Nunn’s Applied Respiratory Physiology, 6th ed.

Nunn’s Applied Respiratory Physiology, 6th ed. Lumb AB, ed. Philadelphia: Elsevier/ Butterworth Heinemann, 2005. ISBN 0-7506-8791-6. 501 pages, $125.00. This is the 6th edition of a classic text of applied respiratory physiology, first published in 1969. The first four editions were authored by Dr. John Nunn himself, and this is the second edition under the direction of Dr. Andrew Lumb, who took over the responsibility for this text with the 5th edition published in 2000. This reviewer believes that this is the definitive reference text of respiratory physiology for anyone involved in perioperative patient care. This is a difficult subject, and the popularity of this text is in large part due to the fact that it is well written. Since it is essentially a single- (now two-) authored book, there is almost no overlap and there are clear references between sections to topics that are discussed in more than one place. Also, the style of writing is excellent, clear and concise. Unlike most multiauthored texts, there is a consistency to the pattern of writing, with little or no fluctuation in the quality from chapter to chapter. New to the 6th edition is the identification of key references that the author feels are particularly noteworthy either due to the importance or the newness of the information contained in the specific citation. This book evolved with the 5th edition to include three separate sections. “Part 1: Basic Principles” contains chapters on the atmosphere, functional anatomy of the respiratory tract, elastic forces and lung volumes, respiratory system resistance, control of breathing, pulmonary ventilation, the pulmonary circulation, distribution of ventilation and perfusion, diffusion of gases, carbon dioxide, oxygen, nonrespiratory functions of the lung, and the history of respiratory physiology. It is difficult to find fault with this section. The concepts are complicated. The diagrams and legends aid tremendously in understanding the principles and the illustrations seem to be as comprehensible as possible. In the chapter on pulmonary circulation, perfusion in zone 1 is discussed before it is explained what the zones of the lung are. This is no problem for someone familiar with the topic but would be confusing to a newcomer. It is surprising that Dr. J. B. West’s name does not seem to be mentioned in the text in relation to these zones nor are his references highlighted. These are certainly landmark research papers in the field. New to this 6th edition is chapter 13 on the history of respiratory physiology. However, this chapter seems to be out of context at the point it is presented in the book and would make more sense as an introductory first or second chapter. “Part 2: Applied Physiology” includes chapters on pregnancy, neonates and children, exercise, sleep, high altitude and flying, high pressure and diving, respiration in closed environments and space, drowning, smoking and air pollution, anesthesia, changes in carbon dioxide tension, hypoxia, anemia, and hyperoxia and oxygen toxicity. This is a primary reference source for respiratory function in this spectrum of normal and abnormal environments. The topics covered are dealt with in depth. The chapter on sleep contains up-to-date information on sleep apnea, which is currently an area of major interest in anesthesia. It is surprising that there is no discussion of pulmonary resection, either assessing a patient’s ability to tolerate a pulmonary resection or the changes in cardiorespiratory function after lung resection. This is certainly an area of major concern to most specialists and trainees in chest medicine, anesthesia, and surgery. “Part 3: Physiology of Pulmonary Disease” covers ventilatory failure, airway disease, pulmonary vascular disease, parenchymal lung disease, acute lung injury, respiratory support and artificial ventilation, and lung transplantation. Here the author acknowledges that the focus is on the physiology of these topics without trying to present comprehensive discussions of clinical management. The author succeeds in his goals. However these are huge topics and it is very difficult to do them justice in less than 100 pages of text. For example, there is a discussion of weaning from artificial ventilation in chapter 32 but no discussion of an approach to the patient who fails weaning. Techniques for assessment of diaphragm dysfunction are mentioned briefly in chapter 6, but no details are provided. Also, the suggested level of PaO2:FIO2 ratio acceptable for weaning (150 mm Hg) may be too liberal. In chapter 30, the discussion of lung collapse (atelectasis) should include a mention of some of the recent evidence that atelectasis causes a local inflammatory response in the lung which progresses to injury. The appendices of this text need to be highlighted because they are extremely useful. No where else is it as easy to access this information on Units of Measurement, Gas Laws, Symbols and Abbreviations, etc. For anyone writing, reviewing, or editing a manuscript that involves respiration, this is an invaluable resource. However, it appears that the x-axis in Figure E.4 should be labeled “100% shunt” not “0%”. In summary, this text remains the primary source of reference information for any health care practitioner involved in the management of patients’ respiration. The essentials of respiratory physiology such as compliance, resistance, gas exchange, etc. are not covered in adequate depth in the standard texts of medicine or anesthesia, and any resident in these fields should have access to this text. It is also an unparalleled source of information for any physician teaching in these areas. However, it does not claim to provide all the information required to treat a patient with a specific respiratory pathology, and the reader should not expect this. Peter D. Slinger, MD Professor of Anaesthesia University of Toronto Toronto, Ontario, Canada [email protected]