PEDIATRICS Vol. 1 No. 5 May 1948, pp. 684-707
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Round Table Discussion

POLIOMYELITIS

CLIFFORD G. GRULEE JR. and JAMES O. ELAM

1. The following equipment was described:

A. A tracheotomy inhalator for administering humidified oxygen, with optional use of positive pressure.

B. Modifications in the respirator collar and headpiece to accommodate the tracheotomy patient.

2. A scheme of treatment which distinguishes between ventilatory deficiency and alveolar deficiency in poliomyelitis was mentioned.

3. The oximeter is useful in determining the indications for oxygen therapy, and artificial respiration and, in some instances, tracheotomy.

4. The bulbar patient with excessive mucus accumulation in the tracheobronchial tree may require frequent bronchoscopic aspiration. Removal of mucus by suction catheter should be limited to brief intervals.

5. The administration of oxygen to the respirator patient before and during the time the respirator ports are open for 5 minute intervals prevents hypoxic insults.

6. Patients may be liberated from the respirator as rapidly as is physiologically expedient on the basis of oximetry.

7. The respirator tends to produce hyperventilation when the arbitrary pressures are used. This may be prevented by adjusting the pressure on the basis of measured respiratory minute volume.

8. Following excessive ventilation in the respirator the patient becomes uncomfortable by sudden reduction in the respirator pressure apparently because his respiratory center has become adjusted to a low arterial CO2 tension. Hence the patient's comfort is not a satisfactory index of normal ventilation in the respirator.