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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.

Trainees hear 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 textbook.

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

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