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Nunn's Applied Respiratory Physiology, 5th ed.

Andrew B. Lumb. Butterworth-Heinemann, 2000. 687 pages. $115.00 (US). ISBN 0-7506-3107-4

Kingston, Ontario

With this 5th edition, John Nunn's classic analysis of respiratory physiology as applied to anesthesia passes into the hands of a new craftsman, Andrew Lumb. It is a job well done. Minor surgery has been performed throughout to make room for new discoveries, so don't throw out your old editions until you make sure your favourite diagrams are still there!

A new section titled Physiology of Pulmonary Disease now pulls together the pathophysiology and treatment previously scattered throughout the book, as well as adding a chapter on airway diseases. Many chapters look very familiar, but all bear evidence of thorough revision. In many cases CT, MR or 3D reconstructed images have replaced the artists' sketches of the past. Chapter 5 is substantially revised with an excellent summary of non-chemical reflex inputs to the respiratory centre. Chapter 7 contains increased coverage of active modulators of pulmonary tone - including NO. NO now appears extensively throughout. Alpha stat and pH stat issues have been added to the discussion of hypothermia in Chapter 10. The use of blood substitutes and issues of critical oxygen delivery have been updated. Chapter 18 presents new material on respiration in closed environments, including submarines, space travel and life in a biosphere! Chapter 21 contains an excellent section on ventilatory control covering current controversial data on the effects of subanesthetic agent concentrations on the acute ventilatory response to hypoxia. Chapter 27 discusses changing concepts of O₂-induced hypercapnia in COPD. Overall, this 5th revision is laudable for thoroughness, readability and up-to-date referencing. It's weakest sections were those on management of artificial ventilation, both neonatal and adult, in acute respiratory failure. In neonates, (Chapter 13) the interaction between the restoration of aerated lung volume and the efficacy of NO in the treatment of hypoxemia was ignored, as was extensive evidence over the past 10 yr on the role of high frequency ventilatory techniques in reducing the need for ECMO in neonates and infants. Again, the section on ventilator-induced lung injury in Chapter 31 is so brief it misses the crux of the most active area of ventilation-related research in our ICUs today. Such deficiencies are inevitable in a book that has tried to broaden its coverage of an already huge field. Perhaps covering the pathophysiology of pulmonary disease is a sufficient and valuable goal, and treatment should be left to other venues? Despite these minor reservations this 5th edition unquestionably continues to be the premier respiratory physiology resource for our specialty.

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