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Equipment Theory for Respiratory Care, 4th edition.

I hate to sound like Andy Rooney, but reviewing RC equipment textbooks makes me grumpy. I mean, how many RC equipment textbooks do we really need? How different can they be? Well, I have discovered that it all depends upon what you wish to use the book for. Upon seeing this book for the first time, I made the mistake of assuming that it could function as an acceptable reference book for me to look up arcane details and specifications about certain pieces of equipment. Wrong! While the book does indeed have a wealth of photos, diagrams and descriptive text, it does not deal in exhaustive specifications. Instead, it seems to be aimed squarely at the student respiratory therapist who is charged with trying to understand, apply and troubleshoot a vast variety of respiratory therapy equipment as part of a formal educational program. To this end, the book is aimed at making the educator's job easier.


This is a large hardbound book. There are 718 pages divided into 12 chapters. All pages are rendered with black font against white paper and photographs are all black and white. They are almost always used to show scale and layout while black and white line drawings are used to depict detail or setup. Most of the line drawings are quite good but a few miss the point they are supposed to convey due to oversimplification.

The book contains a number of features which will make it attractive to educators. One is the liberal use of troubleshooting flowcharts or logic diagrams. These decision trees address and teach the importance of using a logical, sequential, stepwise approach to problem solving with respect to equipment malfunctions. And, importantly, they also stress monitoring the patient as well as the machine. Although there are no detailed specifications to render this book particularly valuable in the reference sense, the use of the troubleshooting diagrams may nevertheless qualify it for inclusion in the RC department bookshelf as a reference tool of a different sort. Another feature of the book is the inclusion of the AARC Clinical Practice Guidelines (CPG) and the specific reference thereto whenever the book introduces the reader to a new piece of equipment. Hopefully, this will start to engrain new students with the idea that the application of either simple or sophisticated equipment to patients should be done on the basis of some evidence that it's actually effective. Hopefully all new RC textbooks in the future will include the AARC CPGs.


All chapters start with a list of objectives for learning and may include some indications for therapy as well as a list of the types of equipment that the chapter will cover, plus a list of key terms. Then, where indicated, most chapters explore the relevant physical principles germane to its particular category of equipment. Thereafter most chapters introduce the relevant CPG(s) and then provide numerous examples of the different brands of equipment in the relevant category. It is here that the photos, diagrams and troubleshooting charts come into play. Most chapters end with a "Clinical Corner," which is a set of questions to the reader designed to challenge the reader's understanding of the material based upon real-life examples of problems or situations where the equipment from the chapter is being used clinically. A Self-Assessment Quiz at the end of the chapter consists of a set of traditional multiple choice questions.

In terms of timeliness, the book seems to be almost up-to-the-minute with respect to the equipment that is included. After hearing from the ranks of educators who had reviewed previous editions, the author deliberately dropped some of the older equipment in the preparation of this edition. This does not seem to have adversely affected the book's historical perspective. Some of the modern equipment that is shown in the book include: both mechanical and electronic oxygen conserving devices, the Vapotherm 2000 high flow oxygen delivery system and the HiOx80 oxygen delivery system from Viasys, plus a number of devices for PEP and flutter therapy. Although IPPB with classical devices (Bird Mark 7 and Bennett PR-2) is covered, newer therapies such as IPV (Intrapulmonary Percussive Ventilation) and the Percussionaire devices are also explained. Have you ever wondered what a Phasitron was?

The section on Physiological Measurement and Monitoring Devices attempts to be comprehensive but results in extreme brevity with respect to all the different devices it covers. Included are pulmonary function equipment, oxygen analyzers, and blood gas analyzers which are better explained in other books. This brevity is probably acceptable as long as students are told that the chapter just scratches the surface and they directed to the other resources. To the book's credit, there is a brief, albeit reasonably accurate, overview of the concept of calibration and quality control of blood gas systems. Unfortunately, there are no photographs of contemporary blood gas/electrolyte analyzers or even any mention that modern instruments also measure electrolytes, glucose, lactate and other components of the blood chemistry. This brings me to another observation about the entire book: there are no references. Granted, the chapters end with a so-called "Selected Bibliography," but there are no specific references to studies or evaluations published in the peer-reviewed literature. I suspect it would be a monumental undertaking to include specific references throughout the text, and I admittedly agree that references may not be helpful for the majority of students using the book. But for those of us who want evidence, or wish to follow up in depth, the lack of references is disappointing.

The second half of the book is devoted to mechanical ventilation and mechanical ventilators. The ventilator section, comprising 6 chapters, begins, predictably, with the physics of mechanical ventilation and the classification of ventilators, then dives into the meat-and-potatoes with examples of various machines as classified by either pressure or volume as the control variable. As for specific devices, the text includes some legacy machines such as the Bear 1, 2, 3, 5 and 1000; Monaghan 225; Puritan Bennett 7200 and others. It also includes more contemporary ventilators such as the Draeger Evita, the Nellcor Puritan Bennett 840, the Siemens Servo i and the Viasys Vela. There is also a large contingent of specialty devices in the realms of transport ventilators, homecare ventilators, non-invasive systems and high-frequency ventilators. Because of the vast array of ventilators at our disposal, the book can do little but scratch the surface in the limited space available. For the most part, there is a basic overview of each device, but no beef. Accordingly, I now have mixed feelings about including ventilators in an RC equipment text. I don't know what the answer is. Arguably, they are part of the universe of RC equipment and should be represented. However, how can a single equipment book do the subject justice without requiring another 2000 pages? It is a daunting question and one that the author might want to take under consideration for future editions.

In summary, this is a reasonably comprehensive textbook about the vast universe of RC equipment. As such, it is not the forum for excessive depth, and most of the discussions about the equipment are understandably superficial. Nevertheless, the book does an excellent job of exposing and summarizing the wide universe of equipment for the new RC student.

Now that I understand who the book is for, I'm not so grumpy anymore.

Reviewed by Michael McPeck RRT
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Author:McPeck, Michael
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Article Type:Book Review
Date:Jan 1, 2005
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