Pulmonary function and circulatory dynamics in artificial pneumoperitoneum. I. Studies on patients with pneumoperitoneum therapy for pulmonary tuberculosis.

Abstract

Although pneumoperitoneum at present is most widely used as a form of collapse therapy in pulmonary tuberculosis, this procedure had been applied some years earlier in the treatment of chronic pulmonary emphysema. In 1924 Reich’ reported on this procedure, considering 300 to 500 cc. the ideal amount of air. He found greatly improved diaphragmatic motion, increased tidal air and respiratory minute volume, higher capillary oxygen saturation and even a decrease in alveolar carbon dioxide. There was often striking clinicalimprovement with a decrease in dyspnea, cyanosis, and coughing, and a reduction in the frequency of asthmatic attacks. Reich attributed the beneficial effects to mechanical improvement in breathing, and, because in some patients improvement persisted after resorption of the air,he concluded that these patients had regained the proper use of the diaphragm. Piaggio-Blanco in 19372 noted the effectiveness of pneumoperitoneum in patients with chronic pulmonary emphysema in a purely clinical study. Other reports34 suggested that pneumoperitoneum was effective in decreasing the frequency and severity of attacks in uncomplicated bronchial asthma. In 1950 Gaensler and Carter5’6and Furman and Callaway7 reinvestigated this procedure in emphysema. The former authors studied the effect of pneumoperitoneum on ventilatory function and pulmonary capacity in 13 patients with chronic pulmonary emphysema, 10 of whom were improved clinically by the procedure. The residual air was always reduced, averaging 26 per cent less while the Inspiratory capacity increased in all cases, averaging 24 per cent more. The vital capacity increased in 10, although the total capacity was somewhat decreased in all patients. A 33 per cent mean Increase in maximum breathing capacity was accompanied by a reduced breathing requirement at rest. With standard exercise the breathing reserve increased from 68.2 per cent of the maximum breathing capacity to 80.5 per cent after treatment. Oxygen consumption was unchanged, the ventilatory equivalent being reduced. Two patients showed increased arterial oxygen saturation and decreased carbon dioxide tension after pneumoperitoneum especially in relation to exercise. A third showed no change in blood gases. Fluoroscopy demonstrated a marked increase in diaphragmatlc motion although the amount of intraperitoneal air was