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Textbook of Ventilation, Fluids, Electrolytes and Blood Gases
Textbook of Ventilation, Fluids, Electrolytes and Blood Gases. Mohan Gurjar. Jaypee Brothers Medical Publishers, New Delhi, 2020. 417pp, price not mentioned. ISBN 978–93–89188–05–09.
This textbook is different in that it takes the reader, potentially a critical care resident/practitioner, not only in a systematic way around the pillars of critical care, namely mechanical ventilation, fluid/electrolyte disorders and management, nutrition and arterial blood gas interpretation, but also in minute detail, covering recent understanding and advances. This is particularly true of newer modes of ventilation and entities such as heart–lung interaction, ventilator-induced lung injury and diaphragmatic dysfunction. The latter have gained more importance during the Covid-19 pandemic, which threw up a plethora of mechanical ventilation-related issues and weaning difficulties. The break-up of mechanical ventilation into its numerous facets simplifies understanding even for the relatively new entrant into critical care. The section on prolonged weaning/ liberation from mechanical ventilation carries a brief mention of tracheostomy. With the majority of tracheostomies being performed percutaneously by the intensivist in present-day intensive care units (ICUs), a more detailed description on indications, technique, dos and don’ts of percutaneous tracheostomy would have added value to this section. End-of-life issues and decision on withholding escalation of care should find a place in the discussion on prolonged ventilation and difficulty in liberation from mechanical ventilation.
The section on fluid therapy is quite comprehensive. The part on monitoring volume status has been dealt with very well.
A section on assessment of adequacy of oxygenation including monitoring of microcirculation (e.g. direct video microscopic visualization) would have added more value to this section. Microcirculation plays a pivotal role in delivering oxygen to the cells and maintains tissue perfusion. The loss of haemodynamic coherence between the macrocirculation and microcirculation, as also the various types of microcirculatory alterations in critically ill patients—wherein improvement of haemodynamic variables of the systemic circulation does not cause a parallel improvement of microcirculatory perfusion and oxygenation of the essential organ systems—warrants a mention, to take the reader/student into the depth of tissue oxygenation and utilization.
The management of the potential organ donor is comprehensive. In today’s world with increasing medicolegal implications of decisions taken in the ICU, the importance of preparing the family for this step and the importance of family counselling should be highlighted. This is especially true if the death has been sudden in a young and previously healthy individual. A small paragraph could have been devoted at the beginning of the chapter on this aspect.
All in all, a textbook that will surely be of use to the new entrants to critical care as well as practitioners.
Department of Anaesthesiology, Pain Medicine and Critical Care
All India Institute of Medical Sciences