Pasargiklian M, Fumagalli G, Ferrara A
Minerva Med. 1979 Jan 7;70(1):1-18.
After giving an outline of pneumogenic respiratory insufficiency, signally that deriving from chronic obstructive bronchopulmonary disease, the Authors describe the intensive care of respiratory insufficiency, first from the anesthesiologist's point of view and then in a broader medical sense. In regard to the latter, the Authors emphasize the importance of material equipment and staff training and teamwork; they also list a number of possible iatrogenic disorders in intensive care. Next they discuss medical aids and more specifically the machinery designed to assist respiration, such as pulmonary ventilators and the "iron lung", as implements that can be used to advantage in medical wards. Then they describe the elements to be used for a correct assessmnet of the severity of respiratory insufficiency, under the following subheadings:--state of coma, if present;--state of acid-base balance, oxemia, and water and electrolyte balance;--circulatory compensation or failure;--need for correcting bronchial obstruction. Through several representative examples concerning the medical correction of alterations of CO2, pH, electrolyte composition, and water and blood volumes, they describe the therapeutic measures to be undertaken particularly as regards the metabolic sequels (alkalosis or acidosis) that may occur in the course of treatment. Coming next to intensive care utilizing mechanical devices, they stress the importance of monitoring the parameters of humoral balance during (and even more so, after) said treatment, in view of avoiding the emergence of iatrogenic disturbances such as the reventilation syndrome and the syndrome of post-hypercapnic metabolic alkalosis.
在概述了肺源性呼吸功能不全，特别是源自慢性阻塞性支气管肺疾病的呼吸功能不全之后，作者们描述了呼吸功能不全的重症监护，首先从麻醉医生的角度，然后从更广泛的医学意义上进行描述。关于后者，作者们强调了物资设备、人员培训和团队合作的重要性；他们还列举了重症监护中一些可能的医源性疾病。接下来，他们讨论了医疗辅助手段，更具体地说是用于辅助呼吸的设备，如肺通气机和“铁肺”，这些设备可在医疗病房中发挥优势。然后，他们在以下小标题下描述了用于正确评估呼吸功能不全严重程度的要素：——是否存在昏迷状态；——酸碱平衡、血氧血症以及水和电解质平衡状态；——循环代偿或衰竭；——纠正支气管阻塞的必要性。通过几个关于纠正二氧化碳、pH值、电解质组成以及水和血容量改变的医学实例，他们描述了尤其针对治疗过程中可能出现的代谢后遗症（碱中毒或酸中毒）应采取的治疗措施。接下来谈到使用机械设备的重症监护，他们强调在上述治疗期间（甚至更重要的是治疗后）监测体液平衡参数的重要性，以避免出现医源性紊乱，如再通气综合征和高碳酸血症后代谢性碱中毒综合征。
