Critical Care Focus Volume 2: Respiratory Failure
HELEN F. GALLEY (ed).
BMJ Publishing Group: London, UK, 1999, second impression 2000.
Paperback. ISBN 0–7279–1466–9.
The only clue to the purpose of this slim volume is a brief note under the catalogue number stating that the chapters are based on talks given at the Intensive Care Society's ‘State of the Art’ Meeting in London in December 1988.
There are six chapters varying in length from 4 to 19 pages. The first, by A. B. Lumb, deals with the respiratory physiology of positive pressure ventilation. The author rightly points out that it is difficult to separate the changes in physiology owing to artificial ventilation from those produced by posture, anaesthesia/sedation and muscle relaxation, but he then makes a number of controversial statements. One is that conscious patients requiring artificial ventilation invariably have severely abnormal lung function. Has he never treated a patient with poliomyelitis or myasthenia gravis? Another is that the preferential ventilation of the dependent parts of the lung during spontaneous breathing is due to the weight of the lung compressing alveoli in dependent zones, so reducing their compliance. In fact, the lower alveoli lie on a steeper part of the pressure–volume curve and so expand more for a given transpulmonary pressure difference. The final outrage for this reviewer was the statement that regional distribution is the same for spontaneous and controlled ventilation. How could he deny the role of the chest wall on distribution?
In Chapter 2, M. Antonelli gives a balanced view of the confused literature on noninvasive respiratory support, while L. Brochard's brief chapter on ventilator weaning merely confirms that there is nothing new to discuss. A. Pesenti contributes an excellent chapter on the effects of changes in position on blood gases in acute respiratory failure, while G. Bellingan reviews the possible role of steroids in modifying the early fibrotic response in acute lung injury. Finally, John West contributes a characteristically clear discussion on the possible role of capillary stress failure in the production of lung injury.
This volume provides a reasonable summary of some topics of respiratory interest in 1998, but could have benefited from some critical editing.