Intermittent Positive Pressure Respiration Research Articles

Traditional treatment of 194 cases of tetanus

Abstract A retrospective survey of tetanus was undertaken for the decade 1957–66 in the Maltese islands. The 194 cases of tetanus reported were treated solely along the conservative lines of sedation, antitoxin and antibiotics. The mortality rate of 22 per cent for the whole series compares favourably with that from other centres. Intermittent positive pressure respiration and complete muscular relaxation are essential in order to decrease further the mortality from severe tetanus, although traditional treatment is still deemed to be very valuable in the milder forms of the disease.

The effect of intermittent positive-pressure respiration on the speed of blood-flow in the deep veins of the lower limb.

The effect of intermittent positive-pressure respiration on the speed of blood-flow in the deep veins of the lower limb.

Perinatal factors and the development of chronic lung disease in preterm infants: a case control study.

A case control study of neonates was performed to determine those factors contributing to the development of chronic lung disease (CLD). During the 5 years 1981-84 there were 487 neonatal survivors at gestations of 25-32 weeks; 391 of these developed respiratory failure (oxygen therapy required for more than 6 h). Fifty-six of the latter developed CLD (oxygen therapy required for more than 28 days and a coarse reticular pattern on chest X-ray). These neonates were predominantly of the shortest gestational ages, regardless of the initial chest X-ray diagnosis. Forty-three of these infants with CLD were matched for gestation and initial chest X-ray appearance (respiratory distress syndrome, n = 20; normal, n = 15; non-specific, n = 8) with 42 control infants. The mean duration of oxygen therapy (P less than 0.001), maximum FiO2 (P less than 0.001), incidence (P less than 0.01) and duration of intermittent positive pressure respiration (IPPR; P less than 0.05) and peak IPPR (P less than 0.05) were significantly greater in the CLD group. Mean birthweight (P less than 0.001), arterial cord pH (P less than 0.05) and base excess (P less than 0.05) were significantly lower in the CLD group. Factors that were not statistically significant in the development of CLD included antenatal fetal heart rate abnormality, hypertensive disease of pregnancy, acute intrauterine infection (chorioamnionitis or umbilical vasculitis), administration of antenatal steroids, sex, patent ductus arteriosus and pneumothorax. The association between CLD and ventilator/oxygen therapy is confirmed. Contrary to other reports, male sex, clinical patent ductus arteriosus and pneumothorax were not associated with CLD.

Work practices relating to intubation and associated procedures in intensive care units in Sweden.

A survey into the current usage of tracheal tubes and associated procedures, such as various sedation regimes and antacid therapy, in intensive care units was carried out in Sweden by sending a questionnaire to physicians in charge of intensive care units in 70 acute hospitals which included seven main teaching hospitals. The purpose of the survey was to see how far the recent advances in tube and cuff design and awareness of the problems caused by prolonged therapeutic paralysis in intensive care units have influenced the attitudes and work practices of physicians in Sweden. Forty-nine replies were received (a 70% response rate). All hospitals used polyvinyl chloride tubes of Magill design, with high residual volume, low pressure cuffs. Intensive care units in 85.7% of teaching hospitals and 47.6% of non-teaching hospitals preferred the nasal route for intubation. Most non-teaching hospitals used a size 7 tube in both adult male and female patients for nasal intubation. The majority of units changed from tracheal tubes to tracheostomy after a period of 1-2 weeks. 85% of all hospitals monitored intracuff pressure as a routine, and in most intensive care units the cuff was inflated to no-leak ventilation. The majority of units rarely used muscle relaxants. Phenoperidine and diazepam were the most popular drugs used for the sedation technique. 71.4% of teaching hospitals and 40.9% of non-teaching hospitals used antacids routinely in patients on intermittent positive pressure respiration. The results are discussed.

Complications of endoscopic sphinecterotomy and their treatment.

