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Book Review

"Manual of Neonatal Respiratory Care", Sunil K Sinha and Steven M Donn, editors. Futura Publishing Company, Inc., Armonk, NY, 2000. 498 pages.

Reviewed by: Frank Primiano, PhD

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Neonatal respiratory care has been evolving constantly during the last four decades. As technologies -- and the capabilities they provide -- change, the procedures required for their use change also. Consequently, there is a real need for up-to-date information about currently available and recent legacy equipment and the strategies for their application. "The Manual of Neonatal Respiratory Care" is a compendium of such information.

This book presents a wealth of information about devices and procedures for neonatal respiratory support that a well-versed practitioner in the field should know. It covers a broad range of topics, beginning with the physiology and fundamentals of neonatal ventilatory mechanics and gas exchange. Descriptions of the features and technical aspects of newer conventional and high frequency ventilators follow, along with chapters on alternative forms of respiratory support such as liquid ventilation, extracorporeal membrane oxygenation, and nitric oxide therapy. It includes the clinical indications for available devices, and practical protocols for their use, and concludes by exploring ethical issues, and by presenting a series of clinical case studies.

The book is written in outline format for quick reference. Complementing this format is an extensive subject index and a comprehensive list of abbreviations and symbols. Both of these are necessary tools for a book that covers so much territory.

The practice perspectives are from both sides of the Atlantic as might be expected from the affiliations of the two editors: Dr. Sinha is from the UK and Dr. Donn from the USA. Of the 63 contributors, nearly one-third are from the United Kingdom, with one from Germany and another from Australia.

The Editors did a fine job of selecting knowledgeable authors, but they might have exercised more editorial control of both content and copy. There are numerous typos, misspellings, errors in unit conversion, and figures incorrectly referenced. The index, which is very good, nevertheless is missing references to some key topics mentioned in the book.

It is likely that the editors provided guidelines to their authors but may not have held them strictly to them. There is a lack of consistency in format and content among various chapters. Some chapters are in true terse, sparse, outline form, whereas others seem to be straight text with the paragraphs numbered to give the appearance of an outline. The internal organization and content of the chapters describing specific ventilators vary from one chapter to another making it difficult to compare the features of different machines against each other.

One of the drawbacks of trying to produce a comprehensive book is that a large area may be covered but only to a limited depth. This can be compounded by the need for brevity in the outline format. Missing is the description of devices that could be used to mechanically ventilate a patient during transport. Also, one might consider mentioning the applicable techniques for, and some of the parameters derived from, measuring and monitoring blood pressure (invasive and non-invasive), airway pressure, gas flow, temperature, inspired oxygen, and perhaps, EEG. It also would be helpful to provide an idea of the sizes of the various machines: a statement of dimensions would suffice but pictures of the whole machine and the detail of the control panel would be better. Lack of space also appears to limit the explanation of artifacts and extraneous features in figures reprinted from other sources to illustrate specific points.

One of the shortcomings of the medical literature is the context sensitivity and ad hoc nature of its terminology and symbols. For example, CV could stand for curriculum vita, cardiovascular, and controlled ventilation, all of which can appear in the same article. Only the context distinguishes them. So it is understandable that the abbreviation list in the front of this book shows multiple definitions for the same abbreviations, e.g., P for para and for pressure, g for gram and for gauge, or PMA for premenstrual age and for pre-market approval. However, there is no excuse for an editor to permit the reverse situation to occur in a book, that is, having more than one symbol for the same variable or concept. In the abbreviation list, g and gm both stand for gram; h and hr, for hour; F and f for frequency, and so forth. Adding to the potential confusion is the assignment of more than one name to the same entity (BR for breath rate and RR for respiratory rate), or defining two abbreviations for a word (F and FR for French) and then using the word itself instead of the abbreviation in a number of chapters. It is difficult enough to understand abstract concepts without symbols and abbreviations that can change from page to page

However, rather than being fatal flaws of the book, the above shortcomings serve more as bothersome distractions. This also is true for the outdated addresses and company names for some of the ventilator manufacturers, for example, Infrasonics (now part of Nellcor Puritan Bennett, Carlsbad, CA, which is part of Mallinckrodt, Inc., St Louis, MO) and Bear (now in Palm Springs, CA and part of Thermo Respiratory Group).

A more important problem is that there are three chapters that deal with ventilatory mechanics and various expressions of the equation of motion for the respiratory system, and none of them explicitly includes a term for the driving force developed by the respiratory muscles. This is conventionally represented as an effective muscle "pressure," PM.

The book is intended as a ready reference, and is sized to fit in the pocket of a lab coat or jacket. If it is subjected to frequent use, however, one wonders how durable the pages will be when repeatedly moved over their plastic binding.

On the whole, the chapters are written at a high level. A great deal of information is distilled into one place that one would have to search numerous texts and a lot of product literature to find. The book, however, is probably not for someone just learning the subject matter. It would be most useful to someone who is familiar with the concepts but needs a reference for specific facts. It would be ideal when planning a presentation or course to teach, for which an overview of topics is required, as a supplement for formal training, or as a review resource. We hope that the book is sufficiently popular that it warrants a second printing, from which the publisher and editors eliminate the distractions we saw in this printin

Frank Primiano, PhD, is the Executive Vice President of Amethyst Research, LLC.

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