Principles & Practice of Mechanical Ventilation, 2nd Edition. By Martin J. Tobin, M.D. New York, McGraw-Hill, 2006. Pages: 1,442. Price: $189.95.

The second edition of Principles & Practice of Mechanical Ventilation, as the editor states in his preface, is not a simple restyling. The first edition has served as an authoritative guide for more than 10 yr; now, along with additional chapters, figures, and diagrams, the book continues to illustrate the techniques, illnesses, and appropriate methods of bedside ventilatory management. After 12 yr, the content has been substantially revised, including 24 new chapters. Emphasis is placed on novel subjects, e.g., ventilator-induced diaphragmatic damage, inhaled antibiotic therapy, liquid ventilation, and inhaled nitric oxide. This book is unrivaled in its comprehensive scope, focusing on the subject and practical implications. The detailed and accurate description of pathophysiology provides insight into the etiology of different clinical conditions. This textbook contains the physiologic and practical fundamentals of everyday clinical activity for pneumologists and critical care physicians. In the era of the Web, this book confirms the value of the printed text; to leaf through the pages is a special experience for both novices and experts.

In 70 chapters, more than 100 leading experts in the field from all over the world have composed a Summa Theologica (as defined by the editor, Martin Tobin, M.D., Professor, Department of Pulmonary and Critical Care Medicine, Loyal University Health System, Maywood, Illinois) in a multidisciplinary approach to paint the “fresco” of mechanical ventilation. Like in the Cenacolo (The Last Supper) by Leonardo, painted in the refectory of the church of S. Maria delle Grazie in Milan, Italy, the visitor (the reader) is attracted by the magnificent view and gradually picks out the precise details, visible only through careful observation (an accurate reading). Similar to this masterpiece, where one can see every single element of the painting drawing the attention straight to the midpoint of the composition, the entire content of the book goes directly to the essence of mechanical ventilation.

The format of the book is well organized and consistent. This second edition contains a valuable “Quick-Find Guide” at the beginning, which lists the different topics. The first five parts focus on the basis and history of mechanical ventilation. This material encompasses physics, physiology, technical aspects, and methods of ventilatory support. The chapter dedicated to positive end-expiratory pressure is one of the most complete treatments ever written about this subject. Appropriately placed charts and algorithms assist in navigating the physiologic steps and management of specific processes. This chapter has a very accurate bibliography with more than 700 references! The sixth part, including chapters 17–19, covers all of the aspects of noninvasive ventilation, thoroughly weighing the validity and relevance of the existing literature, taking into account the change of protocols, machines, and interfaces. Parts 7 and 8 are dedicated to the unconventional methods of ventilatory support and to the application of ventilator support in specific settings, including acute respiratory distress syndrome. In part 9, the effects of mechanical ventilation on heart–lung interactions remain an unsurpassed classic. The corpus of knowledge regarding the artificial airways and complications is synthesized in the 10th and 11th parts. The last three parts are devoted to the collateral problems of mechanical ventilation, incorporating treatment of ventilated patients, adjunctive therapies (where new “trendy” ideas such as inhaled antibiotic therapy are discussed), and ethical and economical issues.

All clinicians who aspire to hone their skills by understanding the fundamental techniques of intensive care medicine would benefit from this book. The text is also especially helpful for those practitioners without access to electronic resources such as the Internet. I highly recommend this text to intensivists, pulmonologists, cardiologists, and physiotherapists who seek expertise in mechanical ventilation. For future editions, an accompanying CD or a PDA version of the text could be useful because these are often efficient reference tools in today's fast-paced clinical environment.