Respiratory Intensive Care.

To surgeons trained before 1970, the techniques, concepts, and vocabulary of respiratory intensive care are frequently bewildering. Even those surgeons trained more recently or house officers now in training could be helped by a guide to the complexities of this field. Dr. Robert M. Rogers, chief of the pulmonary section of the University of Oklahoma, offers such a manual in this collection of essays by contributing authors on the analysis and treatment of the patient in respiratory failure. A number of the chapters appeared in a special issue of CHEST on respiratory intensive care published in August, 1972. Those chapters and others written for this collection give a reasonably complete picture of the management of the moderately or seriously ill patient with respiratory failure. Difficult subjects such as hypercapnia and hypocapnia, acid-base balance, and the physiology and management of hypoxia are attacked in crisp, clear discussions. The beautiful diagrams in a chapter on oxygen transport by Dr. Klocke will aid the uninitiated in understanding this field. Many find working with ventilators confusing. There is a good, full description of ventilator management, including a chapter on positive endexpiratory pressure. Reading this section of the book should clarify the use of respirators considerably, particularly for anyone who at 2:OO a.m. and alone, has wondered how to set the dials on a MA-1. For surgeons, the chapter on pulmonary complications of general surgery by Dr. Pierce should be useful, although the concepts of diffuse microatelectasis and of increased closing volume in the perioperative period (both of which are stressed) are not particularly new. There are good sections on setting up a respiratory intensive care unit and on two procedures (fiberoptic bronchoscopy and bronchopulmonary lavage) used in some patients with failure of gas exchange. As in any multi-authored book, there is some padding and overlap. The proportion here, however, is acceptably low. In general, Respiratory Intensive Care can be recommended as an accurate, clear, and sensible introduction to the subject.