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March 2021

RESPIRATORY FAILURE IN THE ACUTE CASE OF POLIOMYELITIS*

Journal/Book: Reprinted from the BRITISH MEDICAL JOURNAL September 18 1954 vol. ii p. 663. 1954;

Abstract: A. B. CHRISTIE M.D. D.P.H. D.C.H. Physician-Superintendent Fazakerley Hospital Liverpool *Read at a joint meeting of the Sections of Microbiology and Pathology and of Preventive Medicine and Infectious Diseases at the Annual Meeting of the British Medical Association Glasgow 1954. Summary The contributions of epidemiologist and virologist to the study of poliomyelitis have been complementary. The clinician however still has to rely an his own clinical resources. The cause of death is respiratory embarrassment and the clinical picture presented by a patient suffering from respiratory failure may be very complex. The factors necessary for the free ventilation of the body are efficient respiratory muscles a clear airway an intact respiratory centre a healthy pulmonary epithelium and a free flow of blond through heart and lungs. Any or all of these may be involved. Treatment directed to improve one factor only may cause clinical deterioration. Anoxia must always be considered along with carbon dioxide tension the pH of the blood and shock. An understanding of respiratory physiology is essential to the safe use of any form of assisted respiration. The problem of respiratory failure in poliomyelitis cannot be dealt with by clinicians alone. At the bedside team-work between physician anaesthetist surgeon and pathologist is essential. In writing this account I had a background of reading and discussion the sources of which I cannot now acknowledge. I have found the articles by Astrup et al. (1954) and by Steigman (1954) of immediate use. Some of the material was included in a report to the Liverpool Regional Hospital Board under whose auspices I visited Copenhagen in 1953 : it was written jointly with Dr. J. R. Esplen consulting anaesthetist to the Fazakerley Group of Hospitals and to him I am indebted for permission to use it but far more for constant advice and collaboration in the management of our cases. schö


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