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Further studies of rimiterol and salbutamol administered by intermittent positive-pressure ventilation, and an important observation on the technique of using the Bennett ventilator.

1. Using the same technique of administering drugs by intermittent positive-pressure ventilation as used in previous studies a source of contamination of solutions nebulized was discovered. This was rectified by using a new ventilator and completely separate patient circuits for each solution nebulized. 2 Salbutamol 0.5% and 0.25% solutions achieved the same degree of bronchodilatation, but there was a significantly greater increase in heart rate produced by salbutamol 0.5%. 3 Rimiterol 0.5% and salbutamol 0.25% produced similar peak mean improvements in FEV and also induced the same degree of tachycardia, but the duration of these effects were significantly shorter in the case of rimiterol. 4 The sustained degree of bronchodilatation achieved by salbutamol 0.25% could not be mirrored by giving two doses of rimiterol 0.5%, the second dose 2 h after the first. 5 Rimiterol 0.5% induced a degree of tachycardia which was similar in peak effect to that observed after salbutamol 0.25%. However, in the controls the second dose of rimiterol, given 2 h after the first, was responsible for only a small increase in heart rate which was not significantly different than that after saline in the other three treatment groups.

Adult

Stomach as source of bacteria colonising respiratory tract during artificial ventilation.

10 adults had intermittent positive-pressure ventilation for 3--34 days. All 10 had paralytic ileus. Microbial overgrowth in the stomach was found in 9 patients (bacterial in 7 and fungal in 2); gram-negative bacteria predominated. The trachea invariably became colonised by bacteria, mainly gram-negative organisms. In 3 instances the gram-negative bacteria were found in the stomach before they appeared in the tracheal aspirate, and in 1 case the pathogen originated in the faeces.

Adult

Effects of continuous positive-pressure ventilation in experimental pulmonary edema.

We compared the effects of continuous positive-pressure ventilation (CPPV), using 10 cmH2O positive end-expiratory pressure (PEEP), with intermittent positive-pressure ventilation (IPPV), on pulmonary extravascular water volume (PEWV) and lung function in dogs with pulmonary edema caused by elevated left atrial pressure and decreased colloid osmotic pressure. The PEWV was measured by gravimetric and double-isotope indicator dilution methods. Animals with high (22-33 mmHg), moderately elevated (12-20 mmHg), and normal (3-11 mmHg) left atrial pressures (Pla) were studied. The PEWV by both methods was significantly increased in the high and moderate Pla groups, the former greater than the latter (P less than 0.05). There was no difference in the PEWV between animals receiving CPPV and those receiving IPPV in both the high and moderately elevated Pla groups. However, in animals with high Pla, the Pao2 was significantly better maintained and the inflation pressure required to deliver a tidal volume of 12 ml/kg was significantly less with the use of CPPV than with IPPV. We conclude that in pulmonary edema associated with high Pla, PEEP does not reduce PEWV but does improve pulmonary function.

Animals

Prospective study of the treatment of septic shock.

A study of 113 patients with septic shock admitted to an intensive therapy unit (I.T.U.) during a 3-year period showed that a significant reduction in mortality was achieved after the introduction of a treatment programme which included early intermittent positive-pressure ventilation and aggressive surgery in addition to conventional management with fluids, oxygen, and antibiotics. Vasoactive drugs played an important but not essential role in therapy.

Adult

Intensive care in rabies therapy. Clinical observations.

Seven patients in India with dog-bite rabies were treated by intensive therapy. Hypoxia was prevented by intermittent positive-pressure ventilation facilitated by muscle relaxants and sedatives. Other measures, included maintenance of nutrition, correction of fluid/electrolyte and acid/base balances, antiviral agents, immunological stimulation, and intensive nursing care by immunised volunteer staff. The patients survived for from 1 to 17 days after the onset of clinical disease. When survival was prolonged (i.e., more than 2-4 days) by intensive care, the disease had diverse and serious effects, including fluctuations in temperature and blood-pressure, cardiac arrhythmia, and diabetes insipidus. Although none of the patients survived, advances in the use of this technique raised hopes that it may eventually be possible to save some patients.

