Pulmonary Drainage Research Articles

85 A Treatment for the Complications of Prolonged Artificial Ventilation of Small Infants

All infants in our center with severe respiratory distress syndrome who have required artificial ventilation with 80–100 % O2 for more than 5 days have shown abnormalities in the lungs with characteristic radiologic findings and prolonged hypercarbia following extubation. Microscopic examination of lung sections of 13 infants who died revealed hypertrophic bronchial mucosal glands and necrotic bronchial epithelium blocking some of the fine airways. The known tendency of the small airways of an infant to collapse and the microscopic appearance of the lung suggested that after extubation vigorous pulmonary drainage might be of value. To prevent this complication rapid graded weaning from the ventilator is now attempted and following extubation, postural drainage, chest percussion, vibration, and tracheal suction under direct vision are performed at first hourly, decreasing to daily intervals by the third day.8 infants (1700–2020 g) maintained on a respirator for 5 to 17 days but not receiving intensive pulmonary physiotherapy, still had evidence of pulmonary disease 2–18 months after extubation. 3 infants (1700–2500 g) who received intensive pulmonary drainage after being on the respirator for 2 ½, 6 ½, 7 ½ days had no apparent pulmonary disease 18, 27, 30 days after extubation. 6 infants (860–4000 gm) with respiratory failure associated with other diseases who were maintained on a ventilator for 1–2 days and who were also treated with intensive suctioning following extubation, recovered promptly. These observations suggest that some of the complications of prolonged artificial ventilation with high O2 concentrations may be preventable. (SPR)

Lung Cancer: Surgery and Survival

Written in a pleasing and readable style often rare today, this short work was originally presented as a Hunterian lecture in the Royal College of Surgeons, London, Oct 4, 1951, and was later expanded. Although the author refers to the classic work of Rouviere and of Cordier on pulmonary lymphatic drainage, this book is really a contemporary study of the patterns of lymph node metastasis in 200 personal resections for bronchial carcinoma carried out between 1941 and 1950. Unique in cancer surveys is the fact that follow-up information was available on all patients. While lobectomy for carcinoma of the lung is often desirable in patients with poor ventilatory function, the author emphasizes that it is frequently not actually feasible even as a palliative procedure because of tumor invasion of the intrapulmonary lymph nodes. The small size of a peripheral neoplasm is no guarantee that it is benign, nor that it

Two cases of total anomalous pulmonary venous return of the supracardiac type with stenosis simulating infradiaphragmatic drainage.

Two patients who died during the neonatal period with congestive heart failure and marked pulmonary congestion were found at autopsy to have total anomalous pulmonary venous return of the supracardiac type with stenosis of the pulmonary vein. The narrowing was the result of an unusual course of the vein, which passed between the left pulmonary artery and left main bronchus and was stenosed at this point. It is emphasized that the clinical and x-ray findings were indistinguishable from those of total anomalous pulmonary drainage below the diaphragm.

Factors affecting bronchial collateral flow in the dog.

A preparation is described in which the pulmonary and systemic circulations were perfused separately. The only connection between the two circulations was by way of the bronchial collateral vessels. The volume of collateral flow could be measured by recording the rise and fall in the pulmonary drainage reservoir. A ‘forward’ bronchial collateral flow and a ‘reverse’ bronchial collateral flow is described and their existence has been confirmed by radioactive iodinated serum albumin studies. Increases in systemic arterial and venous pressures have been demonstrated to cause an increase in bronchial collateral flow. Independent increases of pulmonary arterial and left atrial pressures resulted in a decrease in bronchial collateral flow, and at suitable pressures a reversal of flow was demonstrable. The data suggest the presence of two bronchial circulations with drainage into the pulmonary arterial and venous systems separately.

Cardiac dextroposition: Hypoplasia of the right pulmonary artery with right venous pulmonary drainage into the inferior vena cava

A case of pseudodextrocardia with hypoplasia of the right pulmonary artery, together with anomalous drainage of the right lung into the inferior vena cava has been described, and the angiocardiographic study reported.

Pulmonary Postural Drainage for Bronchiectasis

SUMMARY Four simple methods of pulmonary postural drainage for bronchiectasis have been outlined. The knee-chest position has been found to be the most successful for it removes a large portion of secretions whenever used. The elbow-to-knee position with and without the aid of a chair, being simple, supplements the knee-chest for it can be used at any time or place. The crouching position has been helpful in arthritic and elderly patients. Experience has proved over a period of five years that patients become expert in the procedure for they are well tolerated, do not require props, assistance or expense. Helpful aids in individual education are outlined. These four exercises have been found to be practicable for bronchiectasis as well as other pulmonary diseases requiring drainage, such as tuberculous basal cavities, purulent tracheobronchitis, lung abscess in the lower lobes, bronchial asthma (depending on the severity of dyspnea), asthma complicated by bronchiectasis and pulmonary emphysema. The exercises are also helpful before bronchographic study and surgical procedures requiring pulmonary drainage.