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Assisted ventilation of the neonate, 4th edition
  1. J P Wyllie

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    J P Goldsmith, E H Karotkin. Published by Saunders, Philadelphia, 2004, $99.00, hardback, pp 578. ISBN 0721692966.

    Since its first publication in 1981, this book has been regarded by many as one of the foremost reference books on ventilation of the neonate. In the 22 years from that edition to this, many new modalities and strategies have been added to the clinician’s repertoire. However, while this fourth edition continues to cover those modalities in great detail, it has also evolved an editorial style in keeping with the drive to deliver evidence based medicine. The failure of numerous randomised controlled trials to define the optimum ventilatory modality is probably due to our inability to accurately delineate appropriate treatment groups. The trainee and practitioner can be left with a bewildering number of treatment options and endless opinions. This book succeeds in describing those options, as well as using the evidence available to direct their use in such a way as to minimise iatrogenic lung damage. Then difference between evidence and opinion is made reasonably clear.

    New chapters have been added which widen the scope of the book. Despite the fact that the chapter on ethical and legal issues has, not surprisingly a US legal focus, it contains issues that should be reviewed by all delivering care to premature and sick neonates. It is refreshing in a book about ventilation to find a chapter near the beginning dealing with whether we should ventilate at all and if so for how long. It is too easy to be swept away by what can be done without first asking if it should be done.

    Buying the first edition (although not in 1981) gave me a better understanding of what I was doing and made me feel I had an edge. Whether that was true or self delusion, it was the chapters on physiology and control of breathing that formed the foundation for my feelings of superiority. These subjects are still often neglected partly because the word “physiology” puts many to sleep. However, in this edition the text is succinct and clear and essential reading. Similarly the chapter on pulmonary function and graphics is both clear and practical, using case studies to illustrate their application. This approach is also evident in the last chapter, where eight cases are worked through applying the lessons of the rest of the book.

    Are there any weaknesses to be found? The chapter on resuscitation is not weak but I suspect it is present in its current form for historical reasons. Few would buy this book to use it as reference for resuscitation of the neonate. The chapter could have been focused on those aspects of delivery room care that may influence later ventilation and respiratory outcomes such as the use of oxygen, CPAP, volutrauma, and atalectotrauma to mention but a few. I also found the chapter on cardiovascular aspects disappointing. It needs to be either expanded with a wider remit or focused to neonates without complex congenital heart disease. There was little about assessment of cardiac function. Also between this chapter and those on pulmonary graphics and volume controlled ventilation, one could come up with three different, but overlapping, target ranges for tidal volume delivery. Last but not least, the quality of the paper might be better, as I suspect that it will be subject to a lot of use.

    Overall then this is another excellent edition of this series. Perhaps the most telling recommendation is that we already have three copies on our unit, and, if you want a comprehensive reference book on ventilation of the neonate for nurses, trainees, and consultants alike, I would suggest you do likewise.

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