1. Blackburn, Susan PhD, RN,C, FAAN

Article Content

Assisted Ventilation of the Neonate, 4th ed. edited by J.P. Goldsmith and E.H. Karotkin. Philadelphia: Saunders; 2004. 588 pages.


Assisted Ventilation of the Neonate, edited by Jay Goldsmith and Edward Karotkin, is a comprehensive text on ventilator management of critically ill infants. This is the fourth edition of this text. The book consists of 29 chapters that provide a comprehensive resource for the care of infants requiring assisted ventilation. Content has been updated to reflect current research, evidence-based practice, and where evidence is lacking, expert opinion.


The first chapter provides a review of the history of ventilation, major breakthroughs, and an introduction to principles and techniques. Chapter 2 is an excellent review of physiologic principles underlying assisted ventilation including lung mechanics, gas transport, ventilation, and perfusion. The third chapter reviews respiratory control and disorders that are characterized by altered respiratory control such as apnea, bronchopulmonary dysplasia, craniofacial syndromes, and neuromuscular disorders. Chapter 4 reviews principles of neonatal resuscitation. Content on ethical and legal issues (chapter 5) related to assisted ventilation is expanded in this edition.


Several chapters focus on related care of infants who are on assisted ventilation, including intubation indications, techniques, and pulmonary care (chapter 6), nursing care (chapter 7), blood gases (chapter 17), pulmonary function and graphics (chapter 18), and nutritional support (chapter 24). The chapter on nursing care describes basic nursing care of infants being ventilated, including thermoregulation, skin care, pain management, developmental care, and family care. This chapter also describes nursing care related to airway management during specific technologies such as high-frequency ventilation and extracorporal membrane oxygenation.


Chapters 8 through 11 describe standard ventilator techniques: continuous positive airway pressure, positive pressure ventilation (pressure-limited and time-cycled), volume-controlled ventilation, and high-frequency ventilation. Several chapters focus on special ventilator and related techniques: lung protective strategies and liquid ventilation (chapter 13), inhaled nitric oxide therapy (chapter 14), and extracorporeal membrane oxygenation (chapter 16). Each chapter summarizes current research and describes the technology, indications, adverse effects and complications, contraindications, and management of infants receiving the specific technology. Advantages and side effects of different ventilator settings and care practices are discussed and illustrated.


Chapter 15 describes ventilator strategies for specific groups of infants, with an emphasis on lung protection. Suggested ventilator strategies are presented for common neonatal respiratory disorders such as respiratory distress syndrome, bronchopulmonary dysplasia, meconium aspiration syndrome, persistent pulmonary hypertension of the newborn, congenital diaphragmatic hernia, apnea of prematurity, and hypoxic-ischemic encephalopathy.


Two chapters (19 and 20) focus on pharmacologic therapies used with infants on assisted ventilation. Drugs discussed include exogenous surfactants, sedatives, analgesics, muscle relaxants, cardiotonic agents, pulmonary vasodilators, bronchodilators and mucolytic agents, diuretics, steroids, and respiratory stimulants. Other chapters focus on cardiovascular management, surgical management of the airway, intraoperative management, and transport of ventilated infants.


Assisted ventilation is not without complications. Therefore chapter 21 examines upper airway, lower airway, and extrapulmonary complications. Major emphasis is on bronchopulmonary dysplasia, air leak syndromes, and retinopathy of prematurity. Later chapters examine pulmonary outcome and follow-up and central nervous system morbidity.


The final chapter presents 8 case studies of actual infants. These cases represent examples of types of infants commonly encountered in the neonatal intensive care unit. Cases include hypoventilation secondary to worsening respiratory distress syndrome, persistent pulmonary hypertension of the newborn, respiratory distress syndrome with patent ductus arteriosus, pulmonary interstitial emphysema, congenital vascular ring, and total anomalous pulmonary venous connection. Appendices include tables for each mode of ventilation, with principles of operation and advantages and disadvantages, assessment forms, common lab values, sample forms, and practice recommendations.


In their Preface, Goldsmith and Karotkin state that their text follows the principles of the Laws of Ventilator Efficiency (LOVE): "1. Know thy ventilator and disease pathology. 2. Develop a specific strategy for the pathophysiology in each individual infant. 2. Change the ventilator strategy as the pathophysiology changes. 4. Always strive to wean the patient off of ventilator assistance (i.e. have an exit strategy." (p. xiii). Their book effectively demonstrates these principles. The book is well illustrated throughout with photographs, line drawings, figures, and tables. Tables summarize specific management and compare different strategies; practice algorithms are also included. This is a valuable resource for both neonatal intensive care unit and individual practitioners.