Cuirass respirator treatment of chronic respiratory failure in scoliotic patients.

The results are reported of domiciliary cuirass respirator treatment, using tailor-made shells, in four patients with severe thoracic scoliosis. Three of the patients had suffered from poliomyelitis. All complained of increasing dyspnoea on exertion, ultimately interfering with almost every activity of daily life; three patients had severe acute respiratory failure necessitating urgent admission to the Respiratory Care Unit. Right heart failure was present in two. Two patients required mechanical treatment via an endotracheal tube. All the patients were discharged home with a cuirass respirator. Standard type shells were used initially with low efficiency due to the poor fit of the cuirass shell to the deformed thoracic cage. Tailor-made shells were constructed from polyester reinforced with glass fibre, modelled on plaster casts of the thoracic cage. Subjectively the patients improved greatly and were able to resume and increase many activities. One patient committed suicide for reasons unconnected with treatment but the other three patients have been doing well from the time the cuirass respirator treatment was started, respectively, 3, 6, and 10 years ago. This treatment seems particularly effective in younger patients with severe paralytic scoliosis and cardiorespiratory failure, although the possibility of using it in older patients suffering from scoliosis of other aetiology should certainly be explored.

Prognosis of post-neonatal respiratory distress syndrome (RDS) treated with positive end-expiratory pressure ventilation (PEEP).

Thirty-six patients with respiratory distress syndrome (RDS) were treated with mechanical ventilation with positive end-expiratory pressure (PEEP). In 16 patients the RDS was the result of direct pulmonary injury due to chest trauma (group A), and in 20 patients the RDS followed non-direct injury of the lungs (group B). Fifteen patients died. At the moment of death the RDS had disappeared. No difference in mortality existed between groups A and B. Four patients died from causes unrelated to the RDS, one patient died from an avoidable error in the treatment. The ultimate outcome did not seem to be related to age, use of mechanical ventilation or PEEP, or occurrence of complications (e.g. a pneumothorax, which appeared to be related rather to the chest trauma). Of probably prognostic significance was the presence of a combination of massive aspiration and RDS. Of the 12 patients who suffered from this combination, nine died. PEEP ventilation was more unsuccessful in raising PaO2 appreciably in these patients than in others. The combination of massive aspiration and RDS posses a therapeutic dilemma. PEEP ventilation is invaluable in the treatment of RDS. Interruption of the PEEP within the first 1-2 days may sometimes result in massive recurrence of the RDS. Endotracheal suctioning which is a prerequisite for the treatment of massive aspiration, may under these circumstances be virtually impossible within this period. A compromise, including PEEP ventilation for as short a period as possible (usually no longer than 2 to 3 days) without interruption, followed thereafter by intensive physiotherapy with endotracheal suctioning, may succeed in saving some of the patients.