[An attachment for a portable manual apparatus for artificial respiration in a contaminated atmosphere].
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The successful treatment of a unilateral penetrating stab wound injury of the chest is reported. Following emergency resection of the upper and middle lobe of the right lung acute pulmonary oedema developed in the dependent left lung. Air-tight suture of an additional injury of the right lower lobe was not possible. To avoid formation of a fistula in the right lung, the patient was intubated with a double lumen endobronchial tube and both lungs were ventilated independently. Application of positive-endexspiratory pressure to the oedematous lung improved oxygenation without exposing the right lung to undue inspiratory pressure. The advantages and indications of a double-lumen endobronchial tube in the primary care of unilateral chest injuries are discussed.
Some simplest attachments and manipulations are described which permit Soviet commercially available ventilators of the PO-type to be used in performing new methods and modes of respiratory therapy--PEEP (positive end expiratory pressure), CPAP (continuous positive airway pressure), and IMV (intermittent mandatory ventilation).
Combined chest wall and lung alterations may lead to severe restrictive respiratory disorder. In advanced cases with hypercapnia, hypoxemia and oxygen intolerance during spontaneous breathing, there are almost insuperable therapeutic difficulties. Three of such patients have been treated, after tracheostomy, at home for 60, 34 and 22 months respectively by intermittent IPPV ventilation. With an improved quality of life all these patients survived up to now. This result seems to be encouraging.
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Three cases of Critically Illness Polyneuropathy (CIP) are reported. The difficulty of weaning the patients from the ventilator, whereas sepsis and MOF had been successfully treated, was the main feature in the three cases. The diagnosis was established by eletromyogram, showing a primary axonal denervation of peripheral nerve fibres, which was confirmed by a pathological study in one patient.
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