Textbook of ventilation, fluids, electrolytes & blood gases

The management of the critically ill patients admitted to the ward or intensive care unit (ICU) would be suboptimal without an in-depth understanding of the physiological and pathological basis of alteration in the ventilation, fluid imbalance and abnormalities detected on the blood gas analysis. The correct interpretation of clinical signs and laboratory parameters, in a timely manner, is of paramount importance for the initiation of the appropriate therapy. The book titled ‘Textbook of Ventilation, Fluids, Electrolytes and Blood Gases’ is an attempt to provide a ready reference book for medical professionals providing care to critically ill patients. The book has been divided into four sections - Ventilation, Fluids, Electrolytes, Blood gases and Miscellaneous.

The section 1 on ventilation comprises 22 chapters and starts with a chapter that describes applied anatomy and physiology of the respiratory system and illustrates various concepts in a simplified manner. Another chapter provides a detailed description of traditional and age-old oxygen delivery devices as well as the latest devices such as high-flow nasal cannula. A chapter on mechanical ventilators also describes various modes of mechanical ventilation including newer ones such as neurally adjusted ventilatory assist, proportional assist ventilation (PAV), PAV plus, Intellivent-ASV and Smartcare. There is enough emphasis on the interpretation of waveforms and graphics during mechanical ventilation. The recognition and management of patient ventilator asynchrony can be challenging during mechanical ventilation. There is one chapter that demonstrates various types of patient ventilator asynchronies and their management. There are dedicated chapters elaborating the clinical approach to the common scenarios faced in the ICU; for example, management of hypoxaemic and hypercapnic respiratory failure, bronchial asthma, chronic obstructive pulmonary disease and bronchopleural fistula. Extra corporeal membrane oxygenation (ECMO) is the highest level of oxygen support. The chapter on ECMO provides an overview of this most advanced therapy and will be useful for all the readers. Another important but less commonly discussed topic is ‘Aerosol drug delivery in ventilated patient’ that has been presented well in the book.

Section 2 on fluid and electrolytes comprises nine chapters. There is a good description of normal physiology of fluid balance and all basic concepts required for fluid management in the ICU. The book provides an informative description of all commercially available fluids used in the critical care setting. Authors have provided a comparison of various crystalloid and colloid solutions in the tabular form for an easy understanding. The chapter on the management of hypovolaemia provides up-to-date information on the approach to the management of shock and haemodynamic monitoring techniques during the fluid therapy. The management of common disorders of fluid (shock) and electrolytes imbalance of sodium (hypo- and hyper-natraemia) and potassium (hypo- and hyper-kalaemia) is exemplified with clinical cases. There are three chapters, one each dedicated to the disorders of calcium, phosphate and magnesium.

The third section on blood gases comprises five chapters. These chapters provide an overview of normal acid–base homoeostasis and approach to patient with acid–base disorders. The authors have explained well the respiratory and metabolic compensations using easy to understand figures. There are dedicated chapters, one each for respiratory and metabolic acidosis and alkalosis. For the diagnostic approach for the acid–base disorders, authors first described the stepwise approach which was followed by clinical case scenarios. The chapter titled ‘Arterial blood gas interpretation in clinical practice’ discusses five interesting cases. Each case gives an important message that can be useful during clinical practice.

Two of the four chapters in the miscellaneous section discuss the nutrition including the role of immune-nutrition, vitamins and trace elements for critically ill patients. One chapter illustrates blood product transfusion practices in the ICU. This book also includes a very important topic, which is commonly ignored, the care of potential organ donor. This is utmost relevant in all ICUs, and all physicians should be sensitized about how to care a potential organ donor.

Overall, the book will be very useful for all critical care physicians as well as those interested in ICU management. The contributing authors are from multiple countries which include the USA, the UK, Australia, Canada, Spain, France, Italy, Mexico, Belgium, Chile, Singapore, Hungary and India. Most of the chapters provide relevant physiology before addressing the pathological condition. Inclusion of case scenarios to illustrate the management approach is an excellent idea.