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Symposium on intensive care: 4. Respiratory failure.

Patients requiring respiratory support may have normal lungs but inadequate ventilation, or they may suffer from defective pulmonary gas exchange despite adequate ventilation. In the first group some form of mechanical ventilatory support is called for, either pressure-cycled or volume-cycled, used first with an endotracheal tube and only later with a tracheostomy. Weaning the patient from the apparatus requires special care. In cases of pulmonary insufficiency the use of positive end-expiratory pressure has been a major advance. Hemoglobin concentration, cardiac output and renal function must receive attention. Open lung biopsy is of the greatest value when the diagnosis is open to question. Resort to a membrane oxygenator to provide extracorporeal oxygenation of blood can sustain for a time the patient in whom hypoxia is critical in degree.