Cuffed tracheotomy vs. tank respirator for prolonged artificial ventilation
Safar, P.; Berman, B.; Diamond, E.; Hoffman, K.; Holtey, W.; Moore, H.; Scoville, B.
Archives of Physical Medicine and Rehabilitation 43: 487-493
1962
ISSN/ISBN: 0003-9993 PMID: 13976019 Document Number: 8636
During the 1960 epidemic of poliomyelitis in Maryland, 24 apneic patients were given respiratory a:cl with volume-cycled intermittent positive pressure respirators. A routine was established which provided adequate ventilation and prevented major pulmonary complications. The routine included the use of large bore cuffed tracheotomy tubes, humidification, artificial coughing and sighing, changing of position, sterile tracheobronchial aspiration and monitoring of ventilation. Five of the 24 patients died within three months. Two of the 5 deaths could possibly have been prevented. Six of the survivors will require artificial respiration for an indefinite period. In addition, circulatory and respiratory parameters of 4 patients were studied during positive pressure ventilation via tracheotomy and with the tank respirator. Clinical results of tank respiration during previous epidemics are compared with results of positive pressure ventilation via tracheotomy. The use of the tank respirator should be reserved for the rare apneic patient with "dry" lungs who does not need tracheotomy. The principal advantages of intratracheal positive pressure ventilation over tank respiration are greater accessibility and mobility of the patient and the increased ventilatory reserve. Intratracheal intermittent positive pressure ventilation produces better ventilation than tank respiration for the patient with abnormal lungs and the patient who is heavy and short.
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