Evolution, refinement, innovation. The iron lung, assist-control ventilation, intelligent control ventilation. We have come a long way in the field of mechanical ventilation as we have evolved from old methods, continue to refine known methods, and look to innovate new ones.

Dr. Tobin’s Principles and Practice of Mechanical Ventilation is a classic text that continues to provide practitioners of today the most comprehensive reference to mechanical ventilation, with updates of new knowledge and advances. The third edition follows the second edition since 2006. The most obvious change is the addition of color, which gives graphs and tables more definition and pictures more character. The book has 68 chapters organized into 15 sections. Each chapter, in a broad sense, is organized into “principles” and “practice,” as promised by the book title. The “principles” portion of each chapter includes topics such as basic physiology, mechanisms, and rationale. The “practice” portion of each chapter includes topics such as indications, comparison of modes, and clinical relevance. Many chapters also have a section on unknowns and future perspectives, which are important points, especially in a comprehensive medical text that will certainly have its contrarians. The organization among chapters gives the reader a consistency that facilitates readability.

The early part of the book provides a historical perspective of mechanical ventilation. This is followed by the physical science of mechanical ventilation and the design of ventilators. A third of the book is dedicated to the various methods of ventilation, from conventional to nonconventional. In addition, topics cover how mechanical ventilation pertains to different clinical settings, physiologic effects, and airway management. This is followed by a patient-centric approach focusing on complications, monitoring, and management of ventilator-supported patients. The final section covers adjunctive therapies and the ethics and economics of mechanical ventilation.

The textbook is best viewed in the hardcover form. However, for less cumbersome transport, the text is available online through Access Anesthesiology® on the McGraw-Hill Medical site, and an electronic book version is also available for portable devices.

The list of authors is an impressive collection of experts from around the world who conduct research and are active in societies in addition to their clinical duties. Every chapter is thoroughly researched and up-to-date. The expert minds give the reader a window into their thinking. Many authors mention ongoing or recently completed research and clinical trials, and the new evidence will undoubtedly be presented in the next edition.

Overall, the book is well organized and easy to read. The chapters can be read separately if you are exploring a topic or the book can be read continuously for comprehension of all the topics. The chapters contain references to other chapters where needed, so repetition is limited. Specifically, as with the earlier edition, the tone of the book is set early in the “Indications for Mechanical Ventilation” chapter. In a clinical sense, the authors of the chapter want to convey the importance of pathophysiologic concepts, applying knowledge and experience, and then making clinical decisions based on the all of the previous. This premise is followed throughout that book. Background and data are presented first, and reader is guided into the decision-making process.

For anesthesiologist, the book provides a perioperative bridge to the world of mechanical ventilation usually found in critical care settings. With this text, an anesthesiologist can become familiar with methods available on anesthesia ventilators. Other methods of ventilation may be worth reading about because many of the technologies found in the intensive care unit ventilator have crossed over to the current anesthesia ventilator. The editor has brought back a chapter on “Mechanical Ventilation during General Anesthesia,” and it is worth reading. Other interesting chapters for the anesthesiologists include an updated chapter on “Complications of Translaryngeal Intubation” and a rewritten chapter on “Complications Associated with Mechanical Ventilation.”

For critical care physicians or respiratory care practitioners, the book is an invaluable reference for all aspects of mechanical ventilation. The book with the basic principles and practical everyday management issues of ventilators and patients is a must have in all libraries. New chapters, with topics ranging from the complex, such as the neurally adjusted ventilator assist mode and extracorporeal life support for cardiopulmonary failure, to the simplest, such as airway secretions and suctioning, show how comprehensive the book continues to be. The book is “the definitive guide” to mechanical ventilation and is likely to continue to be “the definitive guide” for future generations.