Mosby's Respiratory Care Equipment.

There are two comprehensive "equipment" textbooks available to the respiratory therapy profession, and this is one of them.

This is a hefty book; it is hardbound and has 885 pages divided into 15 chapters. I like the way it looks when you open the pages. The text is in a crisp 10 pt Times New Roman black font against white paper, as would be expected. But chapter pages, headings, and table backgrounds are in very pleasing shades of green on the white paper. This color theme is carried throughout the book and is both easy on the eyes and helps to differentiate important portions of the pages. Most of the line drawings are black on white and quite nicely done. Drawings that incorporate waveforms use the green color theme effectively to call attention to the waveforms, as do schematic drawings of equipment control panels. All photographs in the book are rendered in black and white and are clear. It appears the authors made an effort to use detailed schematic drawings when photographs would not be expected to show the important features of specific equipment adequately.

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The book begins with a chapter on basic physics and concisely covers the key precepts of physics that are necessary for a reasonable understanding of how medical equipment works. That includes a little bit about energy and matter, a review of the gas laws, an overview of fluid mechanics and the principles of electricity. The second chapter is a routine review of medical gas manufacturing, storage and transport; not unlike similar chapters found in basic respiratory therapy texts. While both of these chapters could probably have been eliminated without detracting from the quality of the book, it is convenient to have them available for reference. In their preface, the authors explain that the structure of the text is designed to follow a typical respiratory curriculum.

The third and fourth chapters deal with medical gas administration devices and humidity/aerosol therapy devices, respectively. The medical gas chapter is comprehensive in the it goes beyond routine oxygen therapy and includes information about hyperbaric oxygen therapy, plus specialized therapy with gases such as nitric oxide, heliox and carbogen. However, if you are looking for a great deal of detailed information about administration of these specialty gases, this chapter will be a bit too basic for that purpose since it only presents a cursory overview.

Chapter 5 concerns the principles of infection control and is short and to-the-point. It just barely covers some relevant microbiology then deals with the standard sterilization techniques of steam autoclaving and ethylene oxide gas. I found this chapter a little lacking in that it would also have been a good place for a discussion concerning respiratory filters and their effectiveness (or purported lack thereof). A section on Droplet Precautions was only 73 words. The SARS epidemic emerged while this book was in press, so I imagine droplet precautions will get more attention in a future edition.

Chapters 6-10 cover Lung Expansion Devices, Assessment of Pulmonary Function, Cardiovascular Diagnostic Testing and Blood Gas Monitoring, respectively. These are all reasonably comprehensive with many excellent representative equipment and technique illustrations. The expansion device chapter is about as up-to-date as can be with coverage of the simple PEP and flutter devices as well as the complex vest and intrapulmonary vibration and oscillation systems. The chapter on cardiovascular diagnostics includes reviews of electro-cardiography, various indwelling vascular pressure catheters and the equipment that measures it. The blood gas chapter seems up-to-date with respect to its inclusion of very contemporary devices such as ion-selective electrodes and indwelling fiberoptic catheters. Of course, the obligatory review of transcutaneous oxygen and carbon dioxide monitoring and pulse oximetry is included.

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The book's tour de force has got to be the four chapters on mechanical ventilators. These four chapters comprise approximately 55% of the book's total pages and may well be the single best reason to purchase the book. The chapter entitled "Introduction to Ventilators" deals with fundamental principles and concepts and is worthy of being read, reread and referenced by all practitioners no matter how long they've been in practice. The remaining chapters deal with the brand names and detail the specific operating features of practically every contemporary ventilator model on the market and remaining in contemporary usage in the US. These final three ventilator chapters are divided into general-use devices; infant and pediatric ventilators; and transport, home-care, and alternative ventilatory devices. These chapters contain an absolutely incredible wealth of information and specifications, presented clearly and concisely and augmented with intelligently-selected illustrations. Aside from the value this comprehensive collection of information has for students, its value to managers considering new ventilator purchases is immense. And for practitioners and inservice educators who may have to teach house officers and nurses, as well as RTs, having all of this quality information in one place should facilitate preparation

The books final chapter is a brief review of sleep diagnostics. It may be a good starting point for one who knows little or nothing about polysomnography and sleep medicine. It explains most of the basic principles of sleep physiology and what can be measured. The chapter explains generically how most of the sleep diagnostic equipment works, but it will not fill most needs for equipment specification and differentiation.

A helpful feature, used throughout the book, are side boxes highlighting important Clinical Practice Guidelines (CPGs) pertaining to relevant information in the text. This is useful feature for managers seeking to correlate Policies & Procedures, or competency evaluations, with the CPGs. One of the things I would have wished for in this book would have been a chapter on medical equipment regulation and safety. Now, more than ever, medical equipment is subject to an increasing amount of regulation vis a vis the Food and Drug Administration, I think it is never too early to begin teaching students about the increasingly challenging regulatory environment they will undoubtedly encounter as practitioners or even managers. However, in summary, I am very impressed with this excellent equipment textbook. In my opinion, it deserves a place in our intellectual tool box and on our shelves.

Reviewed by Michael McPeck RRT