Forty-nine adults who had undergone cardiopulmonary bypass surgery were randomly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone. After extubation, the patients started their assigned exercise programs. A physical examination and pulmonary function tests were performed preoperatively, at the start of the exercise program, and 24 and 48 hours after the start of the program. The results showed a significant decrease (approximately 50%) in lung volumes but no airflow obstruction in patients who had coronary artery bypass graft. In those patients who had valve replacement, lung volumes fell, and in addition, mild airflow obstruction occurred. A majority of patients had postoperative pulmonary complications. There were no significant differences among the exercise programs in improving lung volumes and airflow or in preventing postoperative complications. We conclude that maximal inspiratory breathing exercises or incentive spirometry, when used in addition to early mobilization, offers no therapeutic advantage over early mobilization alone after cardiopulmonary bypass surgery.

Amikacin was given to 14 noninfected men as three consecutive intramuscular injections (7.5 mg/kg) at 12-h intervals. Serum and bronchial secretion specimens were obtained at various times during flexible fiberoptic bronchoscopy after the final dose. Serum and bronchial secretion concentrations obtained between 1.5 and 2.0 h after the final dose ranged from 17 to 40 ug/ml and 2.3 to 8.4 ug/ml with a mean of 23.7 ± 2.9 and 5.23 ± 1.5 ug/ml, ±1 standard error of the mean, respectively. The highest bronchial secretion concentration in each subject correlated with the highest serum concentration (r = 0.83, P < 0.001), and all concurrent serum and bronchial secretion concentrations demonstrated a significant correlation (r = 0.82, P < 0.001). Clearance occurred at the same rate (halflife serum = 2.84 h; half-life of bronchial secretion = 2.60 h, P > 0.5). The mean bronchial secretion concentration of the 15 specimens obtained more than 7 h after the final dose was less than 1.0 ,ug/ml, with a range from 0.3 to 1.6 pg/ml.

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1. Almitrine, an agonist of peripheral chemoreceptors, has been shown to be effective in lowering PaCO2 in patients with chronic obstructive lung disease. The aim of this investigation was to evaluate the pulmonary haemodynamic response to almitrine in clinically stable patients with chronic airflow obstruction and chronic hypercapnia (PaCO2 7.1 +/- 0.5 kPa, mean +/- SD). 2. Seven men, aged from 55 to 64 years, had the following values for pulmonary function (means +/- SD): FEV1.0 0.67 +/- 0.16 litre; VC 2.12 +/- 0.52 litres; FEV1.0/VC 33 +/- 8%. They had haemodynamic monitoring during 1 h of almitrine (1 mg/kg intravenously) and solvent (placebo) in a random fashion while receiving 28% oxygen. Before infusion, six patients had evidence of pulmonary hypertension and the mean pulmonary artery pressure (PAP) for all seven patients was 4.3 +/- 1.6 kPa (mean +/- SD); the pulmonary vascular resistance (PVR) was 0.61 +/- 0.22 kPa 1(-1)s (mean +/- SD). 3. There were no significant changes from baseline values during placebo. During almitrine, however, the PAP and right ventricular stroke work (mean +/- SD) increased significantly at 30 min (6.0 +/- 2.1 kPa, P less than 0.001, 0.38 +/- 0.12 J, P less than 0.05, respectively) with maximum increase of PVR at 45 min (1.01 +/- 0.34 kPa 1(-1)s, P less than 0.001, mean +/- SD). The lowest PaCO2 (mean +/- SD) was observed at the end of the infusion (5.7 +/- 0.5 kPa, P less than 0.001). 4. These results confirm the benefit of almitrine in lowering PaCO2 in patients with chronic airflow obstruction who have chronic hypercapnia but also demonstrate significant pulmonary vasoconstriction.

Helium-oxygen (HeO₂) flow volume curves were done in young, healthy, nonsmoking adults. This paper discusses the theoretical design of the test, the nomenclature, and the results in this population. Our study shows that HeO₂ and air curves crossed around 15% of vital capacity; one point of identical flow occurs more frequently than has been appreciated; and fully developed laminar flow occurs infrequently at low lung volumes in young adults.