Gustav J. Beck

The ventilatory effects of the head-down position in pulmonary emphysema

Abstract Observations were made on the effect of visceral elevation of the diaphragm produced by the head-down position in patients with pulmonary emphysema. Striking relief of dyspnea was accompanied by increased diaphragmatic excursion and a marked decrease in the minute volume of ventilation. In twenty-four subjects the average decrease in pulmonary ventilation on tilting from the sitting to the head-down posture was 22 per cent. The average decrease in pulmonary ventilation for this group in the sitting position, when 100 per cent oxygen was substituted for air, was 15 per cent. The arterial oxygen saturation was measured in the lying head-down position after forty-five minutes; in one case with associated cardiac insufficiency a fall of 1.6 volumes per cent took place; in three more cases there was no significant change; in six cases the arterial oxygen saturation increased. In seven of ten patients in whom an average fall of 26 per cent in pulmonary ventilation took place with the head-down position the pH and pCO 2 showed little or no change. In two cases a rise in pCO 2 of 4 and 5 mm. Hg was found, with a fall in pH from 7.43 to 7.39 and from 7.50 to 7.45. In one patient with an associated respiratory acidosis the pH rose markedly, from 7.27 to 7.44. The effect of elevation of the diaphragm by upward pressure of the viscera resulted in increased diaphragmatic excursion, comparable in some respects to raising the resting level of the diaphragm by increase of the intra-abdominal pressure through the use of abdominal belts or by pneumoperitoneum. The increased efficiency of alveolar ventilation of the lower lobes induced by diaphragmatic as compared to costal breathing was illustrated by the blood gas changes in eight of ten subjects tested. In three cases in which the arterial oxygen saturation was unchanged there appeared to be adaptation to an accustomed degree of anoxia which permitted marked lowering of pulmonary ventilation and consequent relief of dypsnea. These observations provide a physiologic basis for the clinical use of viscero-diaphragmatic breathing in patients with pulmonary emphysema.

Original communicationThe use of prednisone (meticorten) in respiratory disease: II. Pulmonary emphysema and pulmonary fibrosis☆

Abstract The effect of prednisone was studied in 50 patients with pulmonary emphysema and pulmonary fibrosis. The clinical results differ from those obtained with cortisone and ACTH in the following ways: 1. 1. Moderate to excellent improvement with relief of dyspnea and increased exercise tolerance in 86 per cent of the patients treated with a daily dosage averaging one-quarter that employed with cortisone. 2. 2. The onset of subjective improvement was significantly more rapid than cortisone, usually within forty-eight hours of initiation of therapy. 3. 3. A striking weight loss ranging between 3 to 9 pounds occurred in 12 of the 50 patients during the first week of therapy including cases of cor pulmonale who had not responded favorably to cortisone. Of interest was the finding of loss in body weight in 4 patients with pulmonary fibrosis who had not previously been treated with cortisone. There was a decrease of 8 and 9 pounds, respectively, in 2 of these patients during the first week of treatment. The possible mechanism of this weight loss at a time when appetite and food intake was increased deserves further study. 4. 4. With the exception of salt and water retention, and the decreased incidence of facial mooning or fat deposition, other adverse reactions observed with cortisone have been encountered, especially gastrointestinal disturbances and reactivation of sinobronchial infection. Appropriate measures to counteract or prevent these conditions have been suggested. The case histories of 5 patients who exhibited significant weight loss are reported.

VALUE OF MECHANICAL AIDS IN THE MANAGEMENT OF A PATIENT WITH POLIOMYELITIS

Excerpt The purpose of this paper is to describe the value of mechanical methods of aiding the functions of the respiratory system in patients with bulbar poliomyelitis in whom inability to expecto...

EFFECT OF PHYSICAL METHODS ON THE MECHANICS OF BREATHING IN POLIOMYELITIS

Excerpt The use of physical methods in the rehabilitation of patients with bronchopulmonary diseases stimulated our interest in the breathing difficulties of convalescent patients with respiratory ...

ASPIRATION PNEUMONITIS COMPLICATING POLIOMYELITIS: A CASE SUCCESSFULLY TREATED BY EXSUFFLATION

Excerpt The purpose of this report is to describe the clinical course of a patient with spinal poliomyelitis who developed pneumonitis and pulmonary atelectasis secondary to the aspiration of gastr...