The Pathogenesis of Respiratory Failure After Trauma and Sepsis

Abstract

Although many of the authors in this book discuss the pathogenesis of lung dysfunction, the review by Demling deserves particular scrutiny. He stretches the pertinent literature over a framework of pulmonary physiology in a fashion that is uniquely readable and understandable. With the breadth of background provided by this article, the reader is ready tor Lewis’ scholarly review of atelectasis and pneumonia and the parallel piece by Weinstein and Skillman on the overall management of respiratory failure. There is no chapter on acute respiratory distress (ARDS) in this book because the term is too vague and ill-defined to be helpful to the clinician. However, for those who recognize a syndrome of diffuse atelectasis combined with interstitial edema at normal hydrostatic pressure, (that is, ARDS) that disorder is discussed in these three articles. Protocols for management of respiratory failure on the surgical service at the Beth Israel Hospital, Boston, and San Francisco General Hospital are presented in this section. A Serious student of respiratory care would do well to compare the similarities and differences of the various protocols presented in this book. Good respiratory care assumes expert management of the other nonpulmonary organ systems. Waxman and Shoemaker present a protocol for such care, with reference to their own methods.