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The Essentials of Respiratory Care--Fourth Edition.

I've read a lot of RT books in my time, but I've never seen this one before. I obviously have not been paying attention, since the book is already in its fourth edition and I am just learning about it for the first time. In the preface to this edition, Dr. Kacmarek indicates that it has been over 15 years since the previous edition came out. Now that I have had the opportunity to read through this book, I really wish I had discovered it earlier. This is an RT book like no other.

That's a strange admission considering that my first impression when I picked up the book and started browsing it was "how boring." But after I started reading it I couldn't put it down. There's no antagonist, there's no protagonist; no heroes or villains; there's actually no characters at all, for that matter. It is, in fact, kind of boring. There's no plot, and there's no story line and, if there's a climax, it is surely lost on me. So what is so intriguing?


This text is a one-of-a-kind compendium of practically all of the most important facts and figures about the science of respiratory therapy respiratory therapy

Medical profession concerned with assisting the respiratory function of individuals who have severe lung disorders. Practices include suctioning to clear secretions from the airway, use of aerosol mists (sometimes medicated) or gases to ease breathing,
 and respiratory care. There are literally thousands of facts in this book. (Many of which I once knew but seemed to have forgotten). I mean, practically everything looks familiar. I know this stuff, or at least I used to. This book is humbling in that it makes you realize the many vast and multifaceted layers of science upon which our profession is built. And if you have been in the field as long as I, it also makes you realize that you may have forgotten more than you currently know.


That is not necessarily a bad thing, rather, it is indicative of the breadth of knowledge that is required to be a respiratory therapist. It has been pointed out many times, by a multitude of authors, that what you know is not always as important as what you are able to search out or look up. If you believe in that, then you will find that this book is a "must-have" addition to your reference library. Let's see what I am talking about.

This book is more challenging to review and explain than others because it differs substantially from the manner in which most texts are written. Rather than explaining concepts in a sequence of grammatically correct sentences, as though telling a story or explaining a concept, this book is 100% in outline form. I tend to believe that this book makes a better reference for experienced practitioners than for students, although that is really up to the instructors to decide. Every concept is presented in a brief, concise and logically sequential outline. That makes it relatively easy to narrow down a subject, drill down into its substance, and come away with an understanding or a refreshed appreciation of the complexities of our field.

As always, here are the vital statistics: hardcover, 839 pages, 46 chapters, 3 editors (authors) and 13 contributors, all of them respiratory therapists. It is a large and heavy book, not one of those little quick reference jobs for your lab coat pocket. Keep it on your desk or in your bookcase, within easy reach.

The book is far too voluminous for me to try to explain the entire contents, so I will merely list the 46 chapters, in order: Basic Chemistry; General Principles of Gas Physics; Microbiology, Sterilization and Infection Control; Anatomy of the Respiratory System respiratory system: see respiration.
respiratory system

Organ system involved in respiration. In humans, the diaphragm and, to a lesser extent, the muscles between the ribs generate a pumping action, moving air in and out of the lungs through a
; Mechanics of Ventilation; Neurologic Control of Ventilation; Oxygen and Carbon Dioxide carbon dioxide, chemical compound, CO2, a colorless, odorless, tasteless gas that is about one and one-half times as dense as air under ordinary conditions of temperature and pressure.  Transport; Intrapulmonary Shunting and deadspace; Anatomy of the Cardiovascular System cardiovascular system: see circulatory system.
cardiovascular system

System of vessels that convey blood to and from tissues throughout the body, bringing nutrients and oxygen and removing wastes and carbon dioxide.
; Physiology of the Cardiovascular System; Cardiac Electrophysiology and ECG ECG electrocardiogram.

