Precipitation by pulmonary infection of acute anoxia, cardiac failure and respiratory acidosis in chronic pulmonary disease

Stone, Daniel J.; Schwartz, Arthur; Newman, Walter; Feltman, James A.; Lovelock, Francis J.

doi:10.1016/0002-9343(53)90353-2

Cited by 58 publications

(10 citation statements)

References 14 publications

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“…With mask ventilation, the arterial blood gases can usually be improved within 1-2 h, especially if the initial arterial carbon dioxide tension (Pa,CO 2 ) is raised [10][11][12][13][14][15][16], although in a controlled study there was no difference in the blood gases between the ventilated and nonventilated patients [17]. Early studies with negative pressure ventilation also showed that ventilation could be adequately supported [18][19][20][21][22], and these findings have been confirmed in subsequent uncontrolled studies [9,[23][24][25]. The mechanisms by which noninvasive ventilation achieves these effects have not been established.…”

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confidence: 99%

The changing role of mechanical ventilation in COPD

Shneerson¹

1996

Eur Respir J

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For many years, mechanical ventilation has been employed in patients with chronic obstructive pulmonary disease (COPD) but the recent development of noninvasive techniques, particularly nasal and face mask ventilation, have considerably increased its use. The enthusiasm for these methods, however, has not been matched by the results from well-constructed studies, and the role of ventilatory support both in acute and chronic respiratory failure is still not settled. Acute respiratory failureThe steadily increasing number of publications on the use of noninvasive ventilation in acute infective exacerbations of COPD are hard to evaluate for several reasons. Firstly, most of the studies are uncontrolled or use historical or other unsatisfactory control groups. The definition of an infective exacerbation and its severity also varies considerably between the studies. Some studies compare the results of ventilation against "standard" medical treatment but this is frequently unspecified and, where details are given, oxygen appears to have been provided in flow rates sufficiently high to risk precipitating hypercapnia. Lastly, the criteria for the success or failure of noninvasive ventilation, such as the need for intubation, differ between studies.Series published before the use of noninvasive ventilation indicated that the intubation rate was around 25% for hospitalized COPD patients with an acute infective exacerbation [1,2]. Their survival to discharge from hospital was around 60-75%, and at 1 year was around 50% and 2 years around 35% [3-6]. The major areas of interest with noninvasive techniques have been to show whether they can adequately ventilate these patients, reduce the intubation rate and improve survival. Approximately 60-80% of patients tolerate both positive pressure ventilation by face or nasal mask [7,8] and negative pressure ventilation [9]. With mask ventilation, the arterial blood gases can usually be improved within 1-2 h, especially if the initial arterial carbon dioxide tension (Pa,CO 2 ) is raised [10][11][12][13][14][15][16], although in a controlled study there was no difference in the blood gases between the ventilated and nonventilated patients [17]. Early studies with negative pressure ventilation also showed that ventilation could be adequately supported [18][19][20][21][22], and these findings have been confirmed in subsequent uncontrolled studies [9,[23][24][25]. The mechanisms by which noninvasive ventilation achieves these effects have not been established.It can reduce respiratory muscle activity [26] and increase maximum inspiratory pressures [9, 24], but whether these or any changes in respiratory drive or mechanics are clinically significant is still uncertain.There are few data regarding the ability of negative pressure systems to avoid or delay intubation, but this question has been addressed in several reports of mask ventilation. Three series using historical controls suggested that the intubation rate could be reduced [27][28][29]. The results of a fourth are published in this ...

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confidence: 99%

The changing role of mechanical ventilation in COPD

Shneerson¹

1996

Eur Respir J

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“…The use of the respirator permitted continuous use of oxygen therapy without the threat of the return of CO2 narcosis. This will be discussed in another paper (14). DISCUSSION We have presented two patients whose primary difficulty was a defective bellows action of the chest cage.…”

