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Practical Pulmonary and Critical Care Medicine: Respiratory Failure

2006 Edition, January 20, 2006

Complete Document

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Active, Most Current

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ISBN: 978-0-8493-6663-5
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Product Details:

  • Revision: 2006 Edition, January 20, 2006
  • Published Date: January 20, 2006
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 445
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Over the past decade, the pace of progress in medicine has been astounding. New developments in diagnosis, management, and therapeutics occur at a breathtaking rate. A new disease emerges and, aided by the ease of transcontinental travel, threatens to become the next pandemic. And just as quickly, the causative agent is identified with diagnostics and therapeutics soon to follow. Old diseases have their mysteries unraveled, and targeted therapeutics provide hope where there was once despair. Some conditions come under control in less than a generation's span, while others plod along inexorably to the end, with little available to alter their course.

Just as the conditions of disease have changed, so have the conduits for information. The speed and availability of electronic databases now allow access to vast warehouses of information at the click of a mouse or flick of a stylus. Where once the resident or houseofficer carried a worn copy of a spiral bound manual, handheld computers are now the essential accessories. The grand old textbooks have followed suit, available in versions abbreviated to fit file-size limits or available in their own electronic internet-based versions. This electronic world not only allows but mandates frequent content changes. Information can be updated daily and even more frequently if necessary. The online resource is now predominant in an arena that was once the domain of the print journal. Whereas attendance at national or international meetings once offered the latest developments, this information can now be accessed from a remote site and disseminated at near-instantaneous speed, certainly before one can return home.

Why then, in this information rich era, would there be a need for this book? First of all, even though there is instant access and availability to volumes of information, there remains a dearth of practical information. No one functions in the vacuum of cyberspace or isolation of an information warehouse. Everyone faces the limitations of available technology, restricted formularies, time pressures, and treatment preferences. In addition to the wealth of knowledge, one requires the wisdom of experience and expediency of practical management. The best technology or therapeutic is only as effective as the treatment that can be instituted by the lone practitioner. Treatment available only to the few or the very specialized usually has no role in general management.

Filling this void is the guiding premise of this book. Even if mutations threaten to render current antimicrobials ineffective or new disease entities emerge, there remains a need for comprehensive and effective supportive care. This care is best provided not by the disease specialist, but by physicians who carry a broader perspective while also maintaining focus on the most pressing problems. In the new lexicon of medicine, this is the hospitalist or intensivist. Because many of the most immediate life-threatening conditions involve the respiratory tract, management often falls under the domain of pulmonary and critical care, either as the pulmonologist and/or intensivist. The need for coordinated comprehensive care is further highlighted by increasingly vulnerable patients as a result of increased longevity, treatment modalities that strip a patient's immune system, and emerging disease entities. The modern pulmonary and critical care physician not only has to deal with the many complexities of illness, but also must choose the best available approach to facilitate recovery.

This has required the intensivist to assume many roles in patient management, but none more important than as the functional equivalent of a chief executive with oversight over total management. This has required familiarity with areas where they are not generally considered expert, and reliance on a multi-disciplinary approach to care. These sections in the text are authored by experts in the area who provide a broad overview, but highlight those issues most important in managing critically ill patients. This brings the intensivist's view to the specialist's world.

As every bibliophile knows, the advantage of a textbook often lies in the additional or complementary information that is often encountered through perusal of its pages. Electronic sources are often unforgiving in their searches, limiting access to pre-determined and pre-defined categories. With a book, one can often identify the needed content within its covers even if one is not quite certain of the initial focus of inquiry. The topic may not be in the first section, but is invariably covered in a subsequent area.

Practical Pulmonary and Critical Care is divided into two volumes based partly on space limitations and partly by design. This first volume focuses on immediate management and diagnosis. For the practicing physician, this is often referred to in billing as the first hour or more of critical care management. This often involves the patient with respiratory failure, one of the most common entry conditions into a hospital or critical care unit. These patients often present in extreme distress and the underlying diagnosis may not be immediately apparent or may require further investigation. Other patients are intubated as part of support measures while therapy is directed at other organs.

This volume includes chapters and strategies on immediate management of these patients. This includes an extensive treatise on oxygen strategies, helium– oxygen, and non-invasive ventilation. If the patient fails these conservative measures, the focus shifts to intubation and ventilator management. The alphabet soup of ventilator modes and waveform interpretation is clarified with a section that allows comparisons between multiple vendors. These patients demand close monitoring, and a chapter is dedicated to the nuances of monitoring their response to therapy as well as mechanical ventilation. Other sections deal with the delicate task of discontinuing mechanical ventilation and patients who require long-term ventilatory support.

These patients often have multi-organ system dysfunction. In addition to ventilatory support, they often require other invasive procedures, either therapeutically or to provide or guide therapeutics. A comprehensive section is dedicated to the most commonly performed procedures, with an abundance of detailed figures and tables. This includes coverage of procedures once reserved for surgical colleagues, such as tube thoracostomy or tracheostomy. Equally important are imaging studies that help diagnose and monitor a patient's response to therapy. The section on radiology covers the gamut with respect to patient management, including the use of the radiograph for confirmation of location of invasive devices, diagnosis, and illustrative cases. The radiographs are all derived from recent cases and reproduce well, providing important detail useful in management. Each topic is covered with a focus on details that facilitate its implementation and potential pitfalls, as well as a practical perspective on its role in overall management.

It is this perspective that not only defines this book, but hopefully lends an enduring quality to its content. There have been very few scientific developments that have completely altered the management of patients. Changes are often incremental and incorporated over several years of practical experience, although medications may be the one exception. The experience of time allows techniques to undergo further refinement. Practical aspects of management are highlighted with detailed descriptions of procedures, protocols, or guidelines. There is often much to gain from historical perspective, and this information is judiciously included as well as that which is evidence based. Therefore, even though technology, medications, and formularies have changed over the past decade, patients with acute respiratory failure still have the same basic requirements in their management. Ventilators must provide the best support while inflicting the least amount of ventilator-associated injury. And once the road to recovery is reached, assisted ventilation should be removed as soon as possible. These basic tenets will not change in the foreseeable future, only the details in implementation. Although a paper-based textbook may not have the allure of electronic media, it can provide a roadmap and framework for efficient and pragmatic care. Once in place, additional information can only enhance the work and final product. We share a common goal to enhance the recovery of patients from a critical illness. We hope this textbook can contribute to that end result.