Despite the careful observance of standard precautions during endoscopic sphincterotomy, serious complications are sometimes unavoidable and these may require various forms of treatment. Surgical intervention is necessary for fulminating pancreatitis, acute arterial hemorrhage, and retroperitoneal abscess. The endoscopic insertion of a drainage tube into the common bile duct can serve to overcome biliary obstruction due to cholangitis secondary to stone impaction, Dormia basket impaction or blood clot. The obstruction can be removed electively either endoscopically or surgically in a symptom-free interval. Uncomplicated perforation can be treated by parenteral feeding and naso-gastric suction. Acute pancreatitis may require further intensive care procedures such as peritoneal or hemodialysis and early intermittent positive pressure respiration. By using these means the mortality rate due to ES is reduced to 0.5%.

Do we overtreat patients undergoing transurethral resection of the prostate?

Two hundred unselected patients undergoing transurethral resection of the prostate have been surveyed. The routine use of endotracheal intubation, muscle relaxants, intermittent positive pressure respiration, intravenous fluids and postoperative sedation was avoided whereever possible. The results of this survey are presented and indicate that such measures can be omitted from the management of patients undergoing transurethral resection of the prostate with no significant increase in morbidity or mortality and, indeed, morbidity and mortality may be decreased by their exclusion.

Continuous positive pressure ventilation in children with bronchopneumonia

The application of a small end-expiratory pressure of 5 cmH2O to the assisted ventilation of nineteen children (mean age 19 months) with bronchopneumonia was compared with intermittent positive pressure ventilation. Within 1 h of introducing continuous positive pressure ventilation the alveolar-to-arterial oxygen gradient was reduced in most patients, with an increase in functional residual capacity and a decrease in total pulmonary blood shunt. Physiological dead space was also reduced, a feature not observed in other studies, and the significance of this finding is discussed. The use of continuous positive pressure ventilation in broncho-pulmonary infection was shown to be effective even at small pressures, and can be recommended especially for patients requiring long-term ventilation.

AN INPATIENT OBSERVATION AND COMPARISON OF THE BENNETT'S I.P.P.R. AND AEROSOL METHODS OF ADMINISTERING SALBUTAMOL

Compared with aerosol administration the Bennett's Intermittent Positive Pressure Respirator (I.P.P.R.) has been the most favoured method of Salbutamol administration in hospitals for the treatment of asthma or Chronic Obstructive Airways Disease (C.O.A.D.).

MASSIVE AIR EMBOLISM IN A NEONATE WITH RESPIRATORY DISTRESS

The occurrence of massive air embolism in a neonate during treatment with intermittent positive-pressure respiration and positive end expiratory pressure is reported as a note of caution. It is possible that this complication may indeed be more common. Careful post-mortem examinations (including radiological examinations) are advocated in order that the true incidence of this devastating event shall be known.

Die Peritonealdialyse zur Behandlung reifer und unreifer Neugeborener mit Atemnosyndrom

Some authors have recommended peritoneal dialysis to improve the therapy of the respiratory distress syndrome (RDS) of newborns. In 1968 we published a report estimated on a newborn suffering from RDS. As a pH of 6.73, was 2 hrs after birth, we administered standard therapy and peritoneal dialysis. The baby has survived and his development has been uneventful.This case and the results obtained by other authors in the treatment of RDS with peritoneal dialysis have led us to treat prematures and newborns suffering from severe RDS with peritoneal dialysis in addition to standard therapy (infusions of THAM, glucose, electrolytes, amino acids, administration of antibiotics and oxygen, and, when indicated, intermittent positive-pressure respiration). Peritoneal dialysis was carried out with bland hypertonic solution in continuous flow technics.We have treated 13 prematures and 1 newborn suffering from RDS and a premature suffering from erythroblastosis with hydrops and RDS. Except for the mature newborn, the gestational age was 25 to 33 weeks. Four prematures had birth weights below 1250 g. The Apgar score of 10 newborns was 3 or less 1 min after birth. Thirteen newborn needed resuscitation in the delivery room. Eight newborns were treated with respiration during the first few hours after birth and 4 other prematures at a later stage. Clinical and laboratory data after birth, on admission to the pediatric hospital and during the course of the disease are shown in tables and figures. The indications for the peritoneal dialysis are described in tables. In 2 patients we saw no positive effect, and we saw only a slight effect in 4 patients. Four prematures survived. The physical and psychological development was normal in 3 infants. One premature with a birth weight of 1200 g had recovered before she died of Candida sepsis at the age of 26 days.Results of the treatment and the efficacy and technical problems of peritoneal dialysis in RDS of newborns are discussed. Our opinion is that the peritoneal dialysis is a good additional aid in the treatment of RDS of prematures and newborns.

