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Pediatric Pulmonary Pearls
bookshelf Those readers of CHEST interested in serving as reviewers for “The Bookshelf” are asked to notify the department editor, Lee K. Brown, MD, FCCP, at the following address: New Mexico Center for Sleep Medicine, Lovelace Health Systems, 4700 Jefferson Blvd. NE, Suite 800, Albuquerque, NM 87109. Please indicate your field(s) of expertise (pulmonary, cardiology, cardiothoracic surgery, critical care, or sleep), and include your curriculum vitae if available. In appreciation for completed reviews, authors may retain the book or software for their own use.
Mechanical Ventilation Manual 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 reper-
2086
toire 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. Srinivasan Devanathan, MD Albuquerque, NM
Pediatric Pulmonary Pearls By Laura S. Inselman, MD. Philadelphia, PA: Hanley & Belfus, Inc., 2001; 230 pp; $45.00 Pediatric Pulmonary Pearls is a worthwhile book that explores and illuminates clinically relevant topics in pediatric pulmonology. The author is an experienced practicing pediatric pulmonologist at the Alfred I. Dupont Hospital for Children in Wilmington, DE, and Associate Professor of Pediatrics at Jefferson Medical College in Philadelphia, PA. In this volume, she focuses on 70 clinical vignettes of patients with respiratory diseases in a manner similar to that used during patient rounds. This quite readable format includes history, physical findings, important laboratory parameters, and numerous, clearly displayed illustrations of radiographs and CT scans. The reader can follow along with each case, formulate his or her own impressions, and consider various therapeutic options. Each vignette highlights an important issue, with pertinent discussion and references to current literature. Following the discussion, the key points demonstrated in the case are summarized as the “clinical pearls.” Dr. Inselman covers a spectrum of clinical topics ranging from the common to the esoteric. Consequently, this volume would interest clinicians at all levels, both in primary care and in pediatric pulmonology. The vignettes provide the reader with practical information derived from clinical experience as well as the medical literature, thus complementing traditional reference materials such as textbooks or journals. The cases include patients that range in age from 1 day to 19 years and adequately represent the type of case material seen by practicing pediatric pulmonologists. For example, a pediatric pulmonologist frequently consults on children who wheeze, and it is often said, “all that wheezes is not asthma.” In fact, Dr. Inselman presents 20 different patients who wheeze, each representing different diagnoses ranging from cystic fibrosis to foreign-body aspiration. Although it does not detract significantly from the overall quality and strength of the work, the reader may not find the table of contents to be user-friendly. In contrast, the index in the back consists of bolded page references that provide direction to particularly relevant cases as well as nonbolded page references that lead the reader to all of the vignettes that touch on that issue in any way. In summary, Pediatric Pulmonary Pearls is an engaging collection of clinical vignettes that are clearly presented and are accompanied by meaningful and useful teaching points. Thus, it provides a helpful review for the practicing physician that can also be used as a handy reference. Carin Lamm, MD New York, NY
Bookshelf
Mechanical Ventilation Manual 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 reper-
2086
toire 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. Srinivasan Devanathan, MD Albuquerque, NM
Pediatric Pulmonary Pearls By Laura S. Inselman, MD. Philadelphia, PA: Hanley & Belfus, Inc., 2001; 230 pp; $45.00 Pediatric Pulmonary Pearls is a worthwhile book that explores and illuminates clinically relevant topics in pediatric pulmonology. The author is an experienced practicing pediatric pulmonologist at the Alfred I. Dupont Hospital for Children in Wilmington, DE, and Associate Professor of Pediatrics at Jefferson Medical College in Philadelphia, PA. In this volume, she focuses on 70 clinical vignettes of patients with respiratory diseases in a manner similar to that used during patient rounds. This quite readable format includes history, physical findings, important laboratory parameters, and numerous, clearly displayed illustrations of radiographs and CT scans. The reader can follow along with each case, formulate his or her own impressions, and consider various therapeutic options. Each vignette highlights an important issue, with pertinent discussion and references to current literature. Following the discussion, the key points demonstrated in the case are summarized as the “clinical pearls.” Dr. Inselman covers a spectrum of clinical topics ranging from the common to the esoteric. Consequently, this volume would interest clinicians at all levels, both in primary care and in pediatric pulmonology. The vignettes provide the reader with practical information derived from clinical experience as well as the medical literature, thus complementing traditional reference materials such as textbooks or journals. The cases include patients that range in age from 1 day to 19 years and adequately represent the type of case material seen by practicing pediatric pulmonologists. For example, a pediatric pulmonologist frequently consults on children who wheeze, and it is often said, “all that wheezes is not asthma.” In fact, Dr. Inselman presents 20 different patients who wheeze, each representing different diagnoses ranging from cystic fibrosis to foreign-body aspiration. Although it does not detract significantly from the overall quality and strength of the work, the reader may not find the table of contents to be user-friendly. In contrast, the index in the back consists of bolded page references that provide direction to particularly relevant cases as well as nonbolded page references that lead the reader to all of the vignettes that touch on that issue in any way. In summary, Pediatric Pulmonary Pearls is an engaging collection of clinical vignettes that are clearly presented and are accompanied by meaningful and useful teaching points. Thus, it provides a helpful review for the practicing physician that can also be used as a handy reference. Carin Lamm, MD New York, NY
Bookshelf