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Acute Respiratory Distress Syndrome: A Comprehensive Clinical Approach

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Acute Respiratory Distress Syndrome: A Comprehensive Clinical Approach Russell JA, Walley KR. (Pp 356, paperback; £29.95). Cambridge: Cambridge University Press, 1999. ISBN 0 521 65410 6.

During little over three decades since its characterisation, the acute respiratory distress syndrome, alone or as a part of the multiorgan dysfunction syndrome, has grown to constitute one of the major challenges facing intensive care specialists across the globe. Within the past decade major advances in our understanding of the aetiology and pathophysiology of the condition and the introduction of new treatment modalities and management strategies have conspicuously failed to improve patient outcome significantly.

In this publication James Russell and Keith Whalley have produced an excellent pocket sized text that provides a comprehensive and up to date review of the current understanding and management of the acute respiratory distress syndrome, and which fills a valuable niche between the journals and larger reference textbooks.

The book is divided logically into concise, easy to read chapters, supported by a wealth of tables, graphs and illustrations, with each chapter individually and comprehensively referenced. All aspects of the syndrome are addressed from epidemiology through molecular biology, pathology and physiology, to resolution and recovery. Individual chapters deal with pulmonary and cardiovascular pathophysiology, mechanical ventilation and weaning, and innovative therapies. Clinical trials are reviewed and assessed in an unbiased, rational, evidence based manner, and recommendations for best practice are proposed upon the basis of available knowledge.

The major strength of the book, however, lies within the authoritative and holistic approach in those chapters pertaining to the clinical management of the patient with ARDS. The book is crammed full of useful practical advice, clinical expertise, and good common sense. I was particularly impressed with the chapters dealing with total patient care and nosocomial pneumonias, and delighted to see so many published algorithms and therapeutic guidelines. In addition, I thought that the insertion of a chapter giving a concise overview of ARDS and its management was an excellent idea. If trainees were to read no more than this, they would learn much.

There were very few things that I did not like about the book. Given the overall quality, I was disappointed with the standard of reproduction of the chest radiographs. The photomicrographs and pathology slides would have benefited by being in colour. In addition, the casual admixture of the terms “multiorgan dysfunction syndrome” and “multisystem organ failure” in chapter 13 runs against current vogue and may confuse the less experienced reader.

Nonetheless, I thought this an excellent text that should have broad appeal. It is relevant to all disciplines involved in the care of the critically ill, both as a reference text and as an easy to read manual for trainees. Furthermore, the diverse aetiologies and unpredictability of multiorgan dysfunction and acute respiratory distress syndromes make this book an invaluable reference for acute ward based staff who may become involved in the early care of this most challenging of conditions.—ML