The Management of Respiratory Distress After Cardiothoracic Surgery

Experience With Fifty Patients Treated With Artificial Ventilation

“…Sixty-two per cent of the patients suffered from medical disorders which had failed to respond to more conservative therapy. There is a smaller percentage of surgical patients in this series compared with some other reports (Gilston, 1962;Norlander et al, 1961) because of the more rigid criteria used to define respiratory failure.…”

Intermittent Positive Pressure Respiration After Open-Heart Surgery

“…In the opinion of the authors, and also of Gilston (1962), the decision to use IPPR must be based on the patient's history and clinical condition. In patients whose main abnormality is in the respiratory system, determination of arterial Pco, is of great help.…”

Tracheostomy and Open Heart Surgery

“…Humidification of the inspired gases is essential in order to limit thick secretions (Burton 1962); for patients having artificial ventilation we use the Spalding kettle type of humidifier on the patient input side of the humidifier (Marshall & Spalding 1953) and for those patients with a tracheostomy alone we use a similar arrangement or an Oxygenaire nebulizer; either can be connected to a perspex T-piece as described by Gilston (1961). High flows of oxygen or an oxygen-enriched mixture are used as necessary.…”

“…Total perfusion time is often prolonged in these cases and repair of the lesion may cause some flooding of the lungs due to increased flow through the right outflow tract and the large bronchial flow which is still initially present. Gilston (1962), in an analysis of respiratory distress after open heart surgery, stated that the main cause was heart failure. In an analysis of the indications for IPPR following open heart surgery, Dr M W Potts and I found a high incidence of Fallot's tetralogy patients needing mechanical ventilation for circulatory reasons.…”