of Neonatal Respiratory Care", Sunil
K Sinha and Steven M Donn, editors. Futura Publishing
Company, Inc., Armonk, NY, 2000. 498 pages.
Reviewed by: Frank
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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
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
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
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
Primiano, PhD, is the Executive Vice President of
Amethyst Research, LLC.