METEORISM PRODUCED BY NASOTRACHEAL INTUBATION AND VENTILATORY ASSISTANCE

INITIALLY perplexed by massive intestinal distention complicating the postoperative course of several of our patients on intermittent positive-pressure respiration and leading to rupture of the Sto...

Epinephrine-Induced Changes in the Pulmonary Pressure-Volume Curve of the Intact and Hypovolemic Rabbit

Thirteen rabbits ventilated by intermittent positive pressure respiration (IPPR) were subjected to the intravenous administration of epinephrine (0.3 mg/kg body wt). Transpulmonary pressure (difference between airway and esophageal pressure) was recorded at different volumes above functional residual capacity (FRC), under static conditions and pulmonary compliance was calculated from the slope of the pressure-volume curve between FRC and 40 ml above this point. The entire pressure-volume curve was found to be shifted to the right following the administration of epinephrine and the mean lung compliance fell to 49 percent of the initial value. The percentage reduction in static compliance measured during life in individual animals correlated well with the lungs/body weight ratio obtained on postmortem. PaO 2 was not markedly reduced. The IPPR did not prevent the development of pulmonary edema but appeared to reduce the quantity of accumulated fluid. In six animals rendered hypovolemic by bleeding, epinephrine exerted little effect on the pressure-volume curve relative to the control readings and the lungs/body weight ratio was near normal.

Combined positive and negative pressure ventilation in the management of severe respiratory distress syndrome in newborn infants.

Eleven newborn infants with severe respiratory distress syndrome (RDS) were artificially ventilated with an intermittent positive pressure respirator while a continuous negative pressure of ––4 to ––8 cm H<sub>2</sub>O was maintained about the chest; thereby achieving the equivalent positive of pressure ventilation. Although only two infants ultimately survived, arterial oxygen tension was improved in all patients, with a mean rise of 69.8 ± 17.3 mm Hg. Simultaneously, the alveolar-arterial oxygen difference fell·by a mean of 63.7 ± 18.4 mm Hg, even though the infants had not improved on preceding trials of both intermittent negative and intermittent positive pressure ventilation alone. These changes are significant at a level of p < 0.01. The maintenance of a continuous transpulmonary pressure gradient is an effective method for improving arterial oxygenation in infants requiring mechanical ventilation for the respiratory failure of RDS.

Meteorism produced by nasotracheal intubation and ventilatory assistance.

INITIALLY perplexed by massive intestinal distention complicating the postoperative course of several of our patients on intermittent positive-pressure respiration and leading to rupture of the Sto...

Effects of physiotherapy during intermittent positive pressure ventilation. Changes in arterial blood gas tensions.

