Chapter-1 / Physiological Foundations - WHNLive Public Library

Ip even to (particularly to)severe chronic lung insufficiencylDffi,cien1ey).c .ses is accompanied by ahe normal acid-base status ofthis reason we have alwaystatus in the research phase inype. So far a change in statusobserved in these checks.eV6lrY In early 1982 of the drop in the-"Jft forced us to a change in the01 responders and nonresponders toe nonresponders can be defined astjjldi~ri'duals in whom there was neithere in the P02-art, nor a drop in thee. no improvement in the value of 112MTI. It is no longer permissible, asIn [91], to class individuals in whome in the resting P02- art is found, anonresponders to the 02MT (see alsoabove).this fundamental finding, the questionmfluencing factors on the responder rateterence to the increase in. the P0 2 -art istopical significance, as the absolute valueP02-art is in some important tissues ofmpnism (arterial vessel walls, lens of thec.) alone decisive for the O2 transport toe, and good lung function alone benethefollowing links in the O2 transporttions of factors influencing the lung-coned,partial failure rate of the 02MT werey be taken from a pilot study [92]. Thecarried out on 46 unselected patients,ales and 17 females) within an age range-75 years (x = 55.9 ± 11.3 years), withnumber of 20-30 treatment hours,d that, with a mean P0 2 - art under O2 inof115.3 mmHg (~ 15.36 kPa) insteadmHg (~ 16.7 kPa), the failure rate rosebe ween 15 and 20% to 33 %. It is cerno.coincidence that in the gro~p with aoportion of non-responders (fallure ratea mean P02-art of 105.5 mmHg (~ 14.1a established during inhalation. It cann from these findings that the success rateapplication of the 36 h 02MT procedurequickly when P0 2 - art under inhalationbelow 125 mmHg (~ 16.7 kPa) (oxygenparingly applied, e.g. < 3 I/min; parevena certain therapy success when themain the arne, if a reduction in theoutput can be recognized (less train on theticularly severe, advanced degeneration of thelung-heart system, e.g. chronic bronchitis).According to the above, the measurement ofthe P02- art (20 min) after begin of O 2 applicationis one of the routine measures of the02MT. Examples of such measurements for the36 h 02MT procedure have been compiled inFigs 48 and 49. In order to ensure that thethreshold of the switching mechanism of themicrocirculation will with great probability becrossed, the O2 flow should be so adjusted thata P02- art between 125 and 145 mmHg (16.7­19.3 kPa) is measured under O2 flow. This aimis often difficult to achieve, especially at thebeginning of therapy (Fig. 49). In such cases allmeans should be used to increase the P0 2 -artunder O 2 inhalation during the first sessions.The adjuvant means include: the increase ofthe O2 flow to 5 Ilmin and more; activation ofthe applied O2, HOT* procedure during 02 inhalation;increase in blood fluidity; administrationof 0.5 g nicotinic acid; drinking of a cup ofstrong coffee; treatment in a lying position withupper body at a lower level (resulting in aP02-art increase of up to 6 mmHg ~ 1.33 kPa);preceding physiotherapy to improve respiratorytechnique [101, 102] and to improve ventilationvalues (gain of up to 15 mmHg ~ 2 kPa);simplification of breathing training by means ofthe respiration biofeedback instrument [103]and, in chain smokers with CO poisoning of thehemoglobin of up to 20 %, preceding detoxificationby means of a 15 min 02MT quickprocedure [18].According to the findings discussed, the groupof lung-conditioned partial therapy nonresponderscan be divided in six subgroups:1. Structural pulmonary diseases with diffusiondisorders, namely, in the existence of ageneralized respiratory insufficiency. Theproportion of such cases in nonselected patientsis less than 10 %.2. Cerebrovascularly decompensated patientslacking compliance due to an organocerebralpsychosyndrome.3. Patients with a high proportion of huntvolume in the lung.4. Individuals with severe CO poi oning ( .g.chain smokers).5. Cardiopulmonally decomp n at d p ti nt :a recompensation i a pr r qui it h f rthe implem ntation of th pr dur.6. In per on with a high P0 2 -art r 0 mm~ 12 kPa .g. du t ph i 1 t min r ining),a high r I v I annot b t t