More than twenty years have passed since Principles and Practice of
Mechanical Ventilation was first conceived. With this third edition, the
textbook has come of age. When the first proposal of the book was under
consideration, reviewers thought that the corpus of knowledge pertaining to
mechanical ventilation would not be sufficient to merit the publication of a
large tome; they opined that the contents of such a book would require much
padding. This time around, the challenge has been to fit everything into a
constrained number of pages. Virtually every aspect of mechanical
ventilation has evolved substantially over the past twenty years, and many
new areas have emerged. Novel ventilator modes have been introduced,
previously discarded modes have acquired a new lease of life, and
long-surviving methodologies have undergone considerable refinement. Much of
the progress has stemmed from research into the mechanisms whereby
ventilators harm patients. In turn, we have learned how minor adjustments to
ventilator settings can markedly enhance patient comfort and survival. A
comparison of the third and first editions of Principles and Practice of
Mechanical Ventilation provides proof of the tremendous progress in this
field during the past twenty years.
much about the practice of medicine, as in phrases such as clinical practice
guidelines. As physicians grow older, they realize that many popular
practices turn out to be ephemeral—it is biomedical principles that
remain evergreen. Mechanical ventilation remains rooted in physiological
principles; it is these principles that guide practice. The wise physician
is ever mindful of the need to balance principles with practice—to
achieve the right equilibrium between theory and pragmatic action. Without a
sound knowledge of the biomedical principles that govern ventilator
management, a physician is reduced to setting a ventilator in a hit-or-miss
manner or to follow a cookbook recipe. With a deep understanding of
physiologic principles, a physician is better equipped to make expert
iterative adjustments to the ventilator as a patient's condition
changes over time. As with previous editions, readers will find detailed
accounts of both biomedical principles and practical advice throughout this
Electronic technology has transformed
medical publishing, providing rapid access to a rich store of information.
Contrasted with the hours previously spent in the periodical rooms of a
library, authors now retrieve pertinent articles at the click of a mouse.
But reading material online is not an unalloyed good. Deeply engaged reading
requires focused attention and commitment, whereas reading online is
accompanied by a dramatic increase in the opportunities for distraction.
Media do not simply act as passive channels of communication, they also
shape the process of thought. Cognitive scientists have begun to uncover the
differences between reading online and off. Deep reading without distraction
leads to the formation of rich mental connections across regions of the
brain that govern such cognitive functions as memory and interpretation.
Neuroscientists expect the internet to have far-reaching effects on
cognition and memory. In contrast to a book, which is a machine for focusing
attention and demanding the deep thinking that generates memory, the
internet is a machine that scatters attention and diffuses concentration.
Given the importance of rapid decisions in critical care medicine, which
demand instant memory recall, a trainee is best advised to acquire the
foundations for his or her storehouse of knowledge from a textbook rather
than from online resources.
Another advantage of a
textbook is that it provides a comprehensive account of a discipline in a
single source, where clinicians can turn to find answers to their questions
about mechanical ventilation. Commonly used online resources, such as UpToDate,
are directed toward generalists and do not provide the depth of knowledge
expected of a subspecialist. The information presented in medical journals
is fragmentary by design; no attempt is made to fit published information
into the mosaic of existing knowledge and topics deemed unfashionable by
editors are ignored. Trainees who rely on bundles of reprints tend to be
ignorant of the boundaries of a subspecialty and unaware of major lacunae in
their knowledge base. No series of journal articles can compete with a
textbook in this regard.
For a textbook to provide
authoritative coverage of a field, the selection of authors is crucial. For
each chapter, I selected scientists and clinicians who are at the forefront
of research in a given subfield. Many of these authors undertook the seminal
research that established a new area of mechanical ventilation, which was
subsequently enriched and expanded by the work of other investigators. Being
at the forefront of an area, these authors are attuned to evolving
developments in a subfield, which makes their accounts extremely current and
guards against early obsolescence of the material included in their chapter.
Each chapter has been extensively revised; twenty-five new authors provide
fresh accounts of previously covered areas; many new topics have been added;
and several chapters found in previous editions were deleted. I personally
edited every line of each manuscript to ensure reliability of the presented
information and to achieve a uniform style throughout the book.
Given that Principles and Practice of Mechanical
Ventilation has become one of the classics on the McGraw-Hill list, the
publisher decided to introduce color printing throughout the new edition.
The result is a book that is not only informative but also aesthetically
attractive. The large number of high-quality illustrations provides a
pedagogical resource for readers who are preparing slides for lectures.
This book would not have been possible without
the help of several people, and to them I am extremely grateful. First and
foremost are the more than 100 authors, whose knowledge, commitment and
wisdom form the core of the book. As with the two previous editions, I am
most grateful to Amal Jubran and Franco Laghi for advice at several stages
of this project. I thank Lynnel Hodge for invaluable assistance on a
day-to-day basis. Richard Adin copyedited the manuscripts with a lawyer's
eye for precision, and Brain Belval and Karen Edmondson at McGraw-Hill and
Aakriti Kathuria at Thomson Digital skillfully guided the book through its
production. Finally, I thank my family for their forbearance.
Martin J. Tobin