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- , 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, , 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 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 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 , I am very opsy procedures, such as the use of endo- surgical issues, , 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, “ 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 a comprehensive and topic, facilitated, in part, by the book’s con- ence formulas and calculations for cardio- simple overview of respiration physiology secutive progression through each organ sys- pulmonary and metabolic variables. and biochemistry, with an excellent didac- tem and by new collaborations, which are The cover style of this 6th edition is sleek tic clinical wrap-up section. reflected in the updates to almost all 211 and contemporary, integrated in a modern Chapter 46, “Respiratory Failure Part II: chapters. Accompanying the book is a com- way but with a medical feel and a new color Acute Respiratory Failure Due to Acute Re- panion online searchable version that is ex- palate that is appealing. The writing style spiratory Distress Syndrome and Pulmonary tremely useful for conducting desktop re- presents the scholarly and authoritative work Edema,” nicely represents a classic topic search. Especially helpful is that the simply and clearly. And the fonts and sub- enriched with new data and findings. In par- references are all hyperlinked directly to the headings are easy-to-read. The contributors ticular, this chapter impresses because it de- journal articles. With some work this online to this book represent a wide and varied fines acute lung injury (ALI) and acute re- book could be enhanced to the level of Up- background of critical care, including inter- spiratory distress syndrome (ARDS) and ToDate, a useful online medical informa- nists, surgeons, anesthesiologists, psychia- their relevant risk factors, followed by sec- tion resource. trists, professors, and clinical instructors. tions that describe the epidemiologic, radio- The list of specific updates is extensive. The quality of information coverage is uni- A portion of this list includes the latest tech- form and consistent from subject to subject, graphic, and various pathology features of niques for gastrointestinal endoscopy (Chap- and the subject matter is presented in a stim- the syndrome, including the pathogenesis ters 13 and 16); surgical, shock and trauma ulating way that appeals to all aspects of of ventilator-induced lung injury. Current events regarding multiple organ failure and and disciplines, and statistics are provided on ALI/ARDS mor- ; recombinant technologies for man- a wide spectrum of (ICU) bidity and mortality. aging sepsis (human activated protein C, clinicians. Chapter 46 also summarizes the numer- the safety of which is nicely referenced in As with previous editions, the text is or- ous biological signaling cascades involved Chapter 32; sepsis in Section 12); modern ganized into 18 sections, each of which en- in the pathogenesis of ALI and ARDS, with interventions for acute coronary events (Sec- compasses numerous chapters of roughly particular emphasis on pro-inflammatory tion 3); the role of the pulmonary artery 10–15 pages each. The first 2 sections, “Pro- cytokines and signaling cascades in the ; techniques in chronic obstructive cedures and Techniques” and “Minimally bronchoalveoli. This is followed by a com- pulmonary disease; strategies for acute re- Invasive Monitoring,” cover critical care prehensive summary of approaches to spiratory distress syndrome and acute lung techniques. The section on minimally inva- ARDS management via mechanical venti- injury (Section 4); diabetes (specifically, sive monitoring will help clinicians mini- lation and pharmacologic interventions. glycemic control, Section 8); new chapters mize the surgical stress response, speed up Overall, Chapter 46 provides timely and rel- on sleep disorders (Chapter 69); epidemic the physiological recovery process, and evant data and up-to-date references. For viral pneumonias (Chapter 67); and a com- shorten the hospital stay. Following these example, reference 61 is a particularly good pletely new section, “Minimally Invasive approximately 25 chapters on techniques, report on endothelial activation associated Monitoring” (Section 2). With patient safety the organization style takes a mostly organ- with survival in patients with lung injury. now a major concern of the general public system approach, with smooth transitions Chapter 47 provides a fastidious review and in policy making, Chapter 210 (Section between sections and among the chapters of status asthmaticus and its therapy, com- 18) is especially timely, in particular, its within each section. Sections 3–9 cover ill- plete with a comprehensive description of details on government regulation of patient ness management of the major organ sys- asthma pathophysiology and links to mate- safety. Opportune updates to patient safety tems, starting with cardiac issues and con- rials on the effects of environmental trig-

RESPIRATORY CARE • OCTOBER 2008 VOL 53 NO 10 1379 BOOKS,SOFTWARE,&OTHER MEDIA gers on airway inflammation. Overall, Sec- guided technique reduces complications and practitioner. Ultimately, this chapter delves tion 4 was very impressive. insertion time, but the book does not men- into the more idiosyncratic case studies and The editors accurately cover the entire tion the value of this technique, possibly sleep pathologies in the context of comor- range of topics in adult critical care, which because there is no solid data or literature to bid conditions such as chronic fatigue syn- is an ambitious task given the dramatic support it, or because it provides little or no drome. changes to virtually all aspects of the field advantage in patients in whom there is no In conclusion, this 6th edition achieves since 2000. Additionally, given that the field predicted insertion difficulty. Regardless, ul- the lofty goal of accurately translating re- has changed so dramatically, this work ac- trasound-guided central-line insertion is search into ICU clinical practice. Each chap- complishes the editor’s goal of being the common in the ICU. Another procedure ter reflects the important advances in med- first all-inclusive accurate reference of its gaining popularity is intubation with the ical intensive care since the publication of kind. It is filled with clear explanations of GlideScope, which the book mentions the 5th edition. Noted shortcomings aside, the latest assessments of the organ systems briefly but does not cover well. In attempt- this is a very complete textbook of the sci- and their various pathologies. Throughout, ing to avoid controversy, the book over- ence and art of intensive care medicine, and the work is erudite and solid, with basic looks that valuable technique. it is updated, organized and easy to read. science and clinical applications covered Perhaps the best strength of this book is Overall, this edition is improved over the well. Topics are given space proportional to that anyone with a medical background can 5th edition, and reflects current principles their importance to critical care. A stated read and assimilate the information. The au- and protocols. goal of the book is to maintain an editorial thors present the topics simply and clearly leadership that ensures that the material and build on a solidly presented foundation M Osama Alnajjar MD evolves sufficiently from previous editions with increasingly detailed information. For Michael J Apostolakos MD to meet the demands of this heterogeneous example, to describe sleep pathology, the Pulmonary and Critical Care Division field, which they accomplish impressively. new Chapter 69 covers all issues of sleep Department of Medicine Furthermore, the material remains a bal- disturbances; it gives a basic review of nor- University of Rochester anced mix of state-of-the-art and traditional mal sleep physiology and builds on these Rochester, New York facts, unencumbered by irrelevant informa- basics to logically reveal the various pathol- tion. The editors took a purposely conser- ogies. This path provides a practical ap- Peter J Papadakos MD vative approach to discussing treatment op- proach to the diagnosis and treatment of Department of Anesthesia tions and thus did not address emerging or sleep problems and a current summary of University of Rochester new ICU procedures that are now commonly their classification. This chapter begins by Rochester, New York used (eg, ultrasound-guided central-line in- naming and describing the basic sleep cy- sertion). Many ICU patients have difficult cles, which serves as a tutorial for the be- The authors report no conflict of interest related central-line insertion, and the ultrasound- ginner and as a reminder for the advanced to the content of this review.

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