Non-invasive Ventive Ventilatory Support

Non-invasive ventilation is no longer the solitary domain of the respiratory physician with a special interest. Its use in both acute and in the more established long-term management of patients with respiratory failure is increasing at a phenomenal rate. No longer an occasional intervention in the corner of a respiratory ward or confined to specialist units, it is being used in acute medicine from accident and emergency through to Intensive Care and is even being used on the surgical wards in patients with pre-existing problems. The technology available is also increasing and becoming more accessible and user-friendly.

With this proliferating spectrum of activity, there is a compelling need for a book that subserves several functions. A practical manual that tells you not only when, how, and what with, but also which situations there may be benefit and which there may not. It also needs to be a reference book with the latest information from clinical studies and either the evidence base that exists or a road map to find that evidence. Most importantly, it needs to be a book written by experts that can assimilate and propagate this information in a pragmatic format. The previous editions started out in this direction and this latest edition takes it far further. It is the definitive text in this area.

Specifically, the chapters on the equipment available and how it works, be it masks or ventilators, are easy to read and highly informative. It is worth getting the book just for this practical catalogue of available equipment. The subsequent chapters on the indications for use in acute disease make interesting reading. This is a fast expanding area and the book is well referenced with a very conscientious attempt by the authors to make this book as evidence based as possible. Regrettably, this has mixed results. The evidence-based approach provides swathes of data which do not make for easy reading and often detracts from defining what the current position is. This reader can cope with this approach if the ‘bottom lines’ are there at the end of the chapter, but this did not occur in every chapter. With such outstanding contributors, the chapters with opinionated and pragmatic summaries were particularly useful. They also make for easier and more interesting reading.

The chapter on weaning from invasive ventilation is particularly good in that regard as the conclusion paragraph sums up the current position very succinctly yet all the detailed information is in the chapter.

The proliferation of non-invasive ventilation in other areas of the hospital is covered and the book describes its application in the accident and emergency department, in transfer of patients on these devices and its use in procedural work.

As would be expected, the sections on long-term non invasive ventilation are exemplary and provide a wealth of practical information. There is also a comprehensive section on paediatric applications. Sleep disorders and their treatment are covered. I particularly enjoyed the section on common practical problems which gave a strong feel of an author who has ‘been there and done that’. The final chapter on ethical and medicolegal aspects of the subject borders on compulsory reading.

My criticisms are few. There are real difficulties in aligning an evidence-based approach across broad subjects while providing a relatively practical approach. Paradoxically, adequate description of available studies and their conclusions do not fall naturally into providing discrete conclusions, in fact, rather the opposite. In many places, I felt frustrated by the ‘evidence’ and looked for the opinion in the ‘bottom line’. The positive side of this is that all the information is there, is accessible, and has usually been effectively dissected so that some conclusions can be drawn.

In all a remarkable blend of reference book and manual, this is a real asset in an increasing number of locations in any hospital, and cheap at the price. I commend it to you.