Book: Respiratory Support in Intensive Care
Authors: Andrew T Cohen
Journal: BMJ (2000)

Eds Keith Sykes, J D Young


BMJ Books, £30, pp 315 




ISBN 0 7279 1379 4

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Rating: ★★★

In 1543 Vesalius demonstrated that rhythmical inflation of the lungs would keep an animal with an open chest alive. It took a further 200 years before John Hunter's experiments resulted in the Royal Humane Society recommending the use of bellows in the resuscitation of the apparently drowned. The first attempts at respiratory support in hospital were confined to patients with normal lungs, usually those with neurological problems.

The early part of the last century saw many polio epidemics, but patients who suffered respiratory muscle paralysis could be kept alive with negative pressure ventilators. In Britain Lord Nuffield offered to make tank ventilators in his Morris car factory and gave one to any hospital in the British Commonwealth that needed one. A major advantage of negative pressure ventilation with a tank ventilator was that it simulated normal respiratory physiology, but, for practical reasons, it was of little use in a patient with substantial pulmonary disease. The introduction of positive pressure ventilation was stimulated by several factors such as the severe polio epidemic in 1952, a desire to ventilate sicker patients, and developments in thoracic surgery.

Many sophisticated techniques are available for ventilating patients with severe pulmonary disease such as acute respiratory distress syndrome (ARDS). Generally there is a careful balance between the risks of pulmonary damage from excess pressure, or “overstretch” of alveoli, and that of achieving adequate oxygenation. The cardiovascular system is invariably compromised by the process of aggressive positive pressure ventilation, but this effect can be minimised by careful choice of mode of ventilation.

This book is aimed at introducing trainees to the principles of respiratory support. This is a rapidly changing field fuelled by equipment manufacturers' desires to invent unique modes of ventilation. To complicate the matter further, many patients are managed on various combinations of spontaneous and mandatory breathing patterns. Although the book is not intended for experienced intensivists, most would probably learn something from reading the comprehensive text.

In recent years there has been an increasing amount of respiratory support available outside intensive care. Respiratory wards increasingly use “non-invasive” ventilation, and ventilation with similar equipment at home is becoming more common. All doctors working in acute medicine need to know how to support airway and breathing. The authors have succeeded in cramming a vast amount of information into this small book, but they could have freed up some space by not wandering off the subject. Little is added when they occasionally discuss non-respiratory aspects of intensive care management. The descriptions of individual intensive care ventilators in the chapter on ventilator technology are well worth avoiding, but otherwise this book is easy to read and difficult to fault. In my opinion it achieves its objectives.