Atlas of Applied Respiratory Physiology.Edited by Richard M. Wahba, M.D..Zeneca, 1999. Pages: 128. Price: Free.

David O. Warner M.D.

Even in this era of relentless high technology and “whiz-bang” molecular medicine, a thorough understanding of plain old respiratory physiology is still essential to the proper care of the perioperative patient. The Atlas of Applied Respiratory Physiology  targets house staff and clinicians who desire a brief review of this important topic. The editor is a respected investigator who has made important contributions to the field for many years and is well-qualified to undertake the task.

The selection of materials is not encyclopedic (which would not be appropriate for this teaching aid), but concentrates on topics of direct clinical interest. On the whole, there is much useful information presented. The chapters from Drs. Hedenstierna and Drummond are particularly valuable, presenting basic concepts of gas exchange and chest wall mechanics in a refreshing manner and nicely updating recent contributions to the field (which are ignored in many recent major anesthesia texts). Unfortunately, reflecting the unevenness typically associated with multiauthored texts, some other chapters are dated. For example, we now know that the distribution of pulmonary blood flow is determined largely by structural determinants in the pulmonary vasculature, not simply by gravity, as in the classic formulation. None of the several chapters that discuss pulmonary blood flow mention this fact. Recent advances in understanding regarding the innervation of the lung also are not discussed.

Some of the areas covered are quite topical, such as lung transplant and thoracoscopy, and go beyond the standard texts. In other areas, the authors fail to take advantage of opportunities to introduce concepts that are of current interest. Welcome additions would include a discussion of practical methods used to measure respiratory mechanics (especially the work of breathing) with modern monitors, introduction of the important concept of “protective” ventilatory strategies in acute lung injury, and the somewhat mysterious benefits conferred by lung volume reduction surgery.

Given the premise that an atlas aids learning via  the effective visual integration of diagrams, figures, and text, many readers may be disappointed by the layout of the book. Although I personally find the type of black and white line drawings presented in this text to be informative, many readers have come to expect a level of graphic sophistication that this book does not deliver. The text is presented in a simple, double-spaced format, entirely separated from the figures on the opposite page, that, in some ways (such as in the labeling of section headings), is not consistent from chapter to chapter. Curiously, individual figures within a page are not labeled, such that it is often difficult to determine the figure to which the text refers. When present, some of the labeling is incorrect (e.g. , chapter 3). Thus, although many of the individual figures are well-rendered, they are often not integrated with the text in an effective way. Nonetheless, the reader willing to invest a bit of time will be rewarded.

Any book in this field inevitably will be compared with John Nunn’s classic Nunn’s Applied Respiratory Physiology.  1Although Nunn’s text remains the definitive reference, the Atlas of Applied Respiratory Physiology  represents a useful supplement that deserves a place in anesthesia libraries.

Lumb A: Nunn’s Applied Respiratory Physiology, 5th edition. Oxford, Butterworth-Heineman, 2000