Tracheostomy and Ventilator Dependency: Management of Breathing, Speaking and Swallowing.

Abstract

Tracheostomy and Ventilator Dependency: Management of Breathing, Speaking and Swallowing. Donna C. Tippet, ed. New York: Thieme, 2000. 320 pp, $69.00. Tracheostomy and Ventilator Dependency is a text written for speech-language pathologists who are involved in the care of patients with long-term tracheotomy, ventilator dependency, or both. The book discusses the care of patients with various causes for their respiratory insufficiency, but the text is slanted toward the care of cognitively intact, long-term ventilator-dependent patients, such as those suffering from high cervical spinal cord injuries. Thus medical specialists who might be involved in patient care at inpatient or outpatient rehabilitation centers, such as otolaryngologists, neurologists, physiatrists, pulmonologists, and pediatricians, are collateral audiences for this text. The book is organized into nine chapters. The first reviews pertinent anatomy and respiratory physiology. The next pair of chapters discuss respiratory insufficiency and the history of mechanical ventilation, with a zealous emphasis on noninvasive techniques. The discussion of the history of mechanical ventilation is interesting, but from a practical viewpoint these two chapters provide little information that is not covered elsewhere in the text. The discussion of indications for ventilation is muddled, the writing is too full of jargon, and the information provided is of little practical utility. The middle three chapters are the heart of the text and provide information that is very useful to otolaryngologists—head and neck surgeons involved in the care and rehabilitation of tracheotomy and ventilator-dependent patients. The first of these middle chapters provides a complete description of alternative tracheotomy tubes and accessory appliances, such as speaking valves. This section alone makes the book a valuable resource. The following two chapters, written by the editor, present alternatives for the evaluation and rehabilitation of speech and swallowing in this patient population. These two chapters are well presented and discuss speech and swallowing solutions tailored to the patient's individual disabilities. The author emphasizes the team approach to the care of these difficult patients and provides practical information and algorithms useful in making real-life management decisions. Next, concerns unique to pediatric patients with tracheotomies are discussed. This chapter is an important complement to the discussion of adult patients. Considerations for transition of the patient from the hospital or rehabilitation center to home are presented in the following chapter. The last chapter discusses ethical issues as related to end-of-life and long-term ventilatory support. While this discussion is interesting, it seems out of place with the rest of the text. Overall, the book would benefit from more aggressive editing to eliminate much of the redundant material. The text is full of vignettes (case histories) that do not add as much as the authors hope. However, I feel that the book's shortcomings can be forgiven for the practical information that is included. This text will be valuable to otolaryngologists who are involved in the care of these challenging patients, particularly to practitioners whose practice includes rehabilitation service patients.