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A simple artificial respiration mask for rats was constructed from the drip chamber of an intravenous solution administration set. The mask was held in place by means of straps and a hole through which the maximillary incisors protruded. This mask permitted artificial ventilation during drug-induced respiratory paralysis, was easily and inexpensively constructed, and may be used with a variety of positive pressure respirators.
The value of artificial respiration for the bridging of crises in patients with myasthenia gravis is emphasized on some typical cases. Further use, beyond a life-saving indication, for limited periods is described. Such relative indications may exist, when there is not yet complete respiratory failure but when a worsening of myasthenic weakness or cholinergic intoxication may threaten a respiratory crisis. In order to prevent serious complications, early artificial respiration may be indicated in the following situations: deterioration of cardio-pulmonary complications, important changes in therapy, particularly at the start of immuno-suppressive treatment, following tracheobronchial aspiration, in chronic cholinergic intoxication, following operations under general anesthesia, particularly after thymectomy. The importance of careful psychotherapy of myasthenics threatened by respiratory crises and the well-timed information on the chances, intentions and goals of intensive care including artificial respiration is emphasized.
From 1972 to 1974 524 patients underwent surgery with extra corporal circulation. 83 (15,8%) patients had to be postoperatively ventilated for a prolonged period or reintubed after a symptomfree interval due to anticipated or manifested complications. 31 (37%) out of these expired. There was no death due to the prolonged ventilation itself, shown by the group, in which the causes for the above treatment were others but respiratory failure or insufficiency. All patients of this group survived. Indications, technique and results are described and discussed.
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The methods used for ventilation of the neonate shold be based upon consideration of the physiological changes which occure in the lungs and circulation at birth of the normal infant. Three important changes must be taken into consideration. The first is the formation of a residual volume of alveolar gas, the second the resorption of pulmonary fluid and the third a decrease in pulmonary vascular resistance, upon which is dependent the change from foetal circulation to that of the neonate. To begin insufflation of foetal lungs it is necessary to use a pressure of between 20 and 30 cm H2O. After the first insufflation, a good deal of air remains in the lungs, even during expiration, as long as pulmonary "surfactant" is present. In the absence of the latter, residual pressure at the end of expiration is necessary in order to avoid the lung emptying itself of air. The resorption of pulmonary liquid from the alveolar spaces into the blood is dependent upon a change in the permeability of the alveolar epithelium, which renders possible the rapid passage of water via the channels which open, probably between the epithelial cells, and this change is dependent upon an expansion of the lungs by a pressure of between 35 and 40 cm H2O. Dilatation of the pulmonary vessels depends in part upon an increase in partial pressure of oxygen and a fall in carbon dioxide in the environment of the pulmonary arterioles, and in part upon mechanical changes brought about by the movements of ventilatation.
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Ventilation with increased end-exspiratory pressure may, especially in cases of blunt chest trauma, result in pneumoperitoneum although there are no intestinal injuries. The case histories of four persons who developed this complication are reviewed. Differentiation between such a complication and a condition requiring laparotomy is often difficult because other injuries, particularly a cerebrocranial trauma, may obscure the clinical symptoms. Diagnostic peritoneal lavage may help towards differentiating between a ventilation-induced pneumoperitoneum and an "acute abdomen" caused by perforation or rupture of an intra-abdominal hallow organ.