Tracheostomy and Ventilator Dependency (2000).  Edited by Donna C. Tippett. Thieme Medical Publications, Inc., 333 Seventh Ave., New York, NY 10001. 311 pages, $69. Reviewed by Gloria H. Polk, Detroit, MI.

This book addresses basic and clinical concepts in management of individuals with tracheostomy
and ventilator dependency. Experts in the fields of neurology, nursing, otolaryngology, pediatrics, pulmonary and critical care, rehabilitation medicine, and speech-language pathology share their knowledge and experiences. The reader begins with a comprehensive review of the structure and function of the respiratory system and the effects of tracheostomy and ventilator dependence and concludes with a review of the relevant ethical principles and a framework for helping patients and healthcare providers making these decisions. Chapter 2 addresses the pathophysiology of respiratory insufficiency, respiratory complications, and respiratory failure, as well as approaches to avoid complications and hospitalizations. The criteria needed for undergoing tracheostomy as well as tracheostomy tube removal and conversion to noninvasive respiratory alternations are presented. A chapter is devoted to the history of mechanical ventilation and the reasons for their use. In another chapter, the reader finds detailed information regarding the current availability of tracheostomy tubes, the advantages and disadvantages of the styles and types of tubes presently manufactured, and speaking valve options that are used with tracheostomy tubes. Preserving oral communication in persons with tracheostomies is the primary focus of Chapter 5. Case studies are presented in support of the effectiveness of compensations presented for communication impairments that result from tracheostomy with or without ventilator dependency. A table outlining the communication options for persons dependent on a tracheostomy or ventilator provides the practitioner with a summary review.

Chapter 6 focuses on management of swallowing disorders. It covers the normal anatomy and physiology relevant to swallow, the effects of tracheostomy on swallowing, bedside and radiographic swallowing evaluation, and techniques specific to these individuals. An algorithm for the evaluation of swallowing is reviewed.

In the final chapters, the impact of tracheostomy and ventilator dependence on oral communication, feeding, and swallowing abilities in children is discussed. The importance of an interdisciplinary model is emphasized and the specialized needs of pre-linguistic ventilator-assisted children are reviewed. Chapter 8 reviews information about post-hospitalization care with such factors as medical stability, community re-entry, caregiver, education, equipment needs, and financial planning.

The author states that this book is "intended primarily for speech-language pathologists who work in highly sophisticated and technologically advanced environments." I think that individuals in the field of education, as well as any practitioners seeking knowledge and understanding of the various concepts associated with tracheostomy and ventilator dependency, will find this book an excellent resource. The broad scope of information covered facilitates this understanding without having to consult multiple references. The outstanding and diverse contributions of the experts enhance the book' s worth. In addition, the numerous figures, cross-reference charts, and case studies throughout the book enhance its application to multiple settings. This book is both theoretical and practical. It provides the background and the detail needed for hands-on management. I highly recommend this book.