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confidence: 83%

Cardiac Failure Secondary to Ineffective Bellows Action of the Chest Cage

Feltman¹,

Newman²,

Schwartz³

et al. 1952

J. Clin. Invest.

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Baldwin, Cournand, and Richards (1) have described the following classification of pulmonary insufficiency:1. Ventilatory a. Restrictive, viz., pulmonary fibrosis, kyphoscoliosis. b. Obstructive, viz., pulmonary emphysema. 2. Alveolar-respiratory a. Distributive, viz., pulmonary emphysema. b. Diffusional, viz., pulmonary scleroderma.The two cases to be presented demonstrate ventilatory insufficiency of the restrictive type due ,in the first instance to primary neuromuscular dysfunction and in the second to chronic pleural disease with resulting calcification and restriction of the underlying parenchyma and diaphragm. Of particular interest was the development of congestive heart failure in both of these patients. These On admission the patient appeared chronically ill without respiratory distress but with cyanosis of the lips, nailbeds, and skin. There was a marked dysarthria. His chest cage moved very little on normal respiration but he had good expansion with effort and could clear most of his cyanosis with forced breathing. The heart was not remarkable on examination except for a markedly accentuated P2. The lungs were clear to percussion and auscultation. The abdominal examination was within normal limits. Neurological examination revealed the right pupil to be larger than the left, and both reacted sluggishly to light and accommodation. The external ocular movements were normal but he had diplopia in all fields. The disc margins were slightly blurred nasally and he had small hemorrhages about the discs. His gait was normal. There was weakness of the jaw, right facial, palatal, tongue, neck, and shoulder muscles with fasciculations noted in these groups. In addition there was atrophy of the masseters, platysmae, tongue, neck and shoulder muscles. There were a few fasciculations of the triceps muscles but no weakness or atrophy. The deep tendon reflexes of the arms were two to three plus bilaterally and there was greater finger stretch on the left than on the right. The abdominal reflexes were diminished bilaterally. There was no atrophy or weakness of the legs and the sensory examination was normal.Laboratory examinations including complete blood count, urine analysis, blood chemistries, spinal fluid, serology, chest X-ray, skull plates, and electrocardiographs were all within normal limits.The patient's neurological status remained unchanged while under observation and adequate nutrition was maintained with tube feeding. Two months after admission a medical consultation was requested because of increasing cyanosis. At this time marked cyanosis was observed without respiratory distress. Expansion of the chest cage during ordinary breathing was minimal but with forced inspiration he was capable of a three inch chest expansion. The lungs were clear and examination of the heart was unremarkable except for an accentuated second pulmonic sound. Abdominal examination was negative. There was no peripheral edema or venous engorgement. The red blood count was 6.75 million with a hemoglobin of 19.4 grams and a hemat...

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“…BOUTOURLINE-YOUNG and WHITTENBERGER [72] described two cases of pulmonary emphysema with hypercapnia and hypoxaemia treated in a body respirator; one patient died and the other survived and was able to return to his former occupation. STONE et al [73] successfully treated by iron lung three patients with chronic pulmonary disease during ARF. LOVEJOY et al [74] reported that, in two out of three patients with severe COPD in comatose state and with severe hypercapnia and respiratory acidosis, the use of iron lung resulted in recovery.…”

Section: Arf In Copd With Chronic Respiratory Insufficiencymentioning

confidence: 99%

Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered

Corrado¹,

Gorini²,

Villella³

et al. 1996

European Respiratory Journal

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Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered. A. Corrado, M. Gorini, G. Villella, E. De Paola. ©ERS Journals Ltd 1996. ABSTRACT: Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators, such as the "iron lung", support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration; whereas, expiration occurs when the pressure around the chest wall increases and becomes atmospheric or greater than atmospheric.In this review, after a description of the more advanced models of tank ventilators and the physiological effects of negative pressure ventilation (NPV), we summarize the recent application of this old technique in the treatment of acute respiratory failure (ARF). Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease and restrictive thoracic disorders, reducing the need for endotracheal intubation. In the paediatric field, after substantial technical improvement, NPV has been successfully reintroduced for the treatment of ARF due to neonatal distress syndrome and bronchopulmonary dysplasia, and for the weaning from positive pressure ventilation in intubated patients.The positive results of these reports need to be formally confirmed by further prospective and controlled studies before recommending the generalized use of negative pressure ventilation in acute respiratory failure as a standard of care.

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Precipitation by pulmonary infection of acute anoxia, cardiac failure and respiratory acidosis in chronic pulmonary disease

Cited by 58 publications

References 14 publications

The changing role of mechanical ventilation in COPD

The changing role of mechanical ventilation in COPD

Cardiac Failure Secondary to Ineffective Bellows Action of the Chest Cage

Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered

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