AnaesthesiaVolume 27, Issue 3 p. 258-264 Free Access Effects of physiotherapy during intermittent positive pressure ventilation Changes in arterial blood gas tensions J. Gormezano, J. Gormezano J. Gormezano, FFARCS, Research Assistant in Anaesthetics and M. A. Branthwaite, MRCP, FFARCS, Consultant Anaesthetist, Brompton Hospital, Fulham Road, London S W5 6HP.Search for more papers by this authorM. A. Branthwaite, M. A. Branthwaite J. Gormezano, FFARCS, Research Assistant in Anaesthetics and M. A. Branthwaite, MRCP, FFARCS, Consultant Anaesthetist, Brompton Hospital, Fulham Road, London S W5 6HP.Search for more papers by this author J. Gormezano, J. Gormezano J. Gormezano, FFARCS, Research Assistant in Anaesthetics and M. A. Branthwaite, MRCP, FFARCS, Consultant Anaesthetist, Brompton Hospital, Fulham Road, London S W5 6HP.Search for more papers by this authorM. A. Branthwaite, M. A. Branthwaite J. Gormezano, FFARCS, Research Assistant in Anaesthetics and M. A. Branthwaite, MRCP, FFARCS, Consultant Anaesthetist, Brompton Hospital, Fulham Road, London S W5 6HP.Search for more papers by this author First published: July 1972 https://doi.org/10.1111/j.1365-2044.1972.tb08218.xCitations: 36AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Spencer, G.T. (1966). In W.D. Wylie, H.C. Churchill-Davidson A Practice of Anaesthesia, 2nd edn, p. 405. London : Lloyd-Luke Ltd. 2 Gilston, A. & Resnekov, L. (1971). Cardio-Respiratory Resuscitation, 1st edn., p. 157. London : William Heinemann Medical Books Ltd. 3 Clement, A.J. & Hübsch, S.K. (1968). Chest physiotherapy by the “Bag-Squeezing” method: A guide to technique. Physiotherapy, 54, 355. 4 Rosen, M. & Hillard, E.K. (1962). The effects of negative pressure during tracheal suction. Anesthesia and Analgesia, Current Researches, 41, 50. 5 Berman, I.R. & Stah, J.W.M. (1968). Prevention of hypoxic complications during endotracheal suctioning. Surgery, 63, 586. 6 Boutros, A.R. (1970). Arterial blood oxygenation during and after endotracheal suctioning in the apnoeic patient. Anesthesiology, 32, 114. 7 Taylor, P.A. & Waters, H.R. (1971). Arterial oxygen tensions following endotracheal suction on IPPV. Anaesthesia, 26, 289. 8 Holloway, R., Adams, E.B., Desai, S.D. & Thambiran, A.K. (1969). Effect of chest physiotherapy on blood gases of neonates treated by intermittent positive pressure respiration. Thorax, 24, 421. 9 English, I.C.W. & Manley, R.E.W. (1970). The Brompton system of artificial ventilation. Anaesthesia, 25, 541. 10 Kelman, G.R., Nunn, J.F. Prys-Roberts, C. & Greenbaum, R. (1967). The influence of cardiac output on arterial oxygenation: a theoretical study. British Journal of Anaesthesia, 39, 450. 11 Ross, J.Jr. & Braunwald, E. (1964). Studies on Starling's law of the heart, IX. The effects of impeding venous return on performance of the normal and failing human left ventricle. Circulation, 30, 719. 12 Watson, W.E., Smith, A.C. & Spalding, J.M.K. (1962). Transmural central venous pressure during intermittent positive pressure respiration. British Journal of Anaesthesia, 34, 278. 13 Nunn, J.F. & Freeman, J. (1964). Problems of oxygenation and oxygen transport during haemorrhage. Anaesthesia, 19, 206. 14 Sykes, M.K., Adams, A.P. McCormick, P.W. Bird, B., Greenburgh, S. (1970). The effect of mechanical ventilation after open-heart surgery. Anaesthesia, 25, 525. 15 Dammann, J.F., Thung, N. Christlieb, I., Littlefield, J.B., Muller, W.H. (1963). The management of the severely ill patient after open-heart surgery. Journal of Thoracic and Cardiovascular Surgery, 45, 80. 16 Sykes, M.K. (1969). Post-operative respiratory insufficiency. In W. Cleland, J. Goodwin, J. McDonald & D. Ross. Medical and Surgical Cardiology, 1st edn. p. 392. Oxford : Blackwell Scientific Publications. 17 Björk, V.O., Grenvik, A. Holmdahl, M.H. & Westerholm, C.J. (1964). Cardiac output and oxygen consumption during respirator treatment. Acta anaesthesiologica Scandinavica, Suppl., 15, 158. 18 Thung, N., Herzog, P. Christlieb, I.I. Thompson, W.M., Jr, Dammann, J.F., Jr. (1963). The cost of respiratory effort in post-operative cardiac patients. Circulation, 28, 552. 19 Gilston, A. & Resnekov, L. (1971). Cardio-Respiratory Resuscitation, 1st edn, p. 163– 191. London : William Heinemann Medical Books Limited. Citing Literature Volume27, Issue3July 1972Pages 258-264 ReferencesRelatedInformation

