[Continuous flow ventilatory support using a multijet insufflation catheter. Physical, mathematical and clinical prerequisites and principles]. / Ventilacná podpora kontinuálnym prietokom viacdýzovým insuflacným katétrom. Fyzikálne, matematické a klinické predpoklady a princípy.

The authors present theoretical principles of a new ventilatory support continuous flow ventilatory support (CFVS) with multijet insufflation catheter (MIC). Theoretical part of the presented work reasons the need of this type of ventilatory support and explains basic mathematical and physiologic principles of described mechanical ventilation method and reveals the advantages of continuous flow ventilatory support with multijet insufflation catheter in comparison with terminal eye catheter. Physical and mathematical analysis on a model of lungs in static and dynamic conditions revealed that the difference in the value of maximal inspiratory pressure is significantly higher in the system with terminal eye catheter and confirmed that the CFVS application with multijet insufflation catheter is connected with minimal risk of barotrauma by gas flow up to 20-26 l/min. The paper concludes that continuous flow ventilatory support with multijet insufflation catheter is more efficient with the possibility of significantly higher gas flow application than with terminal eye catheter and without the risk of pressure rise in the airways and without rise of breathing work. (Fig. 10, Ref. 11.)

[Continuous flow ventilatory support with multijet insufflation catheter. Initial clinical experience]. / Ventilacná podpora kontinuálnym prietokom "viacdýzovým insuflacným katétrom". Prvé klinické skúsenosti.

BACKGROUND: Clinical application of continuous flow ventilatory support with multijet insufflation catheter is not mentioned in the literature until now. Despite the use of various forms of ventilatory support, in 10-30% of patients disweaning from mechanical ventilation is unsuccessful even if they fulfil clinical and biochemical criteria. AIM: To evaluate the efficiency of a new ventilatory support continuous flow ventilatory support with multijet insufflation catheter--in clinical conditions. METHODS: Continuous flow ventilatory support with original, patented multijet insufflation catheter with nasal installation into the trachea was used in a group of 14 patients. In a subgroup of 8 patients with chronic obstructive lung disease (COLD) was this method used for development of global respiratory insufficiency due to infectious complications and in a subgroup of 6 patients it was successfully used as a ventilatory model for weaning of patients from longterm mechanical ventilation in whom other ventilatory modes for weaning were unsuccessful. RESULTS: No patient with COLD had to be intubated and 30 minutes after the start of ventilatory support with multijet insufflation catheter mean respiratory frequency decreased from 33 +/- 2.8 to 27 +/- 2.5 d/min, paCO2 from 11.9 +/- 1.7 to 10.8 +/- 1.6 kPa and paO2 increased from 5.7 to 6.8 +/- 1.3 kPa by FiO2 of 0.3. Up to 24 h after the start of ventilatory support blood gases were improved to values characteristic for partial respiratory insufficiency. Frequency of spontaneous ventilation decreased to 20 +/- 2.2, paCO2 decreased to 6.4 +/- 1.2 kPa and paO2 continually increased reaching the value of 8.9 +/- 1.4 (FiO2 = 0.3) in the 24th hour of ventilatory support. Ventilatory support lasted in average 5 days, than it could be removed. In the second group of patients continuous flow ventilatory support was used because of unsuccessful weaning following longterm mechanical ventilation. After extubation and 30 minutes after continuous flow ventilatory support start the breathing frequency decreased to 27 +/- 2.5 d/min, paCO2 showed further fall to the value of 3.9 +/- 0.9 due to hyperventilation caused evidently by continuing paO2 decrease to the value of 8.8 +/- 1.4 kPa. Only after 60 minutes following the start of ventilatory support, by equal breathing frequency, the values of blood gases increased (paO2 to 9.9 +/- 1.5 kPa, paCO2 to 5.2 +/- 1.1 kPa) and also Vt increased (0.38 +/- 0.3) which allowed to carry on with continuous flow ventilatory support, it could be interrupted after 48 hours. CONCLUSION: On the basis of the obtained results it can be stated that continuous flow ventilatory support represents an efficient ventilatory mode in patients with chronic obstructive lung disease with global respiratory insufficiency and enables to bridge the period of management e.g. of infectious complications without intubation and mechanical ventilation. As a noninvasive ventilatory regime it can be also used of patients from longterm mechanical ventilation. Application in acute respiratory for weaning (ARF, ARDS) requires further prospective studies. (Tab. 5, Fig. 4, Ref. 28.)

Changing risks in tuberculosis.

Past and present experience with tuberculosis in New York State exclusive of New York City is presented. TB has been on the decline since the turn of the century and reached an all-time low in 1974 with only 844 new active cases and 137 deaths reported. Although incidence rates are highest among the poor, the bulk of cases come from middle and upper socioeconomic levels. Cohort analysis shows an individual's risk of developing pulmonary or miliary TB is greatest at age 20-24, whereas the greatest risk of dying from TB is before age 5. Projections based on past experience indicate a male born in 1970-74 will have a lifetime risk of developing pulmonary or miliary TB of 80/100,000 and of dying from TB of 4/100,000. For females the respective risks are 40/100,000 and 6/100,000.