Cytarabine

Mechanisms of reflex cardiac arrest in tetraplegic patients.

Four patients with physiologically complete high cervical spinal-cord lesions, sustained within the previous 6 weeks, were observed. All needed intermittent positive-pressure ventilation. In the stage of spinal shock, stimuli to the trachea induced bradycardia, and in two patients cardiac arrest resulted. The bradycardia occurred when the patients were hypoxic, and seemed to be due to a vaso-vagal reflex. Normally this reflex is opposed by sympathetic activity, and during hypoxia by increased pulmonary (inflation) vagal reflex activity due to increased breathing. In these patients, however, compensatory sympathetic activity was prevented by the cervical cord lesion, and increased pulmonary vagal reflex activity by the fact that the breathing was artificial and therefore did not increase with hypoxia. Treatment in emergency includes the administration of atropine. Adequate oxygenation and, if this cannot be achieved, maintenance atropin should prevent the bradycardia and cardiac arrest associated with stimulation of the trachea in artificially ventilated tetraplegic patients.

Adolescent

Haemodynamics of cardiac tamponade during various modes of ventilation.

Cardiac output and pleural, pericardial, arterial and cardiac pressures were measured in baboons during different modes of ventilation in the presence of acute cardiac tamponade. Fluctuations in pleural pressure during intermittent positive pressure ventilation were transmitted to the pericardial fluid. Cardiac output and transmural right ventricular end-diastolic pressure were significantly greater during spontaneous ventilation than during intermittent positive pressure ventilation with or without positive end-expiratory pressure. It is recommended that a patient undergoing surgery for cardiac tamponade be allowed to breathe spontaneously until the chest is opened and the pericardium incised.

Animals

Triggering modalities to synchronise non-invasive respiratory support in preterm infants: a systematic review and meta-analysis.

BACKGROUND: Increasing evidence suggests that synchronised nasal intermittent positive pressure ventilation (sNIPPV) may be the optimal mode of non-invasive respiratory support. However, no comprehensive review of sNIPPV modes is available. This review aims to describe different synchronisation methods for sNIPPV and compare their effectiveness in clinical, physiological and technical outcomes with other modes of non-invasive respiratory support. METHODS: This review identified all clinical studies in preterm infants that compared sNIPPV to other non-invasive respiratory support modes or compared different trigger modalities between 1990 and 2026. A search was carried out in MEDLINE, Embase and the Cochrane Library. Main outcomes were categorised as clinical (eg, extubation failure (EF)), physiological (eg, breathing effort) and technical (eg, synchronisation rate). RESULTS: 49 studies (2864 infants) were included, with a low to moderate risk of bias. Meta-analysis showed a reduction in EF (risk ratio=0.38; 95% CI 0.17 to 0.85; p=0.03) in favour of sNIPPV compared with nasal continuous positive airway pressure (nCPAP). Physiological outcomes were significantly improved during sNIPPV compared with nCPAP and nasal intermittent positive pressure ventilation (NIPPV), especially breathing effort. When reviewing technical outcomes, non-invasive neurally adjusted ventilatory assist showed lower patient-ventilator asynchrony (PVA) (index ranging from 7% to 50%), a higher synchronisation rate (80%-99%) and a shorter trigger delay (35 ms) compared with other sNIPPV modes. CONCLUSIONS: This review shows that synchronising NIPPV results in consistent physiological (reduced patient effort) and technical benefits (reduced PVA). However, evidence on positive effects on (long-term) major clinical outcomes remains limited and requires further studies. PROSPERO REGISTRATION NUMBER: CRD420251022479.

Humans

The effect of focal twitching on the intracranial pressure during paralysis and mechanical ventilation.

