according to the American As- book is an easy-to-use reference. movement). The “age awareness” and “red sociation for Respiratory Care clinical prac- The last chapter, on emergencies, mainly flag” alerts appear throughout the book and tice guidelines. I particularly liked the table included information on airway obstruction, emphasize the most important parts of each on troubleshooting mechanical-ventilator bronchospasm, anaphylaxis, and respiratory section. Chapter 2 provides a table with alarms, which includes potential causes and arrest. I think these discussions will be eas- which to interpret assessment findings and interventions. ily understood, and they include the patho- probable causes, which will be very useful, Chapters 5–10 cover the most common physiology, assessment findings, complica- especially for students to help them criti- respiratory conditions, from pneumonias tions, and treatment options. I particularly cally think through the various possible di- (viral vs bacterial) to obstructive, restric- like the illustrated step-by-step explanation agnoses or problems a patient may present tive, and neoplastic disorders, and traumatic of what happens during anaphylaxis. Other with. injuries. Each chapter covers the pathophys- chapter highlights were on ways to manage Chapter 3, on diagnostic tests and pro- iology, assessment findings, complications, an obstructed airway and a list of common cedures, provides detailed synopses of re- antidotes for drug/toxin-induced respiratory and treatment considerations of a given dis- spiratory diagnostic tests, including the depression. ease, in a brief, accurate, and easy-to-follow course of obtaining the samples. The chap- The appendix has a very useful section format. I noticed that the description of di- ter starts with blood studies, particularly ar- on common English-to-Spanish translations, agnosing acute respiratory distress syn- terial blood gas values and white-blood-cell such as ¿Tiene ud tos? (Do you have a drome (ARDS) failed to completely use the counts. The section on arterial blood gases cough?) and ¿Ha tenido ud problemas de American/European Consensus Confer- covers the common probable causes of ab- los pulmones? (Have you had any lung prob- ence’s definition. There is a mention of P / normal blood gas values in an easy table aO2 lems?). I’m sure most clinicians who speak F ratio of Ͻ200 mm Hg (P Ͻ 60 mm format. The one typographical error I no- IO2 aO2 only English will greatly appreciate this sec- Hg on room air), but there is mention that ticed in the chapter was in the alveolar gas tion when taking care of patients who speak the patient needs a pulmonary artery wedge equation, which is given as: only Spanish. I know I will. Ͻ pressure of 12 mm Hg, which is lower In summary, this text is wide-ranging in than the 18 mm Hg stated in the consensus- ϭ ͑ ͒ ͑ ͒ its coverage of all areas of respiratory care. PaO2 FIO2 PB – PH2O – 1.25 PaCO2 conference definition. Most importantly, I found this compact text logically struc- there was no mention of using a low-tidal- tured, well written, accurate, and, most im- It should read volume strategy when ventilating a patient portantly, useful to health care practitioners with ARDS. The National Institutes of especially nurses, respiratory therapists, and ϭ ͑ ͒ ͑ ͒ Health ARDS Network study found that a PAO2 FIO2 PB – PH2O – 1.25 PaCO2 students. I recommend this text. tidal volume of 4–6 mL/kg predicted body Ͻ The chapter also covers sputum and fluid weight and a static pressure of 25 cm H2O Greg S Carter RRT studies, the difference between transudative reduced mortality by 20%, compared to the Respiratory Care Program and exudative effusions, endosopic and ra- traditional style of ventilation, when treat- Tacoma Community College diologic imaging, pulmonary function tests, ing patients with ARDS. Tacoma, Washington and noninvasive monitoring such as end- Another item I would have liked to see tidal CO and pulse oximetry. I would have added is in the asthma section of this chap- The author reports no conflict of interest related 2 to the content of this review. liked to see more on pulse oximetry, such ter. The authors mention that the National as device limitations and precautions (eg, Institutes of Health endorses a stepwise ap- Irwin and Rippe’s Intensive Care Medi- abnormal hemoglobins and low-perfusion proach (step 1 mild persistent, through step 4 cine, 6th edition. Richard S Irwin MD and states) and debunking of some widespread severe persistent) to treating asthma. How- James M Rippe MD, editors. Philadelphia: misconceptions regarding the appropriate ever, they failed to mention the correspond- Wolters Kluwer/Lippincott Williams & applications of pulse oximetry. ing treatment the National Institutes of Wilkins. 2008. Hard cover, illustrated, 2,847 Chapter 4, on treatments, is a nice refer- Health endorses. I found it odd that the au- pages, $239. ence. It covers all the major treatments seen thors would describe the steps of diagnos- in respiratory care. This chapter starts off ing the severity of asthma but fail to include This is the 6th edition of this title, which with a thorough yet brief dialogue on drug the treatment options. Including that treat- is a classic multi-author adult critical care 1378 RESPIRATORY CARE • OCTOBER 2008 VOL 53 NO 10 BOOKS,SOFTWARE,&OTHER MEDIA textbook and reference with substantial clin- can be found in other various chapters: in tinuing through pulmonary, gut, endocrine, ical utility and a cross-disciplinary approach Chapter 51 with reference to prophylaxis and hematologic problems. for the intensivist. Having searched for an for deep venous thrombosis, and in Chapter Section 10 covers pharmacology and poi- updated, thoroughly comprehensive refer- 68 regarding the latest findings in lung bi- soning syndromes. Sections 11–16 address ence on evidence-based medicine, I am very opsy procedures, such as the use of endo- surgical issues, shock, neurological prob- impressed with all aspects of this new edi- bronchial ultrasound to pinpoint lymph lems, organ transplants, metabolism, nutri- tion, mostly that the authors maintained the nodes and blood vessels during transbron- tion, and immunological issues. The con- strengths of the previous editions while pro- chial needle aspiration. cluding sections tackle important ancillary viding crucial updates. Edition 6 remains an There are many new illustrations and considerations vital to ICU medicine—spe- easy-to-use reference with a now-familiar graphics, and new annotated up-to-date ref- cifically, psychiatric issues and “Contem- outline style. The content is systematic, erences and case studies throughout. Also porary Challenges.” solid, timely, and organized in a practical, new is the inclusion of the “Advances in Each section is well-organized and suc- organ-by-organ way. Other important main- Management” subsections at ends of the cinct. Section 4 is a prime example; it de- stays include common techniques and pro- chapters; these summarize randomized con- tails pulmonary problems in the ICU, sub- cedures; surgical and trauma sections; and trolled clinical trial results and key advances grouped with the individual chapters pulmonary, immunologic, transplantation, in the chapter subjects. The illustrations re- distinguished with highly descriptive titles, endocrine, cardiac, and psychiatric sec- produce well, complement the text, are suf- the first 5 of which (Chapters 45–49) each tions—all of which have been appropriately ficient in their descriptions, and are abun- describe a specific respiratory-failure sce- expanded. General updates establish this as dantly spread throughout the book. The nario. Chapter 45, “Respiratory Failure a multidisciplinary work that covers medi- index is highly detailed and useful, and the Part I: A Physiologic Approach to Respira- cal and surgical intensive care across every appendices provide state-of-the-art refer- tory Failure,” provides
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