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Atlas of Applied Pulmonary Physiology

Richard M. Wahba (Ed.). Zeneca Pharma, 1999.

Kingston, Ontario

This atlas is a multi-authored book with contributions from several anesthesiologists with international reputations. Unquestionably, a well-designed diagram is an essential tool for any discussion of respiratory physiology. Hence, the concept of a teaching tool based on a series of diagrams explained in expanded legends. This approach works well for chapters 2, 4, 7, and 9 to 13. Chapter 2 clearly depicts the need for anterior displacement of the hyoid bone in laryngoscopy. Chapter 4 contains many well-designed diagrams, clearly explained. The role of atelectasis and airway closure during anesthesia is clearly depicted in chapter 7 and Figures 10.2.1-3 provide excellent summaries of factors affecting end-tidal/arterial CO₂ gradients. All sections of chapter 11 are strong, with excellent sections on one-lung ventilation and the five critical periods in management of lung transplantation. Section 12D emphasizes the often-neglected issue of nutrition. The sections on postoperative pulmonary function changes and the physiology of epidural analgesia are all well done.

However several chapters are marred by incorrect units (Figures 1,2,3), unlabeled isopleths (e.g. Figures 8,4,5), mystery lines (Figures 8,4,3), or garbled legends (Figures 1,3,3). These irregularities are part of a larger problem of inadequate proof-reading and inconsistency of style. For example, the basic physiologic convention for abbreviations is followed erratically and mean values are rarely indicated in abbreviations.

Also, several topics are ignored. Work of breathing is addressed sketchily, ARDS is discussed with no mention of the concepts of ventilator-induced lung injury that have been a major focus of ICU debate for at least eight years, and there is no mention of newer data de-emphasizing the influence of gravity on perfusion distribution in the lung.

This atlas definitely contains diagrams I will use for teaching. However this is not the book for the clinician or resident with little respiratory physiology background. It assumes a basic knowledge of terms and concepts. Its niche will be for review of concepts once known but now fuzzy, and as a source of illustrations for teaching.

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