Patients Breathing Room Air Research Articles

Respiratory effects of ethyl alcohol intoxication.

To the Editor.— Death from acute alcohol intoxication is thought by many to be due to respiratory failure. Yet in recent laboratory studies, moderately intoxicating doses of ethyl alcohol (120 mg/100 ml) had no consistent effect on respiratory rate or minute volume and sometimes increased ventilation. We therefore studied ten severely intoxicated adults brought to the Cincinnati General Hospital emergency unit. Very high blood concentrations of ethyl alcohol (BEC) in these patients caused only moderate respiratory depression. The patients were chronic alcoholics without clinical evidence of cardiopulmonary disease. Screening of blood samples by means of gas chromatography excluded the presence of other drugs in addition to ethyl alcohol. Of the ten patients, two were unconscious and eight were conscious but lethargic, with slurred speech and incoordination. Arterial blood for pH and gas analysis was drawn while the patients breathed room air. Venous BEC were determined by gas chromatography. Arterial blood

THE CRITICALLY ILL CHILD: MANAGEMENT OF TRACHEOSTOMY

The indications for and methods of performing a tracheostomy in children are many and varied. There is still controversy as to the size, types, and placement of the tube; the type of incision; the relative indications for tracheostomy in infants and older children; the use of prolonged endotracheal intubation in preference to tracheostomy; and even the type of instruments used to perform the tracheostomy. However, problems discussed here are mainly the proper care of the child with a tracheostomy tube, including those associated with its removal. Whatever the disease state from which the child suffers, certain basic principles must be kept in mind during all tracheostomy care. These relate to: (1) inspired gas mixtures, (2) humidification in inspired gas, (3) suctioning of secretions, (4) positive pressure breathing, (5) chest physiotherapy, (6) weaning of a patient from tracheostomy, (7) home care of tracheostomy by parent, and (8) complications of tracheostomy. Let us now examine these factors in detail. INSPIRED GAS MIXTURES Gas mixtures most commonly administered via tracheostomy are of oxygen and air, in percentage that will maintain arterial oxygen tension (PaO2) at near normal. Sometimes this will require 100% oxygen or sometimes 100% air, which is, of course, 20% oxygen. Whatever the mixture, the PaO2 should never exceed 250 mm Hg; ideally, it should never approach this figure. Immediately following tracheostomy, arterial blood gases should be measured with the patient breathing room air, providing that his clinical condition will tolerate this minimal oxygen percentage. If by clinical judgment additional oxygen is required, the inspired percentage should be carefully measured at the time blood is drawn for gas determination.

The Relation of Postoperative Atelectasis to the Solubility of Gas Filling the Lungs at Termination of Anesthesia

This study was undertaken to test the hypothesis that thorough ventilation of lungs with gas of low solubility at the termination of anesthesia protects against postoperative atelectasis. Two similar groups of patients were studied. Each group received a 10-minute period of test gas administration at termination of anesthesia, one receiving room air, the other 100 per cent oxygen, following which all patients breathed room air for the remainder of their convalescence. Atelectasis was defined as a fall in PaO2 from preoperative to postoperative values without generalized hypoventilation or decreased inspired oxygen concentration. Arterial blood studies were performed 1-hour and 24-hours postoperatively. In addition, the clinical records of all patients were scrutinized for evidence of postoperative pulmonary complications. No difference in incidence of atelectasis or pulmonary complications was detected in either group. The hypothesis was, therefore, rejected.