Three patients with head injuries developed minor facial twitching while their intracranial, intrathoracic and systemic arterial pressures were being monitored and they were on mechanical ventilation. These twitches were disclosed by the coincided great and damaging increases in the intracranial pressure, while the intrathoracic and arterial pressures were virtually unchanged. The intracranial hypertension was attributed to cerebral vasodilatation which was presumed to be due to the accumulation of cerebral metabolites since other causative factors such as systemic hypertension and hypoxia were under control. Cerebral elastance modulated the rise in intracranial pressure.

Acid-Base Equilibrium

[Intermittent positive pressure breathing (IPPB) with respirators in home nursing].

29 patients using a home respirator have been studied. Management of the respirator and inhalation were correct in 86%. Bacteriologic contamination in home treatment poses few problems. Blood gases and spirometric lung function tests do not demonstrate amelioration but show stabilization in long term treatment. Costs are high. Nevertheless, this treatment is indicated in certain carefully selected patients. Follow-up checks are essential.

Adrenergic beta-Agonists

[Comparative study of venous contamination with low FiO2 and with pure oxygen in disease-induced pulmonary edema].

A comparative study of the venous contamination (Qs/Qt = (Cc'O2 - CaO2) / (Cc'O2 - C-vO2) under FIO2 = 0.45 - 0.6 and under FIO2 = 1, was realised in 9 patients with lesions of pulmonary oedema. Increasing the FIO2 lead to an increase in the venous contamination three times (average increase was 36 p. 100 of the initial value), to no change two times and a decrease four times (average decrease of 34 p. 100). The values of the venous contamination under average FIO2 are statistically lower in the group where it rises on increasing the FIO2 than in that in which it falls or remains unchanged (p is less than 0.005).

Humans

[Note on the care of tracheotomized patients].

After considering the indications for tracheotomy on his intensive care unit, the author describes the risks of this operation and the means of avoiding them. Out of 1940 patients admitted over a period of 5 years on the intensive care unit of the Royal Victoria Infirmary, Newcastle-on-Tyne, 175 were tracheotomised, inclusing 133 who were submitted to intermittent positive pressure ventilation. Only three patients had complications linked to the tracheotomy, complications which were the cause of the death of two of them.

Hemorrhage

Pulmonary function in premature lambs during the first few hours of life.

This study establishes the mean values, variations, and trend of pulmonary function during the first few hours of life in premature lambs. Measurements of intraesophaheal and tracheal pressure, air flow, tidal volume, and functional residual capacity enabled calculations of lung compliance, specific lung compliance, and inspiratory and expiratory resistance of the lungs. Arterial carbon dioxide tension and pH were maintained within a physiologic range. Mean arterial oxygen tension (PO2) at elevated inspired oxygen tension, varied in the individual animals from 51 to 185 mm Hg at an inspired oxygen concentration of 46 to 71%. It was found that the lungs of premature lambs delivered by cesarean section were mechanically unstable; the lambs were all ineffectual at breathing and required some form of mechanical ventilation. During the first 6 hours of postnatal life the lungs of premature lambs are characterized by a wide range of mechanical values and blood gas tensions.

Animals

The haemodynamic effects of unsupplemented nitrous oxide-oxygen-relaxant anaesthesia in cardiac patients.

The effect on the systemic and pulmonary circulation of unsupplemented nitrous oxide in about 30% oxygen, with and without IPPV, was investigated in five cardiac patients and compared with control periods at rest with air breathing. The results of this investigation show that nitrous oxide in conventional oxygen concentration does not cause any great haemodynamic changes. During tracheal intubation, however, significant increases in both systemic and pulmonary blood pressures were registered. However, these pressures reverted to the control values immediately after the tracheal intubation. The results of this study support many earlier clinicaly good experiences obtained when using this conventional nitrous oxide-oxygen mixture in cardiac patients.

Adult