Acute pulmonary insufficiency in chronic pulmonary disease is a medical emergency. Its therapy is difficult, and the mortality isgreat.A number of approaches to the problem have been employed, including the use of antibiotics, corticosteroids, oxygen, tracheotomy, and various mechanical devices to improve respiration. The physiologic derangement seen in this condition is relatively constant although it may occur in a wide variety of diseases. There is severe arterial hypoxia and hypercapnia. Associated with the persistent hypercapnia is a decreased sensitivity of the respiratory center to the stimulus of carbon dioxide. The sole remaining stimulus to respiration is the hypoxia. When the arterial oxygen is increased above physiologic levels, such as occurs during breathing of 100 per cent oxygen, this stimulus is lost, alveolar ventilation decreases, arterial hypercapnia increases, the pH of the arterial blood decreases, and death ensues. In order to decrease the hypercapnia or minimize its increase and, at the same time, prevent severe hypoxia, oxygen in concentrations of less than 100 per cent was used in the treatment of this condition. The sensitivity of the medullary respiratory center to Pco2 may thus be gradually increased. What role the increased arterial oxygen plays in this improvement is unknown.’ The observations obtained from this form of therapy are the subject of this report. Methods All patients evaluated had chronic pulmonary disease, but of different etiologies. They were acutely ill with severe pulmonary insufficiency at the time of these observations. Studies were performed with the patients breathing ambient air, 100 per cent of oxygen by nasal catheter, and varying concentrations of oxygen administered by IPPB/I (intermittent positive pressure breathing, inspiratory). Arterial blood samples were obtained and analyzed for oxygen and carbon dioxide tensions by the Riley bubble technique.2 Admittedly, this is not the most accurate procedure available, but with a well-trained biochemist, periodically checked by tonometer studies, the physician at the bedside can quickly obtain valuable clinical information which win give an objective approach to further treatment. Varying concentrations of inspired oxygen were obtained by mixing compressed air and 100 per cent oxygen in the nebulizer of a Bennett Model PR-lA Respirator. *}�m the Cardiopulmonary Laboratory and the Medical Service, Veterans Administration Hospital, Hines, Illinois. tDirector, Cardiopulmonary Laboratory, Saint Joseph Infirmary, Louisville, Kentucky.
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