Medical management of the long-term respirator patient

Abstract

a respirator preserves the life of an extensively paralyzed child during the te phase of poliomyelitis, physicians have triumphed over death, but they re created for themselves a problem in chronic illness and in providing faties for the physical, mental and social rehabilitation of a seriously disabled ient.” We wish to discuss problems in the medical management of some of the g-term respirator patients. The impaired respiratory capacity of these patients stems primarily from involvement of primary and accessory muscles of respiration. The dia‘agm is the most important respiratory muscle. At rest it accounts for apximately 60 per cent of the ventilation. It secures its innervation, however, n cervical roots III and IV, and occasionally from V. The cervical innerion largely supplies the central portion or central tendon of the diaphragm I its crura. The costal portion of the diaphragm, on the other hand, is largely Iplied by the lower six intercostal nerves, which also send some fibers to the tral tendon. The intercostal nerves also innervate the intercostal muscles, ,ch also play an important role in respiration. The most important group accessory muscles of respiration are those of the neck and shoulder girdle, ch are chiefly involved in upper costal respiration. A second important scular structure concerned with respiration is the abdominal wall. All these ups of muscles derive their innervation from the cervical or thoracic segments he spinal cord. For this reason these long-term respirator cases are primarily se w’ith high spinal involvement. True, of course, some may have had some ree of bulbar involvement during their acute illness; however, there is little lence that the bulbar residual involvement is the primary source of the longn respiratory difficulty. Of the thirty-six patients all except three developed poliomyelitis over lteen months ago. All of them required the assistance of a respiratory aid --From the Poliomyelitis Rehabilitation Center, aided by &II annual grant from the National Foun,n for Infantile Paralysis. *Professor and Director of Department of Medicine, Creighton University School ol Medicine. **Instructor in Neurology. Creighton University School of Medicine.