An Inexpensive Continuous Positive End-expiratory Pressure (PEEP) Adaptor for Positive Pressure Respirators

A simple, easily constructed device for delivering PEEP with an intermittent positive pressure respirator is described with details of construction. It is inexpensive, accurate, and disposable. We feel it is important at this time when hospital costs are rising at an alarming rate to utilize inexpensive, albeit accurate devices. A simple, easily constructed device for delivering PEEP with an intermittent positive pressure respirator is described with details of construction. It is inexpensive, accurate, and disposable. We feel it is important at this time when hospital costs are rising at an alarming rate to utilize inexpensive, albeit accurate devices. PEEPCHESTVol. 61Issue 4PreviewThe use of positive end-expiratory pressure (PEEP) is now well established as an effective means of improving pulmonary oxygen transport in the adult respiratory distress syndrome (ARDS, a response of the lung to a variety of pulmonary injuries).1,2 In ARDS, reduced pulmonary compliance and impaired oxygenation occurs in spite of conventional ventilatory assistance. Since our original description of the ARDS syndrome3 and the use of PEEP (once called continuous positive pressure breathing by us—CPPB)4 considerable interest in this pressure wave alteration has developed. Full-Text PDF

RESPIRATORY STIMULANTS IN TREATMENT OF PERINATAL ASPHYXIA

The effects of two analeptic drugs—taloximine and ethamivan—have been studied in asphyxiated fetal and newborn rabbits. In primary apnoea ethamivan reduced the time before the onset of gasping, while during gasping taloximine increased the gasp rate. In secondary apnoea neither drug initiated respiration, though most animals could be resuscitated by using intermittent positive pressure respiration. From these results it is suggested that analeptic drugs have no place in obstetric or neonatal departments.

Intensive care of small premature infants. II. Postmortem findings.

SummaryTwenty‐seven deaths in premature infants weighing less than 1 250 g who were treated with intermittent positive pressure respiration are reported. The major pulmonary abnormalities were hyaline membrane formation, infection, and hemorrhage occurring‘ alone or in combination with intraverticular hemorrhage. Hyaline membranes were associated with severe clinical features of respiratory distress, whereas infection was not. Prolonged treatment resulted in “bronchopulmonary dysplasia” in only 1 case where severe clinical respiratory distress was associated with the finding of hyaline membranes at post mortem.

ARTERIAL HYPOTENSION CAUSED BY A COMBINATION OF RAISED INTRATHORACIC PRESSURE AND CERTAIN MUSCLE RELAXANTS

SUMMARY A pilot study was made of the effects of raised intrathoracic pressure on arterial blood pressure shortly after the intravenous administration of three non-depolarizing muscle relaxants. Mean airway pressure was measured as an index of intrathoracic pressure during intermittent positive pressure respiration. Appreciable falls of blood pressure were observed within 10–15 minutes after the administration of tubocurarine and to a lesser extent after alcuronium but not after administration of pancuronium. This effect was especially marked in elderly patients and those with severe cardiovascular disease.

The effect of mechanical ventilation after open-heart surgery.

The effect of mechanical ventilation after open-heart surgery.