1 University Department of Anaesthesia, Critical Care and Pain Medicine, 51 Little France Crescent, Edinburgh EH16 4SA, UK E-mail: g.b.drummond{at}ed.ac.uk
In this Postgraduate Issue, I have assembled contributions on aspects of respiratory sciences that should be clinically important in the practice of anaesthesia, intensive care, and pain medicine. Respiratory physiology has always possessed a strong analytical framework and evidence base that links science with clinical application. With better understanding of the links between clinical management of mechanical ventilation and outcome in respiratory failure, such as the widely discussed ARDSnet trial1 clinicians should have become strongly aware of how important it is to know how to apply and interpret the science of respiratory mechanics. Indeed, there has been a renaissance in interest in pulmonary mechanics, reflected by the two contributions in this issue, by Stenqvist and by de Chazal and Hubmayr, each with their own take on the assessment and application of respiratory mechanics. I make no apologies, therefore, in providing two views of this important subject. It is remarkable how some of the concepts revived by these authors were topical in the first flowering of respiratory science2 and still have great relevance today. A further intensely practical contribution, by Baudouin, also refers to the ARDSnet study. Some contributions aim to re-set our thinking, and demand a change from classical physiology, such as the fishy story from Oxford (long at the forefront of respiratory physiology) by Hahn and Farmery, and the remarkable new findings of the Leiden group of Dahan and Teppema who have a long-established reputation in the study of the factors that control and regulate breathing. Their contribution should provide a fresh insight into the relationship between basic science and clinical practice in the use of sedatives and analgesics.
Sleep disturbances and airway control have been a topic of intense research over the last 20 years and the contribution from Hillman, Plant and Eastwood synthesizes these fields perfectly. The more we understand about the interaction of patients with our machines the better, and the complexities of these are explained by the contribution of the Heraklion group of Professor Georgopoulos. The lungs are complex organs: Dr deBoer explains their capacity to affect drug handling, and Dr Magnusson and Professor Spahn address the theoretical and practical aspects of atelectasis and gas exchange. Kaisers and Kelly review the potential uses of liquid ventilation and Mills, Wild, Eberle, and van Beek give a comprehensive view of MR imaging with some remarkable pictures of regional function.
Gas exchange, particularly oxygen uptake, has been at the forefront of concepts of resuscitation and optimization for two decades: now we know how to measure it properly in the ITU, with a review by Dr Walsh. Finally, I have provided an account of how thinking may have lagged behind measurement on the forgotten boundary of the lungs, the abdomen, and provide an alternative, abdominal, explanation for several previous ideas in anaesthesia, and the postoperative period.
I hope that the readers of this issue find it as rewarding and entertaining to read as I have found it to assemble.
References
1 The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volume as compared with traditional volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2002; 342: 13018[CrossRef]
2 West JB. Respiratory Physiology: People and Ideas. New York: American Physiological Society, 1996