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Use of a Pressure-Cycled Respirator (Bird) in Respiratory Failure Due to Severe Obstructive Pulmonary Disease

MARGARET BILLINGHAM, M.B.B.S. (LOND.); and FREDERIC ELDRIDGE, M.D., F.A.C.P.
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Palo Alto, California


Ann Intern Med. 1969;70(6):1121-1133. doi:10.7326/0003-4819-70-6-1121
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SUMMARY:

A pressure-cycled intermittent positive pressure respirator (IPPB) (Bird, Mark 7) was used to treat 42 episodes of severe acute respiratory failure in 32 patients with chronic obstructive pulmonary disease. This apparatus was able to reduce carbon dioxide levels in all but one patient, the mean pressure of carbon dioxide (PCO2) values decreasing by 32.5 mm Hg from the pre-IPPB level of 80.8 mm Hg within 24 to 48 hr after institution of IPPB. The effectiveness of the therapy is shown by the fact that no patients died in the first 3 days, only 6 patients (14%) died within the first 2 weeks, 33 episodes ended with removal from the respirator, and 21 patients (50%) were ultimately discharged from the hospital. We conclude that pressure-cycled respirators can be as effective as any other type of respirator, including those that are volume-cycled, if they are properly used and the results monitored by frequent arterial blood gas and pH measurements. The importance of controlled oxygen flow, inspiratory flow regulation, and controlled expiratory flow is discussed.

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