Book Review

ARDS: Acute respiratory distress in adults

N Engl J Med 1997; 336:1920-1921June 26, 1997

Article

ARDS: Acute respiratory distress in adults
Edited by Timothy W. Evans and Christopher Haslett. 544 pp., illustrated. New York, Chapman and Hall, 1997. $153.95. ISBN: 0-412-56910-8

A wealth of epidemiologic, clinical, and basic research findings concerning or potentially relevant to the acute respiratory distress syndrome has emerged over the three decades since the original clinical description of the disorder. The editors of this book have taken on the daunting task of assembling a comprehensive overview of the syndrome and have touched on almost all the current clinical and research issues.

This multiauthored book has five parts. The introductory and overview chapters in the first part discuss the definitions, epidemiology, clinical spectrum, and pathology of the acute respiratory distress syndrome. Concise and clear, these chapters also provide a useful historical context for the subject and summarize issues related to the classification and pathogenesis of this heterogeneous syndrome.

The second part deals with cellular and molecular mechanisms involved in the acute respiratory distress syndrome. In an admirable attempt to be comprehensive, the editors have included 10 chapters that deal separately with topics such as cytokines, adhesion molecules, fibrosis, and infections. For the most part, the chapter authors attempt to relate these broad topics directly to the acute respiratory distress syndrome, but in many instances, the link between basic mechanisms and the clinical syndrome is not well established. This part of the book therefore seems somewhat diffuse and unfocused, but the contributors have done a good job of summarizing what we know (and do not know) about pathogenetic mechanisms in the syndrome.

The third part of the book covers the physiology of acute lung injury, discussing basic physiology, vascular control, pulmonary surfactant, lung fluid balance, and systemic manifestations of the acute respiratory distress syndrome. Overall, this part of the book is informative, but a clearly defined audience might have focused the discussions and reduced the overlap with other chapters. Nevertheless, these chapters provide a physiologic foundation for clinical management. New and experimental methods of ventilation (pressure-targeted and high-frequency ventilation) and oxygen delivery (extracorporeal membrane oxygenation and intravascular gas exchange) are considered in an additional section. The efficacy of these approaches and even some aspects of conventional management is controversial to varying degrees because of the lack of data from good clinical trials. The editors have included a chapter on clinical trials as they relate to the acute respiratory distress syndrome. Although unlikely to quiet the debates, the discussion provides a useful context in which to evaluate treatments for the syndrome. A closing chapter, which considers the prospects for pharmacotherapy, highlights the challenge of evaluating new treatments.

The acute respiratory distress syndrome is many things to many people. This book may be overly ambitious, but it makes clear how much we have to learn. Physicians and scientists interested in the acute respiratory distress syndrome will find much useful information in the book.

Joan G. Clark, M.D.
Fred Hutchinson Cancer Research Center, Seattle, WA 98104