1. electrocardiogram

2. electrocardiograph

Also called an electrocardiogram, it records the electrical activity of the heart.
 Interpretation; Hemodynamic Monitoring hemodynamic monitoring Clinical medicine A general term for the ongoing evaluation of hemodynamics ; Renal Anatomy and Physiology; Fluid and Electrolyte Balance electrolyte balance
The relative concentrations of ions in the body's extracellular and intracellular fluids, especially those produced from ionized salts.
; Acid-Base and Blood Gas Interpretation; Anatomy and Physiology of the Nervous System; Pharmacology; Clinical Assessment of the Cardiopulmonary System; Pulmonary Function Testing; Obstructive Pulmonary Disease and General Management Principles; Obstructive Pulmonary Disease and Ventilatory Management; Restrictive Lung Diseases: General and Ventilatory Management; ARDS Ards

District (pop., 2001: 73,244), Northern Ireland. Formerly part of County Down, Ards was established as a district in 1973. Much of its land is devoted to crops and pasture. Newtownards, settled c. 1608 by Scots, is its administrative seat and manufacturing centre.
, SARS and Sepsis; Nutrition; Intrauterine intrauterine /in·tra·uter·ine/ (-u´ter-in) within the uterus.

Within the uterus.

Situated or occuring in the uterus.
 Development and Comparative Respiratory Anatomy; Assessment and Management of the Newborn; Respiratory Disorders of the Newborn; Mechanical Ventilation of the Newborn; Respiratory Disorders of the Pediatric Patient; Assisted Ventilation for Pediatric Patients; Pulmonary Rehabilitation; Home Respiratory Care and Mechanical Ventilation; Gas Therapy; Oxygen, Helium, and Nitric Oxide; Aerosol Therapy and Humidity; Airway Clearance Techniques; Analyzers; Airway Care; Modes of Mechanical Ventilation; PEEP; Initiation, Maintenance, and Weaning weaning,
n the period of transition from breast feeding to eating solid foods.


the act of separating the young from the dam that it has been sucking, or receiving a milk diet provided by the dam or from artificial sources.
 from Mechanical Ventilation; High Frequency Ventilation High frequency ventilation is a type of mechanical ventilation that employs very high respiratory rates (>150 breaths per minute) and very small tidal volumes (usually below anatomical dead space). ; Noninvasive Positive Pressure Ventilation Positive pressure ventilators help patients with respiratory problems to breathe easier. They use high pressure gas at the opening of the patients lungs in order to mobilize oxygen flow down the pressure gradient, and into the patient's lungs. ; Tracheal tracheal

pertaining to or emanating from trachea.

tracheal aspiration
see transtracheal aspiration.

tracheal band sign
on contrast radiography of a dilated esophagus, the impression made ventrally by the trachea.
 Gas Insufflation insufflation /in·suf·fla·tion/ (-sah-fla´shun)
1. the act of blowing a powder, vapor, or gas into a body cavity.

2. finely powdered or liquid drugs carried into the respiratory passages by such devices as aerosols.
; Prone Positioning; and Liquid Ventilation.

Each chapter is further subdivided into additional sections. A great deal of effort has obviously gone into the planning and execution of the outlining of this book so that information is presented in a logical sequence for boning up on a subject in general, or for looking up specific information for reference. The book does a surprisingly good job of explaining concepts with words alone and with the appropriate mathematical formulas and their derivation. Nevertheless, the book includes many excellent charts, tables and illustrations to further illuminate subjects that can not be adequately covered without a visual. There are no specific references, but each chapter contains a bibliography of pertinent materials including books, journal articles and appropriate web sites.

No undertaking of this magnitude would be possible without an occasional mistake. I discovered a few, by accident. On page 21 in the chapter on General Principles of Gas Physics, Avogadro's Number is listed as "6.02 = 1023" (sic) when we know from having it drummed into our heads in RT school that it is "6.02 X 1023." On page 617 in the chapter on Oxygen, Helium, and Nitric Oxide, the Hi-Ox 80 oxygen mask is listed as being provided by Respironics (sic) when, in fact, it is from ViaSys. So read carefully.

This book is my new best friend. I highly recommend it for what it is: a detailed and comprehensive compendium of facts, in outline form, about the science of respiratory care. It is an excellent resource for revisiting any number of the thousands of subjects that are no longer quite as fresh in our minds as they used to be. This book brings back many fond memories.

Reviewed by Michael McPeck FAARC FAARC Fellowship of the American Association for Respiratory Care  RRT RRT Rapid Response Team
RRT Registered Respiratory Therapist
RRT Renal Replacement Therapy
RRT Regional Response Team
RRT Right Side (philately)
RRT Relative Retention Time
RRT Round Robin Test
RRT Rating Region Table
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Author:McPeck, Michael
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Article Type:Book Review
Date:Sep 22, 2005
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